Water

EMTs must ensure that patients, caregivers and staff have sufficient safe drinking water at all times, distributed through appropriate water collection points and facilities, to enable medical, personal hygiene, drinking, cooking, cleaning and laundry activities.

EMT must provide or access a robust water supply capacity, with redundancy in the event of supply disruptions. Without safe water, EMTs cannot provide safe health care and risk exposing staff, patients and local populations to infectious disease transmission and worsening public health problems. EMTs need to ensure the availability of technical expertise to carry out water management activities, which again underlines the need for a strong component to support the operation of each EMT.

1. Adequate equipment is in place to treat sufficient raw water according to the needs per EMT type and expertise to ensure proper functionality.
2. Perform water quantity calculation based on recommended minimum standards:
   • 40–60 litres per staff member per day
   • 5 litres per outpatient
   • 40–60 litres per inpatient per day
   • 100 litres per surgical intervention and delivery
3. Ensure that treatment technologies/procedures for treating water from available local raw water resources comply with WHO standards and national regulatory standards.
4. Water is treated with a disinfectant so that there is a free residual chlorine at the tap of 0.5–1 mg per L and turbidity is below 5 nephelometric turbidity units (NTU). There are no faecal coliforms per 100 ml77 at the point of delivery.
5. Ensure that water quality and safety analysis test kits are available and functional and keep records of water quality and safety analysis.
6. Ensure a minimum storage capacity of 48 hours of drinking water to ensure a constant water supply even in the event of short-term interruptions.
7. Training of staff in the management of aspects of sourcing, treatment storage and supply of water systems.
8. Type 2 and 3 require the installation of a pressurized water supply system to ensure adequate water supply at all times, especially in critical clinical areas.
9. Provide sufficient drinking water delivery points in each waiting area, clinical work areas, food preparation points, dining rooms and staff rest areas.

• Testing for E-coli typically takes 24 hrs to complete and conducting such tests in a response phase of an emergency may be impractical for every load of water that moves through the EMT system.
• Using a multi-barrier approach to water treatment is the best way to reduce the risk of unsafe water use.78 Every step of the process, from source protection to water treatment and safe storage, helps to reduce health risks.
• Consider installing foot, elbow or sensor infrared taps to minimize the risk of cross-contamination at all end-user water supply points or handwashing stations.
• Anticipate the need for extra equipment such as submersible or centrifugal pumps or transport equipment that permits adaptation to a wider range
  of situations, including the collection of water and its transport to the treatment area.