Standard 9: Field Hospital

Why this criterion matters. A field hospital opened in a hurry can be unsafe before the first patient arrives. A defined minimum set-up, checked before admission, means the basics are in place from the start.

Sample. Review the set-up checklist and floor plan for every unit opened or expanded in the last 12 months, and the water and waste test records for the same period.

1. The minimum set-up is checked and signed before the first admission.

Method. Check the signed checklist date against the first admission date.

Evidence to show. Minimum set-up checklist (FLD-FRM-001).

Pass when. Every checklist is signed before the first admission.

2. Triage, treatment and isolation areas are separate.

Method. Walk the unit against the floor plan and check each area.

Evidence to show. Floor plan and minimum set-up checklist (FLD-POL-001).

Pass when. Three separate areas exist and are used as planned.

3. Water, sanitation and waste meet the minimum before admission.

Method. Check the water test and the waste disposal record before the first admission.

Evidence to show. Water test record (WAT-FRM-001) and waste disposal record (WST-FRM-001).

Pass when. Water tests and waste records are on file, dated before admission, and within limits.

Immediate fail (any one means the criterion is not met)

• A patient is admitted before the set-up checklist is signed.
• The unit has no separate isolation area.

Why this criterion matters. When patients arrive in numbers, the unit must still sort them by clinical need. A triage system that works only on quiet days fails the patients who need it most.

Sample. Review the triage log for the three busiest days in the last 6 months, and the surge rehearsal record.

1. Every arrival is triaged with a recognised tool.

Method. Check each arrival in the log for a triage category.

Evidence to show. Triage record and log (HOS-FRM-001).

Pass when. At least 95% of arrivals have a triage category.

2. Triage continues at peak volume.

Method. Check the log for triage entries across the peak hours.

Evidence to show. Triage record and log.

Pass when. No peak-hour period has a gap in triage.

3. The surge plan is rehearsed.

Method. Check the rehearsal record for a surge drill in the last 12 months.

Evidence to show. Rehearsal and drill record (HOS-REG-004).

Pass when. A surge drill is recorded in the last 12 months.

Immediate fail (any one means the criterion is not met)

• Patients are treated without being triaged at peak volume.
• Triage stops during a surge.

Why this criterion matters. Surgery in a field hospital is done under pressure, with limited equipment and staff. The surgical checks, sterile practice and anaesthesia safety must still be done in full.

Sample. Review 15 operations in the last 6 months, including 5 done under constraint, with their checklist and sterilisation records.

1. The surgical safety checklist is completed for every operation.

Method. Check each operation in the sample for a completed checklist.

Evidence to show. Surgical safety checklist record (SRG-FRM-001).

Pass when. Every sampled operation has a completed checklist.

2. Sterilisation is recorded and checked for every set of instruments.

Method. Check the sterilisation log and indicator record for each sampled operation.

Evidence to show. Sterilisation log and indicator record (FLD-POL-002 applies).

Pass when. Every instrument set has a passing indicator recorded.

3. Anaesthesia safety applies under constraint.

Method. Check the anaesthesia record for each sampled operation.

Evidence to show. Anaesthesia record and monitoring chart (SRG-FRM-002).

Pass when. Every sampled operation has an anaesthesia record with monitoring.

Immediate fail (any one means the criterion is not met)

• An operation is done with no surgical checklist.
• Instruments are used without a passing sterilisation record.

Why this criterion matters. Blood and medicines are scarce in a field hospital, and the temptation to skip checks is strong. Standards adapted to the setting keep them safe without pretending the setting is a hospital.

Sample. Review 20 blood issues and 30 medicine issues in the last 6 months, and the shortage log.

1. Each blood release is recorded, including emergency release.

Method. Check each blood issue and each emergency release for a record.

Evidence to show. Blood request and issue record (BLD-FRM-002) and emergency release record (BLD-FRM-004).

Pass when. Every issue and release has a record.

2. Each medicine issue is checked and recorded.

Method. Check each medicine issue for the dispensing check.

Evidence to show. Dispensing check record (HOS-FRM-009).

Pass when. At least 95% of issues have the check recorded.

3. Each shortage has a written, approved alternative used only under that approval.

Method. Check each alternative used against the approval recorded before use.

Evidence to show. Standards adapted under constraint policy (FLD-POL-002).

Pass when. Every alternative used was approved in writing before use.

Immediate fail (any one means the criterion is not met)

• Blood is issued with no record.
• A medicine is given with no check and no record.

Why this criterion matters. A field hospital cannot treat everyone. Each patient who needs more care must have a defined route for referral or evacuation, known before it is needed.

Sample. Review the referral and evacuation log for the last 12 months, and the route test records.

1. Each care need the unit cannot provide has a defined route.

Method. Read the route plan and check each care need has a receiving facility and route.

Evidence to show. Referral and evacuation route plan (FLD-PLN-001).

Pass when. Every care need has a named route.

2. Each route is tested at least every six months.

Method. Check the test entries in the log for each route.

Evidence to show. Referral and evacuation log (FLD-REG-001).

Pass when. Every route has a test in the last six months.

3. Each referral is recorded with its time and the receiving facility.

Method. Check each referral entry for the time, the facility and acceptance.

Evidence to show. Referral and evacuation log.

Pass when. At least 95% of referrals are recorded in full.

Immediate fail (any one means the criterion is not met)

• A patient needing care the unit cannot give has no route.
• A route has never been tested.

Why this criterion matters. Field hospitals rely on volunteers and temporary staff. They must work within a defined scope and under supervision, because their experience and their licences may differ.

Sample. Review the scope and supervision records for all volunteers and temporary staff on duty in the last 6 months, and 10 shift rotas.

1. Each volunteer or temporary worker has a written scope before first duty.

Method. Check each person for a signed scope dated before first duty.

Evidence to show. Volunteer scope and supervision record (FLD-FRM-002).

Pass when. Every person has a signed scope before first duty.

2. Each shift has a named supervisor.

Method. Check each sampled rota for a named supervisor on every shift.

Evidence to show. Rota with supervisor names.

Pass when. Every sampled shift has a named supervisor.

3. Clinical credentials are checked.

Method. Check the credential record for each clinical volunteer.

Evidence to show. Staff credential record (STF-FRM-001).

Pass when. Every clinical volunteer has a credential checked and recorded.

Immediate fail (any one means the criterion is not met)

• A volunteer performs a procedure outside their scope.
• A volunteer works with no supervisor on shift.

Why this criterion matters. In a field hospital, a patient may arrive with no identity and leave with no record. A record kept in whatever form is possible, with identity and treatment, is the only way to continue care.

Sample. Review 30 patient records from the last 6 months, including 10 patients admitted without identification.

1. Each patient has a record with identity, treatment, medicines and referral.

Method. Check each sampled record for the four items.

Evidence to show. Field patient record (FLD-FRM-003).

Pass when. At least 95% of records have all four items.

2. A patient without identity is given a temporary identifier on arrival.

Method. Check each record of an unidentified patient for a temporary identifier.

Evidence to show. Field patient record.

Pass when. Every unidentified patient has a temporary identifier from arrival.

3. Records are kept under the records rule.

Method. Check the storage and retention of the records against the rule.

Evidence to show. Records management and retention policy (REC-POL-001).

Pass when. Records are kept and retained as the rule states.

Immediate fail (any one means the criterion is not met)

• A patient is treated with no record kept at all.

Why this criterion matters. Crowded, temporary settings spread infection quickly. Infection control must be practised, and outbreaks found and reported through a defined route.

Sample. Review the infection surveillance register for the last 6 months, and each outbreak or cluster recorded in the period.

1. Infections are watched every day.

Method. Check the register for a daily entry over the period.

Evidence to show. Healthcare-associated infection surveillance register (HOS-REG-005).

Pass when. Every day in the period has an entry.

2. A suspected outbreak is reported within 24 hours.

Method. Check the time each outbreak was reported against its first case.

Evidence to show. Outbreak detection and response plan (FLD-PLN-004).

Pass when. Every outbreak was reported within 24 hours.

3. The response plan is rehearsed each year.

Method. Check the rehearsal record for the last 12 months.

Evidence to show. Rehearsal and drill record (HOS-REG-004).

Pass when. A rehearsal is recorded in the last 12 months.

Immediate fail (any one means the criterion is not met)

• A suspected outbreak is not reported.
• An outbreak is not isolated when the plan requires it.

Why this criterion matters. Field units can be targets of violence or exposed to the security situation around them. A plan to protect patients and staff, written and known, reduces the chance of harm.

Sample. Review the security risk assessment, the evacuation rehearsal record and every security incident in the last 12 months.

1. A security risk assessment is done before opening and reviewed each year.

Method. Check the assessment date and the review date.

Evidence to show. Unit security and evacuation plan (FLD-PLN-002).

Pass when. The assessment is dated before opening and reviewed in the last 12 months.

2. The unit can be evacuated, and the evacuation is rehearsed each year.

Method. Check the rehearsal record for a unit evacuation in the last 12 months.

Evidence to show. Rehearsal and drill record (HOS-REG-004).

Pass when. A unit evacuation is recorded in the last 12 months.

3. Each security incident is reported.

Method. Check each incident for a report.

Evidence to show. Violence and aggression incident record (WRK-FRM-003).

Pass when. Every incident has a report.

Immediate fail (any one means the criterion is not met)

• The unit has no evacuation plan.
• A security incident is not reported.

Why this criterion matters. People in a field setting face trauma, loss and exhaustion. Offering psychological support, and recording the offer, makes sure it reaches those who need it.

Sample. Review the psychosocial records for 20 patients and 10 staff in the last 6 months, and the debrief records after each critical incident.

1. Psychological support is offered to patients with a traumatic event.

Method. Check each sampled patient for an offer.

Evidence to show. Psychosocial offer and debrief record (FLD-FRM-004).

Pass when. At least 90% of sampled patients have an offer recorded.

2. Staff are offered a debrief after each critical incident.

Method. Check each critical incident for a debrief offer.

Evidence to show. Psychosocial offer and debrief record.

Pass when. Every critical incident has a debrief offer recorded.

3. Each offer and answer is recorded.

Method. Check each offer for the answer.

Evidence to show. Psychosocial offer and debrief record.

Pass when. Every offer has the answer recorded.

Immediate fail (any one means the criterion is not met)

• A distressed patient is not offered support.

Why this criterion matters. A field unit is temporary, but its patients are not. When it closes, the patients and their records must go to a permanent service, or care stops.

Sample. Review every closure or handover in the last 3 years, and the records of 10 patients transferred at closure.

1. A closure plan names the permanent service for each patient.

Method. Read the plan and check each open patient has a named service.

Evidence to show. Closure and handover plan (FLD-PLN-003).

Pass when. Every open patient has a named service in the plan.

2. Each patient is transferred with a written handover.

Method. Check each sampled transfer for the handover form.

Evidence to show. Handover record (HOS-FRM-004).

Pass when. Every sampled patient has a written handover.

3. Records transfer with the patient and are accounted for.

Method. Count patients and records at closure and compare.

Evidence to show. Closure record and count.

Pass when. The count of records matches the count of patients.

Immediate fail (any one means the criterion is not met)

• A unit closes with a patient or a record unaccounted for.

Why this criterion matters. Donated medicines and equipment often arrive with unknown history, expired stock and wrong storage. Checking each item before use prevents harm from something that looked helpful.

Sample. Review the donation check records for 20 donated items used in the last 6 months, and every item withheld.

1. Each donated item is checked before use.

Method. Check each item used for a completed check dated before use.

Evidence to show. Donation check record (FLD-FRM-005).

Pass when. Every item used has a check dated before use.

2. An item that fails a check is withheld and recorded.

Method. Check each failed check for withholding and a record.

Evidence to show. Donation check record and the disposal record.

Pass when. Every failed check is withheld and recorded.

3. No withheld item is used.

Method. Check the issue record for any withheld item.

Evidence to show. Medicine and equipment issue record.

Pass when. No withheld item appears in an issue.

Immediate fail (any one means the criterion is not met)

• An expired or unapproved donated medicine is used.

Why this criterion matters. A patient who reports sexual violence needs medical care, evidence preserved and support, within a short time. Without a written pathway, that care is delayed or missed.

Sample. Review the written pathway, and the records of every patient who reported sexual violence in the last 12 months. If none, review the pathway and a rehearsal.

1. A written pathway sets out the clinical response.

Method. Read the pathway and check it covers the response, the time limits and the referral.

Evidence to show. Clinical response to sexual violence (FLD-SOP-004).

Pass when. The pathway covers all three and is current.

2. The clinical response starts within the set time.

Method. Check the time of report against the time of first treatment.

Evidence to show. Sexual violence response record (FLD-FRM-006).

Pass when. Every report started within the set time.

3. Consent is recorded before any evidence is kept.

Method. Check each record for consent before evidence.

Evidence to show. Sexual violence response record.

Pass when. Every record has consent recorded before evidence.

Immediate fail (any one means the criterion is not met)

• A report of sexual violence receives no clinical response.
• A patient is not referred to support.

Why this criterion matters. Triage decides who is seen first. Without a recognised tool, the sickest patient can wait behind the least sick, and nobody can show why.

Sample. Review 30 emergency arrivals from the last 6 months, chosen at random, with their time to triage and time to treatment.

1. Every arrival is triaged within the set time.

Method. Check the time from arrival to triage for each sampled arrival.

Evidence to show. Triage record and log (HOS-FRM-001).

Pass when. At least 90% are triaged within the set time.

2. A recognised triage tool is used.

Method. Check each triage record for the tool used.

Evidence to show. Emergency triage procedure (HOS-SOP-001).

Pass when. Every record names a recognised tool.

3. The most urgent patients are seen first.

Method. Compare the time to treatment for the most urgent category against the others.

Evidence to show. Triage record and log.

Pass when. Every most-urgent patient is seen before less urgent patients, or the reason is recorded.

Immediate fail (any one means the criterion is not met)

• The sickest patient waits behind a less sick patient with no reason recorded.

Why this criterion matters. A hospital that loses power, water or oxygen, or receives a mass casualty, needs a plan that people have practised. A plan on the shelf does not work under pressure.

Sample. Review the mass-casualty and utility failure plan, the rehearsal record for the last 12 months, and the water contingency plan.

1. A written plan covers mass casualties and loss of power, water and oxygen.

Method. Read the plan and check each of the four hazards is covered.

Evidence to show. Mass-casualty and utility failure plan (HOS-PLN-001).

Pass when. All four hazards are covered.

2. The plan is rehearsed at least once a year.

Method. Check the rehearsal record for the last 12 months.

Evidence to show. Rehearsal and drill record (HOS-REG-004).

Pass when. A rehearsal is recorded in the last 12 months.

3. Staff know their role.

Method. Check the rehearsal debrief for each staff role.

Evidence to show. Rehearsal and drill record.

Pass when. At least 90% of staff on duty are recorded as knowing their role.

Immediate fail (any one means the criterion is not met)

• There is no written mass-casualty plan.
• The plan has never been rehearsed.

Why this criterion matters. The surgical safety checklist works only when the team says it out loud, together, at each pause. A checklist filed after the operation protects no one.

Sample. Observe 5 operations, and review the checklist for 15 operations in the last 6 months, including the time each was completed.

1. The checklist is completed out loud at each pause.

Method. Observe the team pause in each observed operation.

Evidence to show. Surgical safety checklist record (SRG-FRM-001).

Pass when. Every observed operation completes the checklist out loud.

2. The checklist covers identity, procedure, site, allergies and blood loss.

Method. Check each completed checklist for each item.

Evidence to show. Surgical safety checklist record.

Pass when. Every checklist covers all five items.

3. The checklist is not completed after the operation.

Method. Compare the completion time with the operation time.

Evidence to show. Surgical safety checklist record.

Pass when. No checklist is completed after the operation.

Immediate fail (any one means the criterion is not met)

• The checklist is completed only as paperwork after the operation.

Why this criterion matters. Anaesthesia is the highest-risk part of the day for many patients. Continuous monitoring through the whole procedure, matched to the level of anaesthesia, is the standard that finds the problem early.

Sample. Review 15 anaesthesia records in the last 6 months, and the machine check records for the same operations.

1. Monitoring is recorded throughout the procedure.

Method. Check each anaesthesia record for continuous monitoring.

Evidence to show. Anaesthesia record and monitoring chart (SRG-FRM-002).

Pass when. Every record shows monitoring throughout.

2. The anaesthesia machine is checked before use.

Method. Check each operation for the machine check.

Evidence to show. Anaesthesia machine and equipment check (SRG-FRM-003).

Pass when. Every operation has a machine check before use.

3. The level of anaesthesia suits the patient and the provider.

Method. Check the level recorded against the provider credential.

Evidence to show. Staff credential record (STF-FRM-001).

Pass when. Every level matches the patient and the credentialled provider.

Immediate fail (any one means the criterion is not met)

• Anaesthesia is given with no monitoring recorded.

Why this criterion matters. Infections after surgery are preventable with a set of checkable practices. A bundle, followed for every procedure and measured, is what makes prevention real.

Sample. Review the bundle compliance records for 15 operations in the last 6 months, and the surgical site infection surveillance record.

1. The surgical site infection bundle is followed for every operation.

Method. Check each operation for the bundle record.

Evidence to show. Surgical site infection bundle compliance record (SRG-FRM-004).

Pass when. At least 95% of operations have a complete bundle record.

2. Antibiotic timing before incision is recorded.

Method. Check each record for the antibiotic time against the incision time.

Evidence to show. Surgical site infection bundle compliance record.

Pass when. At least 95% have antibiotic timing recorded within the set window.

3. Surgical site infections are reported and reviewed.

Method. Check the surveillance record for each infection.

Evidence to show. Healthcare-associated infection surveillance register (HOS-REG-005).

Pass when. Every infection is recorded and reviewed.

Immediate fail (any one means the criterion is not met)

• A procedure is done without the bundle.

Why this criterion matters. Transfusing the wrong blood is one of the most dangerous errors in hospital. Two staff check the patient and the product at the bedside.

Sample. Review 20 transfusions in the last 6 months, the bedside check record for each, and the cold chain record for the blood used.

1. Two staff check the patient against the blood product at the bedside.

Method. Check each transfusion for the two-person bedside check.

Evidence to show. Bedside transfusion check and reaction record (HOS-FRM-007).

Pass when. Every transfusion has the two-person check recorded.

2. Each reaction is recorded and reported.

Method. Check each recorded reaction for a report.

Evidence to show. Blood transfusion procedure (HOS-SOP-008).

Pass when. Every reaction is recorded and reported.

3. The cold chain is kept for each unit.

Method. Check the cold chain record for each unit issued.

Evidence to show. Cold chain storage and transport record (BLD-SOP-004).

Pass when. Every unit issued has a cold chain record within limits.

Immediate fail (any one means the criterion is not met)

• A transfusion is given without a two-person bedside check.

Why this criterion matters. A transfer that starts without a written plan depends on memory. A plan with a back-up route, a timing schedule and crew named lets the team respond calmly when something changes.

Sample. Review 10 patient transfers in the last 6 months, and each transfer plan.

1. A written plan is completed before departure.

Method. Check each transfer plan for a completion time before departure.

Evidence to show. Transfer plan (PTR-FRM-002).

Pass when. Every plan is completed before departure.

2. The plan includes a back-up route and crew.

Method. Check each plan for a named back-up route and crew.

Evidence to show. Transfer plan and contingency procedure (PTR-SOP-012).

Pass when. Every plan names a back-up route and crew.

3. The plan includes the handover point.

Method. Check each plan for the handover point.

Evidence to show. Transfer planning procedure (PTR-SOP-001).

Pass when. Every plan names the handover point.

Immediate fail (any one means the criterion is not met)

• A patient is moved with no written plan.

Why this criterion matters. Some transfers should go by ground, others by air or by escorted commercial flight. Without a clear rule, the decision is made under pressure and can be wrong. A written rule, and the right of the crew to refuse an unsafe transfer, protect the patient.

Sample. Review the transfer mode policy and 10 transfer mode decisions in the last 12 months.

1. A written rule names who decides the transfer mode.

Method. Read the policy and check the decision maker and review date.

Evidence to show. Transfer mode decision and right to refuse (PTR-POL-001).

Pass when. The policy names the decision maker and is current.

2. Each decision is recorded with its reason.

Method. Check each decision in the sample for the reason.

Evidence to show. Transfer plan (PTR-FRM-002).

Pass when. Every decision has a reason recorded.

3. A crew or escort can refuse without penalty.

Method. Check the policy for the refusal right and the records of any refusal.

Evidence to show. Transfer mode decision and right to refuse (PTR-POL-001).

Pass when. The refusal right is written, and no refusal was penalised.

Immediate fail (any one means the criterion is not met)

• A transfer judged unsafe goes ahead with no decision recorded.

Why this criterion matters. Staff who are attacked cannot give care. A risk assessment, de-escalation training and a reporting route reduce both attacks and their impact.

Sample. Review the violence risk assessment, the de-escalation training records and every violence incident in the last 12 months.

1. A violence risk assessment is done and reviewed.

Method. Check the assessment date and review date.

Evidence to show. Violence and aggression prevention and response procedure (WRK-SOP-006).

Pass when. The assessment is reviewed in the last 12 months.

2. Staff are trained in de-escalation.

Method. Check the training record for staff on duty.

Evidence to show. Training record (WRK-SOP-006).

Pass when. At least 90% of staff on duty have de-escalation training recorded.

3. Every incident is reported and reviewed.

Method. Check each incident for a report and a review.

Evidence to show. Violence and aggression incident record (WRK-FRM-003).

Pass when. Every incident has a report and a review.

Immediate fail (any one means the criterion is not met)

• An act of violence against staff is not reported.

Why this criterion matters. Children, people with disability and patients who lack capacity can be harmed without anyone noticing. A named safeguarding lead and a flag in the care plan protect them.

Sample. Review 20 admissions in the last 6 months, including any child, person with disability or patient who lacks capacity.

1. Vulnerable patients are identified at admission.

Method. Check each admission for a vulnerability flag.

Evidence to show. Vulnerability flag record (HOS-FRM-010).

Pass when. At least 95% of admissions have the flag checked.

2. A named safeguarding lead is in place.

Method. Check the rota or policy for the named lead.

Evidence to show. Vulnerable patients and safeguarding procedure (HOS-SOP-013).

Pass when. A named lead is recorded for every shift.

3. Protections are recorded for each flagged patient.

Method. Check each flagged patient for a recorded protection.

Evidence to show. Vulnerability flag record.

Pass when. Every flagged patient has a protection recorded.

Immediate fail (any one means the criterion is not met)

• A child is admitted with no safeguarding check.