Considering the possibility of increase in novel coronavirus infections, the Health Ministry has decided to use train coaches as COVID Care Centres for suspected or confirmed patients categorized as mild or very mild cases.
According to a "guidance document on appropriate management of suspect/ confirmed cases of COVID-l9: Railway Coaches - COVID Care Centre" released by health ministry on Wednesday, the patients lodged in coaches will be observed for their symptoms and clinical condition.
In cases of change of the symptoms or clinical conditions, they would be referred to a designated centre or hospital for further management, the document said.
Separate coaches for suspect and confirmed cases should be ensured to avoid cross infection, the document says.
"As far as possible, wherever cases are admitted in the COVID Care Center coach, preferably individual cabin should be assigned for each case. Should the situation warrant, up to a maximum of two confirmed patients can be assigned in individual cabin," the ministry stated.
The Centre has classified health facilities into three categories -- COVID Care Center, Dedicated COVID Health Centre (DCHC) and Dedicated COVID Hospital (DCH).
The COVID Care Centers offer care only for cases that have been clinically assigned as mild or very mild cases or suspect cases while Dedicated COVID Health Centre are hospitals that offer care for all cases that have been clinically assigned as moderate.
Dedicated COVID Hospitals will offer comprehensive care primarily for those who have been clinically assigned as severe and these should either be a full hospital or a separate block in a hospital with preferably separate entryexit.
The Ministry of Railways, as its contribution to national cause, has initiated conversion of Railway Coaches into COVID Care Centers to provide additional beds for coronavirus infected patients as and when required, the ministry said.
According to the Standard Operating Procedures released by the ministry, special train coaches shall be cleaned and disinfected as per protocol for disinfection of quarantine facilities issued by Ministry of Health.
The document mentioned a list of 215 stations where the special train coaches can be placed.
The Railways will designate state-wise nodal officers for allocation of trains and for coordinating with the respective state and UT government and share the list of their nodal officers with them.
After the allocation by the Railways, the train shall be placed, at required station with necessary infrastructure, and handed over to district collector or district magistrate or one of their authorized persons, the SOPs stated.
The state government shall map at least one COVID Dedicated hospital for each train so that patient can be shifted to the hospital in case of emergency. The state and UT government shall make suitable ambulance arrangements for shifting the patient.
Preferably one Basic Life support Ambulance with oxygen and ambubag should be stationed at the railway station where the train is placed, the SOPs said.
The respective state and UT government request for placing the coaches at the other 130 stations only if they agree to provide staff and essential medicines at such stations.
"The Railways would be responsible for provision of all the items as prescribed by Health ministry for the CVOID care centers, including arrangements for oxygen cylinders in each coach and other necessary items including linen etc," it stated.
Para-medic staff on train will do bio-medical waste segregation at source and respective state and district shall do waste disposal arrangements following the mechanism being followed for hospitals.
"Standard Treatment Protocols of the Ministry shall be followed for management of cases. The staff deployed at the special train coaches shall be suitably oriented and trained, wherever necessary," the ministry said.
Wherever the train is stationed, the rolling stock department of Railways shall make arrangements for watering of coaches regularly, any repairs required in coaches, and also for replenishment of chlorine tablets at the bio-toilet discharge and wherever required, catering arrangements shall be made by IRCTC of the commercial department.
"The Railway Protection Force will ensure suitable security to the coaches, patients and staff working there. Proper signages shall be placed outside railway stations, platforms and near location of coaches to guide authorities and patients to the coaches in a way that they are separate from the general public using the railway facilities," according to the SOPs.
One changing facility for doffing at end of the train on platform where the train is parked is required to be provided, the ministry said. This facility, if not available as a permanent set up, may be provided as a temporary arrangement by the Railways.
As a special case, the Ministry of Environment change has provided one-time exemption from registration of train coaches for the purpose of generating hospital waste.
However, the guidelines issued by CPCB and the State Pollution Control Board related to treatment of COVID patients has to be followed.
Before a train is handed back to Railways, the staff deployed there shall ensure all biomedical waste bins are cleaned and emptied, the train cleaned and disinfected, the SOPs said.
The Railway staff will have to again disinfect the train as per protocol issued by Ministry of Health from time to time and lock it till further orders, the SOPs stated.