Successful Implementation of Hospital Disaster Preparedness and Response Plan During Mass Casualty Bus Accident: A Case Report from Nepal

Background: Nepal's mountainous terrain and frequent natural disasters necessitate robust hospital disaster preparedness systems. The Hospital Disaster Preparedness and Response Plan (HDPRP) was developed following the 2015 Nepal earthquake to enhance mass casualty management capabilities in healthcare facilities. This case report documents the first real-world implementation of Nepal's HDPRP framework during a bus accident at Dhaulagiri Hospital, Baglung. Case Presentation: A passenger bus accident at Nishikhola, Burtibang resulted in 26 casualties requiring immediate medical attention. Dhaulagiri Hospital activated its Hospital Incident Command System (HICS) within one hour of notification. A six-member command structure coordinated the response, including incident command, disaster focal person, operational manager, logistics officer, information officer, and administrative officer. The hospital implemented comprehensive emergency protocols including triage, resource mobilization, zero billing policy, and inter-agency coordination. All 26 casualties were successfully managed with only two requiring referral to higher-level facilities. No mortality occurred during the hospital stay. Conclusions: This case demonstrates successful implementation of Nepal's HDPRP framework in a real-world mass casualty incident. Key success factors included pre-established protocols, designated command structure, effective inter-agency coordination, and comprehensive resource mobilization. The experience validates the effectiveness of structured disaster preparedness protocols in resource-limited settings and provides valuable insights for improving hospital emergency response capabilities.