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This material was developed and produced

by the Health Emergency Management Staff


(HEMS) of the Philippine Department of Health
(DOH) with the support of the World Health
Organization (WHO).

This manual may be reproduced or translated


into other languages without prior permission
from the HEMS, provided the parts used are
distributed free or at cost (not for profit) and
acknowledgment is given to HEMS as the
source.

The HEMS would be grateful to receive cop-


ies of any adaptations or translations of the
manual into other languages. Copies may be
addressed or delivered to:

The Director
Health Emergency Management Staff
Department of Health
San Lazaro Compound
Rizal Avenue, Sta. Cruz, Manila
Guidelines
for
Health Emergency Management

Manual for Hospitals

Second Edition

Health Emergency Management Staff


Department of Health
World Health Organization

Philippines
2008 3i
ACKNOWLEDGMENTS

The Manual of Guidelines for Health Emergency Management for Hospitals is one of
the three manuals revised by the Health Emergency Management Staff. The two others
are for the Operations Center and for the Centers for Health Development.

Grateful acknowledgment is given to:


- All our colleagues whose first-hand experiences in the field – their insights, pains
and successes – served as the bases for the changes.
- Technical and support staff in the office that facilitated the smooth flow of
activities.
- De La Salle Health Sciences Institute, Dasmarinas, Cavite for promoting a critical
view among its contributors/writers and for administrative assistance in the
systematization and organization of the final form of the manuals.
- World Health Organization, Western Pacific Regional Office-Emergency and
Humanitarian Action, and WHO Philippines for technical assistance and financial
support in the development and production of the three manuals.

Our thanks to God Almighty for guiding and leading us along the path in the realization
of the manuals and their ultimate application for the protection and safety of our
communities and our people.

- Health Emergency Management Staff

TECHNICAL WORKING COMMITTEE

Carmencita A. Banatin, MD, MHA


Director III
Health Emergency Management Staff
Chairperson

Manual of Guidelines for Centers for Health Development


Assistant Chairperson: Marilyn V. Go, MD, MHA
Chief
Health Emergency Preparedness Division
Health Emergency Management Staff
Members:
Eng. Aida C. Barcelona Health Emergency Management Staff
Elnoria G. Bugnosen, RN Center for Health Development - CAR
Atty. Annabelle C. de Veyra, RN Center for Health Development - VIII
Florinda V. Panlilio, RND Health Emergency Management Staff
Noel G. Pasion, MD Center for Health Development - IV A
Mary Grace H. Reyes, MD, MPH Center for Health Development Metro Manila
Edgardo O. Sarmiento MD Bicol Sanitarium

Manual of Guidelines for Hospitals


Assistant Chairperson: Arnel Z. Rivera, MD
Chief
ii 4 Health Emergency Division
Health Emergency Management Staff
Members:
Romeo A. Bituin, MD Dr. Jose Fabella Memorial Hospital
Emmanuel M. Bueno, MD East Avenue Medical Center
Alexis Q. Dimapilis, MD San Lazaro Hospital
Ma. Belinda B. Evangelista, RN National Kidney and Transplant Institute
Edna F. Red, MD Health Emergency Management Staff
Romeo J. Sabado, MD National Center for Mental Health

Manual of Guidelines for Operations Center


Assistant Chairperson: Teresita DJ Bakil, RN
Supervisor, Operations Center
Health Emergency Management Staff
Members
Elmer Benedict E. Collong, RMT Philippine Heart Center
Mylyn G. dela Cruz, RN Health Emergency Management Staff
Rosalie A. Espeleta, RND Center for Health Development Metro Manila
Marlene F. Galvan, RN Health Emergency Management Staff
Virgilio G. Gamlanga, RN Health Emergency Management Staff
Susana G. Juango, RN, MPH Health Emergency Management Staff
Luis Ferdinand G. Nonan, RMT Health Emergency Management Staff
Merlina M. Villamin, RN Health Emergency Management Staff

De La Salle Health Sciences Institute Project Team


Estrella P. Gonzaga, MD
Associate Professor
College of Medicine
Coordinator
Josephine M. Carnate, MD, MPH
Professor
College of Medicine
Co-Coordinator for Centers for Health Development
Cynthia Lazaro-Hipol, MD, MPH
Professor
College of Medicine
Co-Coordinator for Operations Center
Christine Serrano-Tinio, MD, MHA
Associate Professor
College of Medicine
Co-Coordinator for Hospitals

World Health Organization


Arturo M. Pesigan, MD, MPH
Emergency & Humanitarian Action
Western Pacific Regional Office
Maria Lourdes M. Barrameda, MD
Philippines

Administrative and Secretarial Support: Aida N. Gaerlan


Copy Editors: Cynthia A. Diaz, Alicia Lourdes M. De Guzman, Mary Ann B. Leones
Cover Design: Anthony E. Santos, Dario B. Noche
Layout Artist: Dario B. Noche
iii
HEALTH EMERGENCY
MANAGEMENT STAFF

VISION
Asia’s model in health emergency
management systems.

We are the leader in human resource


development, technical assistance, and health
emergency care, with state-of-the-art equipment
and logistics. Our health emergency policies,
plans, programs and systems are internationally
acclaimed and benchmarked to guarantee
minimum loss of lives during health emergencies
and disasters.

MISSION
To ensure a comprehensive and integrated
health sector emergency management
system.

As the health emergency management arm


of the DOH, the HEMS was institutionalized,
by virtue of Executive Order 102, to ensure a
comprehensive and integrated Health Sector
Emergency Management System to prevent or
minimize the loss of lives during emergencies
and disasters in collaboration with government,
business and civil society groups.

CORE VALUES
God-centered and God-inspired values
of commitment, respect for life
and environment, and leadership
and excellence.

iv6
CONTENTS

Acknowledgments ii
Message – Secretary, Philippine Department of Health vii
Message – World Health Organization viii
Foreword – Director, Health Emergency Management Staff ix
Acronyms x
Glossary xii

PART I: The Health Emergency Management Staff 1


Chapter 1: Vision and Mission 3
Chapter 2: Policy Base: National Policy Framework on Health Emergencies and Disasters 4
Chapter 3: Action Base: Roles in Managing Health Risks of Emergencies 5
Chapter 4: Legal Mandates 7

PART II: Health Emergency Management in Hospitals 23


Chapter 1: Introduction 25
Roles and Responsibilities of Hospitals 26
Chapter 2: Activities During the Emergency Preparedness Phase 27
A. Development of Policies, Guidelines, Procedures and Protocols for Health Emergency
Management 27
B. Development of a Hospital Emergency Preparedness, Response, Recovery (HEPRR) Plan 29
C. Development of the Organization 39
D. Physical Infrastructure Development 48
E. Systems Development 51
Chapter 3: Activities During the Response Phase 57
A. Activation 57
B. Operations/Support Management 59
C. Extension/Termination 62
Chapter 4: Activities During the Recovery/Reconstruction Phase 63
A. Activation 63
B. Operations/Support Management 63
C. Termination 64

PART III: Guidelines 65


Section 1. Guide to Policy Formulation 67
Section 2. Guide to the Formulation of the HEPRR Plan 70
Section 3. Job Action Sheets 86
Section 4. Deployment of Response Teams 102
Section 4.1. Ambulance Services for Emergencies and Disasters 105
Section 5. Hospital Operations Center 107
Section 6. Early Warning and Alert Systems 111
Section 6.1A. Code Alert System for the DOH Central Offices 114
Section 6.1B. Integrated Code Alert System for the Health Sector 118
Section 6.2. Alert Signals 126
Section 7. Rapid Health Assessment / Assessment for Recovery 133
Section 8. Mass Casualty Management 138
Section 9. Management of the Dead and Missing 155
Section 10. Public Health Services 163
Section 11. Mental Health and Psychosocial Support 165
Section 12. Coordination and Networking 173
Section 13. Human Resource Development 181
Section 14. Logistics Management 188
Section 15. Information Management System 195
Section 16A. Health Promotion and Advocacy 199
Section 16B. Risk Communication and Media Management 207
Section 16C. Risk Communication in Hospitals 217
Section 17. Health System in Emergency or Disaster 219
Section 18. Evaluation 223
Section19. Research and Development 228

STANDARD OPERATING PROCEDURES 231


I. Information and Dispatch 233
II. Advance Medical Post-Site Selection, Signage and Logistics
III. Handling Equipment Attached to Patient
235
236 7v
FIGURES
1. Emergencies and Health 33
2. Epidemic Emergencies 33
3. Example of a Hospital HEPRR Planning Group/Committee Structure 40
4. Basic Hospital Emergency Incident Command System Structure 44
5. Comprehensive Hospital Emergency Incident Command System Organizational Chart 46
6. Patient Care Stations 49
S8.1. Rescue Chain in a Mass Casualty Management System 138
S8.2. Role of the Hospital in a Mass Casualty Management System 141
S8.3. Victim Flow: “Conveyor Belt” Management Diagram 150
S9.1. MDM Functional Structure 155
S12.1. The Spectrum of Coordination Activities 175
S16B.1. Flow Chart: Steps in Communicating Health Risk 211
S17.1. Strategy for Controlling Communicable Diseases 221

TABLES
1. Timeline of Health Sector Roles by Health Emergency Management Phases 5
2. Timeline of the Three Phases of Health Emergency Management 6
3. Strategies Used in Health Emergency Management 18
4. 10 P’s of Health Emergency Management 53
S1.1. Comparison of Policy Content of A.O. 168 s.2004 and A.O. 2007-001B 69
S4.1. Human Resource Requirements by Alert Level Status in Hospital and CHD for On-scene
Response 102
S4.2. Competency Requirements and Required Training Course/Package for Responders 103
S5.1. Standard Operating Procedures for Emergency Operations Centers (EOCs) 108
S8.1. Triage Levels by Period, Location and Categories 146
S8.2. Use of Color Tag for Prioritization of Care 147
S11.1. Checklist of Minimum Mental Health and Psychological Services 166
S13.1. Training Process 183
S13.2. Competency Requirements and Required Training Course/Package by Roles 184
S15.1. Data Collection Tools 196
S18.1. Comparison of Key Activity Characteristics 226
S18.2. Reasons to Conduct Exercise Program Activities 227
BOXES
Examples in the Use of Terminologies 28
Outline of Hospital Health Emergency Preparedness, Response and Recovery Plan 36
Pointers in Formulating a Health Emergency Management Plan 39
Key Information: Readily Available and Regularly Updated 109
Rapid Assessment Surveys 135
Basic Key Questions Required Within 24 Hours of the Event 136
Field Organization Checklist 151
Requirements from DOH Hospitals in MCM 154
Metro Manila Hospital Network 180
What Not To Do During a Crisis 208
Seven Cardinal Rules of Risk Communication 212
What Does Media Like 213

FORMS 237
Form 1 HEARS Field Report 239
Form 2 Material Inventory 240
Form 2-1 Inventory Checklist 241
Form 3-A Rapid Health Assessment 242
Form 3-B Rapid Health Assessment in Mass Casualty Incident 244
Form 3-C Rapid Health Assessment in an Outbreak 245
Form 5 List of Casualties 246
Form 5-1 Patient List from Field Medical Commander 247
Form 5-2 Mass Casualty Medical Case Record 248
Form 6 HEMS Coordinator’s Final Report 251
Form 6-1 Post-Mission Report 255
ANNEXES 257
1. Considerations in Hospital Design, Energy and Communications 259
S18.1 Five Types of Evaluation Exercises: Characteristics and Guidelines 264

REFERENCES 271

vi8
MESSAGE

The Philippines has frequently been beset by health emergencies and disasters. These
health emergencies have corresponding risks that affect people both physically and
psychologically. Added to these are risks to their properties, disruption in services,
threats to their livelihood and environmental degradation. Hence, there is a need for
systematic monitoring, coordination and evaluation to mitigate the effects of these risks.

The health workers involved in health emergency management play a vital role in all the
phases of emergencies and disasters by assuming different tasks and responsibilities.
Within the health sector, the hospitals and the regional health offices, in addition to the
local health workers, form our implementing arm. In all phases spanning prevention,
preparedness, response and recovery are different systems, policies, guidelines and
protocols, which guide and equip our health workers to efficiently and effectively man-
age all types of emergencies.

Emergency management is evolving, dynamic, and should be continuously updated so


as to keep up with the needs of our time. Hence, guidelines for emergency manage-
ment, which were originally drafted in 2000, need to incorporate certain updates and
revisions for enhanced emergency management.

I would like to commend the Health Emergency Management Staff for all their efforts
and perseverance in revising these three important manuals, which are the Guidelines
for the Operations Center, the Hospitals, and the Centers for Health Development. Last-
ly, I thank the World Health Organization not only for their support in the development
and reproduction of these materials but also for being our constant allies in responding
to different health emergencies. I am highly recommending the use of these manuals to
guide all health workers in disaster response.

Let us continue to work together for timely, reliable and a well-coordinated response to
all forms of health emergencies and disasters.

Mabuhay!

FRANCISCO T.DUQUE III, MD, MSc


Secretary of Health
v9ii
MESSAGE

It is a fact that the Philippines is one of the most hazard-prone countries in the world.
The Government though has been wisely taking steps to continuously increase its pre-
paredness to hazards.

The Department of Health’s Health Emergency Management Staff (DOH-HEMS) is


dedicated to overseeing its preparedness and response to health emergencies nation-
wide, directly or by assisting local units. In line with this, it embarked on this project to
develop manuals of operations for different responding units.

These manuals of operations which the DOH-HEMS developed together with those
actually involved in health emergency response, like the hospitals and different Centers
for Health Development, is a tool essential to smooth operations during emergencies.
While a manual by itself does not guarantee the success of an operation, it can make
responding to emergencies as predictable as possible without precluding the need to
make adjustments whenever necessary.

The manuals are a testament to the amount of time and effort that were put into the
review, planning, and coordination by these units in the process of writing and rewriting
these manuals. Such links and understanding between responding units are crucial to
the speed, efficiency and effectiveness of any response to emergencies.

The manuals can very well serve other purposes other than their original purpose. They
can also be tools for more detailed planning by the different units and other interested
parties.

The challenge now is to ensure that the manuals are well-understood by all concerned,
the protocols practiced, the necessary resources and tools made available at all times,
and provisions made for later review and revision of these manuals as would be neces-
sary in the future.

Congratulations to the Department of Health for developing these manuals. I am sure


that this is a major step to improving further the efficiency and effectiveness of health
emergency response in the country.

DR. SOE NYUNT-U


Country Representative
10
viii World Health Organization, Philippines
FOREWORD

In year 2000, the Health Emergency Management Staff developed and disseminated
three manuals to guide health workers working in the Operations Center, Hospitals,
and Centers of Health Development in the field of health emergency management.
The manuals consisted of some protocols, guidelines and procedures being used in
response to emergencies. Most were based on experiences, readings, and trainings.
But times have changed with disasters coming in different forms and magnitude, risks
and consequences getting more complex, human-generated disasters becoming more
frequent, and most of all, some facts and procedures have slowly become outdated and
deficient.

Hence, there was a need to review and revise the three manuals. The process involved
the review of the initial edition, resource materials compiled from previous trainings,
both locally and internationally, and most of all, valuable inputs from actual field experi-
ences and best practices of the front-liners and key players. Key action points ranging
from mandates and desirable level of preparedness in each phase of the disaster cycle
were integrated in a manner that a very user-friendly guideline will be made available
to all health emergency managers and program planners engaged in the field of emer-
gency management.

Although some might be generic in approach, these guidelines are basically adapted to
the Philippine setting in consideration of the mandates of agencies, and observing the
Local Government Code and existing laws and regulations. As we belong to the Health
Sector, the manuals are specifically for health emergency managers at all levels of in-
strumentalities. Each manual can exist on its own but complements the other manuals.

I hope you will find all three manuals very useful in your planning activities, in respond-
ing during emergencies and also in providing support during the recovery and rehabili-
tation phase. In the process, I hope that every user will eventually become a contributor
to its continuous evolution.

CARMENCITA A. BANATIN MD, MHA


Director III

11
ix
ACRONYMS

ACLS – Advanced Cardiac Life Support


ADPC – Asian Disaster Preparedness Center
AFP – Armed Forces of the Philippines
AO – Administrative Order
ATO – Air Transportation Office
ATTF – Anti-Terrorism Task Force

BFAD – Bureau of Food and Drugs of the DOH


BFAR – Bureau of Fisheries and Aquatic Resources
BFP – Bureau of Fire Protection
BFP-EMS – Bureau of Fire Protection - Emergency Medical Services
BFP-SRU – Bureau of Fire Protection - Search and Rescue Unit
BHDT – Bureau of Health Devices and Technology of the DOH
BIHC – Bureau of International Health Cooperation of the DOH
BLS – Basic Life Support
BOC – Bureau of Customs

CBRNE – Chemical, Biological, Radio-Nuclear Agents and Explosives


CHD – Center for Health Development of the DOH
CHO – City Health Officer
COA – Commission on Audit
CSSR – Collapsed Structure Search and Rescue

DBM – Department of Budget and Management


DFA – Department of Foreign Affairs
DMU – Disaster Management Unit of the DOH
DND – Department of National Defense
DOH – Department of Health
DOT – Department of Tourism
DSWD – Department of Social Welfare and Development

EHS – Environmental Health Service of the DOH


EO – Executive Order
EOC – Emergency Operations Center
EOD – Emergency Officer-on-Duty
ER – Emergency Room

FIMO – Field Implementation Management Office

GA – Government Agency

HAZMAT – Hazardous Materials


HCF – Health Care Facilities
HE – Health Emergency
HEARS – Health Emergency Alert Reporting System
HEICS – Hospital Emergency Incident Command System
HEMS – Health Emergency Management Staff of the DOH
HEPO – Health Education Promotions Officer
HEPR – Health Emergency Preparedness and Response
HEPRRP – Health Emergency Preparedness, Response and Recovery Plan
HRD – Human Resource Development
HRM – Human Resource Management

IASC – Inter-Agency Standing Committee


ICS – Incident Command System

JAS – Job Action Sheets

LCF – Local Calamity Fund


LDCC – Local Disaster Coordinating Council
LGE – Local Government Executive
12
x LGU –
LGUTMH –
Local Government Unit
Local Government Unit Teams for Mental Health
LHAD – Local Health Administration and Development

MCH – Maternal and Child Health


MCI – Mass Casualty Incident
MCM – Mass Casualty Management
MDM – Management of the Dead and Missing
MFI – Mass Fatality Incident
MHO – Municipal Health Officer
MIS – Management Information System
MMD – Materials and Management Division of DOH
MMDA – Metro Manila Development Authority
MOA – Memorandum of Agreement
MOU – Memorandum of Understanding

NBI – National Bureau of Investigation


NCDPC – National Center for Disease Prevention and Control
NDCC – National Disaster Coordinating Council
NEC – National Epidemiology Center of the DOH
NGO – Nongovernment Organization
NNC – National Nutrition Council
NPCC – National Poison Control Center
NPMC – National Program Management Committee
NSC – National Security Council
NTC – National Telecommunication Commission

OCD – Office of Civil Defense


OIC – Officer-in-Charge
OpCen – Operations Center

PAG-ASA – Philippine Atmospheric, Geophysical and Astronomical Services Administration


PAR – Philippine Area of Responsibility
PCG – Philippine Coast Guard
P/C/MSWDO – Provincial/City/Municipal Social Welfare and Development Officer
PD – Presidential Decree
PET – Pocket Emergency Tool
PGH – Philippine General Hospital
PHEMAP – Public Health Emergency Management in Asia and the Pacific
PHIVOLCS – Philippine Institute of Volcanology and Seismology
PHO – Provincial Health Officer
PIE – Post-Incident Evaluation
PMDT – Program Management and Development Teams
PNP – Philippine National Police
PNP-CL – Philippine National Police - Crime Laboratory
PNRC – Philippine National Red Cross
PNRI – Philippine Nuclear Research Institute
PO – People’s Organization
PPE – Personal Protective Equipment

RA – Republic Act
RDCC – Regional Disaster Coordinating Council
RESU – Regional Epidemiologic Surveillance Unit
RHEMS – Regional Health Emergency Management Staff
RMHT – Regional Mental Health Teams

SEARO – Southeast Asia Regional Office of WHO


SOP – Standard Operating Procedure
STOP DEATH – Strategic Tactical Option for the Prevention of Disaster, Epidemics, Accidents and Trauma
for Health

UN – United Nations
UNICEF – United National Children’s Fund
UP-PGH – University of the Philippines-Philippine General Hospital

WHO – World Health Organization


WMD – Weapons of Mass Destruction
WPRO – Western Pacific Regional Office of WHO
13
xi
GLOSSARY

All-hazard – An approach to emergency management based on the recognition that there are common
elements in the management of responses to virtually all emergencies, and that by standardizing a
management system to address the common elements, greater capacity is generated to address the
unique characteristics of different events

Burn-out syndrome – A state of exhaustion, irritability and fatigue which markedly decreases worker’s
effectiveness and capability

Capacity/readiness – An assessment of local capacity to respond to an emergency (a risk modifier)


Casualty – Victims both dead and injured, physically and/or psychologically
Certificate of missing person believed to be dead in time of disaster – A document to be issued by
the National Disaster Coordinating Council indicating that the person is believed dead as a result of a
disaster based on validation and recommendation by the concerned local government unit. This docu-
ment is issued in lieu of a Death Certificate and can be used solely for the processing of claims for
benefits.
Collective grave – Burial of two or more dead bodies/body parts in an orderly process, preserving the
individuality of every body and maintaining individual characteristics of each body
Command post – Form of site-level emergency operations center, assembled as needed by the first
agencies to respond to an event
Community – Consists of people, property, services, livelihoods and environment; a legally constituted
administrative local government unit of a country, e.g., municipality or district, that is small enough to
be able to identify its own leaders (to make participation meaningful) and large enough to control its
resources, e.g., village, district, etc
Coordination – Bringing together of organizations and elements to ensure effective counter-disaster
response. It is primarily concerned with the systematic acquisition and application of resources (orga-
nization, manpower and equipment) in accordance with the requirements imposed by the threat of
impact of disaster.
Complex emergency – A state where the normal social or economic order has collapsed to the extent
that the national authorities are no longer able to guarantee security or provide services to all or
part of the country
Cremation – The process that reduces human remains to bone fragments of fine sand or ashes through
combustion and dehydration
Crisis – A state brought about by adverse life experiences wherein the normal coping mechanism or
problem solving is not working
Critical incident – Any event causing unusually strong overwhelming emotional reactions which have the
potential to interfere with work during the event or thereafter in the majority of those exposed

Death certificate – Documented proof of the death of someone; a legal instrument which includes the
victim’s name, age, sex, the cause and manner of death, the time and date of death, as well as the
professional who confirms the death
Disaster – Any actual threat to public safety and/or public health where local government and the emer-
gency services are unable to meet the immediate needs of the community; an event in which the lo-
cal emergency management measures are insufficient to cope with a hazard, whether due to lack of
time, capacity or resources, resulting in unacceptable levels of damage or numbers of casualties;
an emergency in which the local administrative authorities cannot cope with the impact of the scale
of the hazard and therefore the event is managed from outside of the affected communities; any ma-
jor emergency where response is also constrained by damage or destruction to infrastructure (i.e., the
lack of resources plus loss of infrastructure overwhelms local capacity and event management from
outside the affected area is needed to direct and support local response efforts
Disaster recovery – The coordinated process of supporting disaster-affected communities in the recon-
struction of the physical infrastructure and restoration of emotional, social, economic and physical
well-being
Donation – Act of liberality whereby a foreign or local donor disposes gratuitously of cash, goods or
articles, including health and medical-related items, to address unforeseen, impending, occurring or
experienced emergency and disaster situations, in favor of the Government of the Philippines which
accepts them
Donor – All persons, countries or agencies that may contract and dispose of cash, goods or articles,
including health and medical-related items, to address unforeseen, impending, occurring or experi-
enced emergency and disaster situations

Embalming – Process of preparing, disinfecting and preserving a dead body before the final disposal
Emergency – Any situation in which there is imminent or actual disruption or damage to communities,
i.e., any actual threat to public health and safety
Emergency management – A management process that is applied to deal with the actual or implied
xii effects of hazards
Emergency operations center – A place activated for the duration of an emergency within which person-
nel responsible for planning, organizing, acquiring and allocating resources and providing direction
and control can focus these activities on responses to the emergency
Emergency preparedness – An integrated program of long-term, multisectoral development activities
whose goals are the strengthening of the overall capacity and capability of a country to be ready to
manage efficiently
Exhumation – Removal of dead body from its grave, usually done to carry out examination or to bury it in
another place

Field management – Encompasses the procedures used to organize the disaster area to facilitate the
management of victims
Formal acceptance – An instrument – Deed of Acceptance – issued by the Secretary of Health or his
designated representative that acknowledges the consummation of the donation and the transfer of
the ownership or interest over the donated item to the Department of Health

Hazard – Any potential threat to public safety and/or public health; any phenomenon which has the poten-
tial to cause disruption or damage to people, their property, their services or their environment, i.e.,
their communities. The four classes of hazards are natural, technological, biological and societal
hazards.
Hazard-prone community – A community exposed to a number of hazards
Health Emergency Management Health Sector – An organization of agencies each with a health unit
primarily devoted to and united to provide state-of-the-art, appropriate and acceptable technical assis-
tance and/or direct services on health emergency preparedness and response to any entity – inter-
national or national

Incident Medical Commander – The highest representative of the Department of Health or Local Health
Office as designated by the city/town local executive (depending on the extent of the disaster) who
shall serve as the liaison officer of the Health Sector to the Command Post headed by the Incident
Commander. For regional disasters, it should be headed by the highest representative from the DOH
CHD.

Major emergency – Any emergency where response is constrained by insufficient resources to meet
immediate needs
Management of the Dead and Missing Persons During Emergencies or Disasters (MDM) – Refers
to five domains, namely: Search and Recovery; Identification of the Dead; Final Arrangement of the
Dead; Handling of the Missing Persons; and Assistance to the Bereaved Families
Mass casualty incident – Any event resulting in a number of victims large enough to disrupt the normal
course of administrative, emergency and health care services
Mass casualty management – Management of victims of a mass casualty event to minimize loss of lives
and disabilities
Mass Casualty Management System – Groups of units, organizations and sectors that work jointly
through standard consensus procedures to minimize disabilities and loss of life in a mass casualty
event through the efficient use of all existing resources
Mass fatality incident – Any event resulting in a number of deaths large enough to disrupt the normal
course of health care services, usually a result of natural and/or human-generated disasters, includ-
ing terrorism or the use of weapons of mass destruction
Mass grave or common grave – Indiscriminate burial of more than two unidentified bodies/body parts in
the same excavated site
Medical controller – A designated senior Department of Health Officer appointed to assume the overall
direction of the medical response to mass casualty incidents and disasters. Control is established
from a designated Operations Center, either in the Central Operations Center or the Regional Opera-
tions Center, and whose main responsibility is to coordinate all the services of the sector
Mental health – A state of well-being in which the individual realizes his or her own abilities, can cope
with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution
to his or her community
Missing person – Any person residing, working, studying or sojourning in a community which is directly
affected by disaster and is nowhere to be found thereafter and has not been heard of since the
disaster
Missing resident of the disaster-affected community – Any person residing in the community, whose
name appears in the community censuses, presumed to be in the community during the disaster,
nowhere to be found thereafter and has not been heard of since the disaster
Missing person from outside the community – Any person living outside the affected community, who
presumably went to the community and was directly affected by a disaster, then nowhere to be found
thereafter and has not been heard of since the disaster. They can be classified as workers, passersby
and transient visitors.
Missing resident working/studying outside the disaster-affected community – Any person residing
in the affected community, who works or studies outside this community but presumed to have not
gone to work or school at the same time of the disaster, nowhere to be found thereafter and has not
been heard of since the disaster
Networking – An approach to broaden the resources available to a person to achieve his personal and
professional goals while supporting others to achieve theirs xiii
Preparedness – Measures taken to strengthen the capacity of the emergency services to respond in an
emergency. Emergency preparedness is done at all levels.

Rapid health assessment – The collection of subjective and objective information to measure damage
and identify those basic needs of the affected population that require immediate response
Recovery management – A process by which a disaster-affected community is restored to an appropri-
ate level of functioning. Recovery is a developmental, rather than a remedial process.
Risk – Anticipated consequences of a specific hazard affecting a specific community (at a specific time);
the level of loss of damage that can be predicted to result from a particular hazard affecting a particu-
lar place at a particular time; probable consequences to public safety of a community being exposed
to a hazard (i.e., death, injury, disease, disability, damage, destruction, displacement)
• Type of hazard determines the kind of risks, e.g., floods cause few deaths but earthquakes cause
many.
• Vulnerabilities and capacity to respond determine how much risk is in the community, i.e., how
many deaths are likely, where they will occur and the kind of people likely to be killed (e.g., old,
disabled).
Risk management – A comprehensive strategy for reducing risk to public safety by preventing exposure
to hazards (target group – hazards) , reducing vulnerabilities (target group – elements of community),
and enhancing preparedness, i.e., response capacities (target group – response agencies); a strat-
egy for identifying potential threats and managing both the source of threats and their consequences

Strategic – Deals with the concepts of relatively long term and big picture in relation to the pattern or plan
that integrates an organization’s major goals, policies and action sequences into a cohesive whole.
Concept is always relative – what a local level of government sees as strategic from their perspective
is likely perceived as tactical from the perspective of a more senior government.
Stress – A state where one’s coping mechanism is not enough to maintain balance or equilibrium
Surge capacity – The health care system’s ability to rapidly expand beyond normal services to meet
the increased demand for qualified personnel, medical care and public health in the event of large-
scale public emergencies or disasters (Agency for Healthcare Research and Quality, USA, 2005)

Tactical – Refers to those activities, resources and maneuvers that are directly applied to achieve goals.
Compare with “strategic” above.
Temporary burial – Shallow burial of two or more dead bodies/body parts in an orderly process, preserv-
ing the individuality of every body, and maintaining individual characteristics of each body pending
proper identification and disposition
Terrorism – The premeditated use or threatened use of violence or means of destruction perpetrated
against innocent civilians or non-combatants, or against civilian and government properties, usually
intended to influence an audience (Memorandum No. 121)
Triage – The process of sorting victims needing immediate transport to health facilities and those
whose care can be prioritized.

Vulnerabilities – Factors that increase the risks arising from a specific hazard in a specific community
(risk modifiers)

Weapons of mass destruction – Radiological, nuclear, biological or chemical elements in nature used
for large-scale damage to life and property, usually by those perpetrating terrorist activities

xiv
1
The Health Emergency Management Staff Part I
2
1 Vision and Mission

VISION
The Health Emergency Management Staff (HEMS) of the Department of Health
(DOH) was created with the vision of becoming Asia’s model in health emergency
management systems.

We are the leader in human resource development, technical assistance, and health
emergency care, with state-of-the-art equipment and logistics. Our health emergency
policies, plans, programs and systems are internationally acclaimed and benchmarked
to guarantee minimum loss of lives during health emergencies and disasters.

MISSION
The HEMS mission: To ensure a comprehensive and integrated health sector
emergency management system.

As the health emergency management arm of the DOH, the HEMS was institutionalized,
by virtue of Executive Order 102, to ensure a comprehensive and integrated Health
Sector Emergency Management System to prevent or minimize the loss of lives during
emergencies and disasters in collaboration with government, business and civil society
groups.

CORE VALUES
The HEMS adopts, above all, God-centered and God-inspired values of commit-
ment, respect for life and environment, and leadership and excellence.

3
2
Policy Base:
National Policy Framework on Health Emergencies
and Disasters

(Administrative Order No. 168 s. 2004; Joint Administrative Order No. 2007-001b)

The DOH’s role in health emergency management is to lead in Health Sector prepared-
ness and response. For its vision, the national policy framework for management of
emergencies and disasters has the Department of Health as Asia’s prime mover in
health emergency and disaster preparedness and response. Its three-fold mission con-
sists of:
1. Leading in the formulation of a comprehensive, integrated and coordinated health
sector response to emergencies and disasters;
2. Ensuring the development of competent, dynamic, committed and compassionate
health professionals equipped with the most modern and state-of-the-art facilities
at par with global standards; and
3. Being the center of all health and health-related information on emergencies and
disasters.

Ultimately, an efficient and effective management of emergencies and disasters will de-
crease mortality and morbidity, promote physical and mental health, and prevent injury
and disability of both victims and responders.

Risk management, a comprehensive strategy for reducing risks to public safety by pre-
venting hazards, reducing vulnerabilities and enhancing preparedness (i.e., response
capacities), is central to the management process applied to deal with actual or implied
effects of hazards. It permeates the identified strategies of capacity building, enhance-
ment of facilities, service delivery, health information and advocacy, health policy, net-
working and social mobilization, research and development, resource mobilization, infor-
mation management system and surveillance, standards and regulation, and monitoring
and evaluation.

Programmatically, the components of Health Emergency Preparedness and Response


are the following:
• Holistic Health Emergency Preparedness and Response to cover all phases of the
emergency/disaster: (1) pre-emergency/disaster phase for emergency preparedness
mitigation and prevention; (2) emergency/disaster phase for response; and (3) post-
emergency/disaster phase for recovery and reconstruction.
• A focus on the Community Risk Reduction Strategy to include decreasing the haz-
ard, decreasing vulnerability, and increasing preparedness.
• Comprehensive coverage for an all-hazard approach, addressing all types of disas-
ters (natural, man-made and technological) and all types of emergencies with a
potential to be a disaster through Mass Casualty Management, Public Health,
Mental Health, and recently with the Management of the Dead and the Missing.
• Mental Health in Disaster as a major component institutionalized in all phases of
disaster and provided to victims, relatives of victims, as well as responders.
• Health Emergency Management integrated in health programs of the community,
local government and the state.

Organizationally, all health facilities are to have a health emergency management office/
unit/ program, under the supervision of the highest officer, such as the Regional Direc-
4 tor/Chief of Hospital or its equivalent officer, to ensure faster decision-making in times of
emergencies and disasters.
Action Base: 3
Roles in Managing Health Risks of Emergencies

The roles of the health sector may be viewed by phases as articulated by the 6th Pub-
lic Health and Health Emergency Management Course in Asia and the Pacific in 2006.
Table 1 presents these roles at each phase of health emergency management.

Table 1. Timeline of Health Sector Roles by Health Emergency Management Phases*

TIME 0--------------- --- EVENT -------- ------------ N

PHASES Pre-emergency/Disaster Emergency/Disaster Post-emergency/


Disaster

Emergency Response Recovery and


ROLES Preparedness, Reconstruction
Mitigation and
Prevention

Assess risks Respond to Institute measures


■ Anticipate the emergencies for recovery and
problems. rehabilitation

Reduce risks ■ Provide ■ Assess health


■ Communicate leadership in the needs over the
the risks; change health sector. long term.
behavior. ■ Assess ■ Provide health
■ Reduce the health services over the
vulnerability, consequences long term.
and strengthen and impact on ■ Restore health
resilience health services. services,
(community, ■ Determine the facilities and
staff, needs. health systems.
infrastructure ■ Protect staff and
and health care facilities.
facilities).

Prepare for ■ Provide health ■ Develop human


emergencies services . resources.
■ Plan, train, ■ Communicate ■ Plan
exercise, the risks. reconstruction to
evaluate. ■ Mobilize reduce risks.
■ Build capacities. resources.
■ Install early ■ Manage
warning logistics.
systems. ■ Manage health
■ Communicate information.
the risks. ■ Manage human
resources.

*Adapted from the Sixth Inter-regional Training Course in Public Health and Emergency Management in Asia and the Pacific (PHE- 5
MAP), 2006. Module 1: Health Emergency Management. Challenges and Roles. WHO (WPRO, SEARO) and ADPC.
Table 2 shows the timeline of actions that need to be taken during emergencies and
disasters – before, during and after the event. The lower part of the table magnifies the
timeline of actions during the response and recovery phases. It lists the general and
health needs that need to be addressed at different stages of the timeline.

Table 2. Timeline of the Three Phases of Health Emergency Management*

TIME 0 ------------------- ----- Event ----------- ------------- N


PHASES Pre-emergency/Disaster Emergency/Disaster Post- emergency/
Disaster
Emergency Preparedness, Response Recovery and
Mitigation and Prevention Reconstruction

TIME EVENT
FRAME First 24 Hours End of First Week End of First Month End of 3 Months Conclusion

STAGE Immediate Short Term Medium Term Long Term

GENERAL ● Search and Emergency ● Security ● Protection (legal ● Education ● Compensation/


NEEDS rescue communication, ● Energy (fuel, and physical) ● Agriculture reconstruction
● Search and heating, light, etc) ● Employment ● Environmental ● Restitution/
recovery (dead) Logistics and ● Environmental ● Public transport protection rehabilitation
● Evacuation/shelter reporting health services for ● Public Communica - ● Prevention
● Food systems - vector control tions and prepared-
● Water (including injury - personal hygiene ● Psychosocial ness
● Public informa- and disability - sanitation, waste services
tion system registers) disposal, etc
HEALTH ● First aid Emergency epidemio- Establishment/ Reconstruction Evaluation of
NEEDS ● Triage logical surveil-lance for re-establishment of and rehabilitation lessons learned
● Primary medical vector-born diseases, health information
care vaccine-preventable system
● Transport/ diseases, diseases of
ambulances epidemic potential
● Acute medical
and surgical care
Control of diseases of Restoration of Specific training Revision of
public health signifi- preventive health programs policies, guide-
cance care services such lines, procedures
as EPI, MCH, etc
Control of acute Restoration of Health informa- Upgrade of
intestinal and respira- services for non- tion campaigns/ knowledge and
tory diseases communicable health education skills, attitude
diseases/obstetrics programs change
Care of the dead Care of the disabled Disability and
psychosocial care

General curative
services

Nutritional surveillance
and support (including
micronutrient supple-
mentation)

Measles vaccination
Vitamin A
*Adapted from the Sixth Inter-regional Training Course in Public Health and Emergency Management in Asia and the Pacific (PHE-
MAP), 2006. Module 1: Health Emergency Management. Challenges and Roles. WHO (WPRO, SEARO) and ADPC.
6
4 Legal Mandates

The Philippine Disaster Management System came into existence through various legis-
lations. Existing laws, like Presidential Decree (P.D.)1566 of 1978 (Strengthening of the
Philippine Disaster Control Capability and Establishing the National Program on Com-
munity Preparedness) and Republic Act (R.A.) 7160 or the Local Government Code of
1991, both support the goals and objectives of the disaster management program at the
local level. These legislations are specifically geared towards organizing disaster coordi-
nating councils at all levels, planning for all types of emergencies, and the delineation of
tasks and responsibilities of national and local government agencies involved in disaster
management.

Towards the end of instituting effective and efficient disaster management programs, the
Department of Health identifies and enjoins all the major stakeholders of the health sec-
tor to develop their inter-operability for a more effective and efficient response to emer-
gencies and disasters. Out of the many laws enacted, only those related to emergency
management are cited in this manual (OCD, Region VIII, 2004; Stop Death Program,
DOH, 2000a; HEMS 2007a). And only the parts or sections of these laws that are rel-
evant to health emergency/disaster management are highlighted here.

MILESTONES OF PHILIPPINE HEALTH EMERGENCY MANAGEMENT

Through the years, health has been an important fixture in disaster-related laws. This
means that in every disaster or emergency, protecting the life and health of the popula-
tion is the core of the Disaster Management System in the country. The DOH, thus, has
always played a key role in all disaster management efforts. Milestone legislations in
Philippine health emergency management include:

1. Two Executive Orders (E.O.) issued by the late President Manuel L. Quezon
during the Commonwealth era, namely, Executive Order Nos. 335 and 337.

a. Executive Order No. 335 – Created the Civilian Emergency Administration


(CEA) which was tasked primarily through the National Emergency Commis-
sion (NEC) to formulate and execute policies and plans for the protection and
welfare of the civilian population under extraordinary and emergency conditions.
The overall manager of the NEC was the Philippine National Red Cross. Local
emergency committees (LEC) from the provincial, city and municipal levels were
likewise organized and headed by the local chief executive. The sanitary officer
was an official member of the LEC.

b. Executive Order No. 337 – Empowered the volunteer guards to assist in the
maintenance of peace and order in the locality, safeguard public utilities, and
provide assistance and aid to people during natural or man-made disasters.

2. Executive Order No. 36 issued by the late President Jose P. Laurel during the
Japanese occupation – Created the Civilian Protection Service (CPS) tasked to for-
mulate and execute plans and policies for the protection of civilians during air raids
7
and other national emergencies. The CPS was handled by the Civilian Protection
Administration (CPA) composed of three members, namely, the Civilian Protection
Administrator, Chief of the Air Warden and the Chief of the Medical and First Aid
Service. E.O. 36 likewise required the establishment of a provincial, city and munici-
pal protection committee with the provincial governor, city and municipal mayor as
respective chairmen. Members of the local protection committees included the high-
est local officials – treasury, justice, engineering, schools, health and the police.

3. Republic Act 1190 or the Civil Defense Act of 1954 – Disaster Preparedness Ini-
tiatives which created the National Civil Defense Administration (NCDA), whose
principal task was to provide protection and welfare to the civilian population during
war or other national emergencies of equally grave character. Under this law, civil
defense councils from national, provincial, city and municipal civil defense councils
were established. Its operating services at all levels (provincial, city and municipal)
were as follows: Warden Service, Police Service, Fire Service, Health Service, Res-
cue and Engineering Service, Emergency Welfare Service, Transportation Service,
Communication Service, Air Raid Warning Service, and Auxiliary Service.

4. Administrative Order No. 151 (December 2, 1968) – Created a National Com-


mittee on Disaster Operation in view of the collapse of the Ruby Tower building in
Manila caused by a powerful earthquake. The committee was composed of the
Executive Secretary as chairman, and as members: the department secretaries
of Social Welfare, National Defense, Health, Public Works and Natural Resources,
Commerce and Industry, Education, Community Development, and Commission on
Budget; the secretary-general of the Philippine National Red Cross; and a designa-
ted national coordinator. Under this order, the national committee ensured effec-
tive coordination of operations of the different agencies during disasters caused by
typhoons, floods, fires, earthquakes and other calamities.

5. Formulation of the Disaster and Calamities Plan (1970) – Prepared on Octo-


ber 19, 1970, after Typhoon Seniang, by an Inter-Departmental Planning Group on
Disasters and Calamities as approved by then President Ferdinand E. Marcos. The
plan created the National Disaster Control Center that was composed of the follow-
ing: chairman – Secretary of National Defense, overall coordinator – Executive
Secretary, and members – Secretary of Health, Secretary of Public Works and Com-
munications, Secretary of Agriculture and Natural Resources, Secretary of Com-
merce and Industry, and Secretary of Community Development.

6. Presidential Decree 1566 of 1978: Strengthening of the Philippine Disaster Control


Capability and Establishing the National Program on Community Preparedness

7. Republic Act 7160 or the Local Government Code of 1991 – Contains provisions
supportive of the goals and objectives of the disaster preparedness, prevention and
mitigation programs. These provisions reinforce the pursuit of a Disaster Manage-
ment Program at the local government level.

8. Department of Health policies on institutionalization of the Health Emergency


Preparedness and Response Program at the local level.

8
RELEVANT LAWS

Presidential Decree No. 1566 of 1978: Strengthening Philippine Disaster Control


Capability and Establishing National Program on Community Disaster Prepared-
ness

Promulgated on June 11, 1978, P.D. 1566 is the basic law in the implementation of the
Disaster Management Program in the Philippines. It contains the following provisions:

■ Section 2 – Creation of National Disaster Coordinating Council (NDCC).

The Department of Health is a member of the National Disaster Coordinating Coun-


cil (NDCC) and the head of the Medical Service; it assumes command over the
health sector.

■ Creation of the multilevel organizations in charge of disaster management.

This multilevel organization starts from the National Disaster Coordinating Council,
the Regional Disaster Coordinating Council, the Provincial Disaster Coordinating
Council down to the Municipal Disaster Coordinating Council.

■ Funding for a 2% reserve for calamities.

PD 1566 authorizes the local government to program funds for use in disaster pre-
paredness, such as the organization of Disaster Coordinating Councils, the estab-
lishment of physical facilities, and the equipping and training of disaster action
teams.

These are the salient provisions of P.D. 1566:

■ State policy on self-reliance among local officials and their constituents in respond-
ing to disasters and emergencies.

■ Organization of disaster coordinating councils from the national down to the munici-
pal level.

■ Statement of duties and responsibilities of the NDCC, RDCC and local DCCs.

■ Preparation of the National Calamities and Preparedness Plan by the Office of Civil
Defense and implementation of plans by NDCC and member agencies.

■ Conduct of periodic drills and exercises.

■ Authority of government units to program their funds for disaster preparedness ac-
tivities, in addition to the 2% calamity fund as provided for in P.D. 474 (amended
by R.A. 8185).

9
Calamities and Disaster Preparedness Plan, 1988

The Department of Health is a member of the NDCC, which is the lead agency in coor-
dinating, integrating, supervising and implementing disaster-related functions. It is repre-
sented by the Secretary of Health. As stated in the national plan, the DOH performs the
following functions:

■ Organizes disaster control groups and reaction teams in all hospitals, clinics, sani -
taria and other health institutions;
■ Provides for the provincial, city/municipal and rural health services to support all
disaster coordinating councils during emergencies;
■ Undertakes necessary measures to prevent the occurrence of communicable
diseases and other health hazards which may affect the populations;
■ Issues appropriate warning to the public on the occurrence of epidemics or other
health hazards;
■ Provides direct service and/or technical assistance on sanitation as may be neces-
sary; and
■ Organizes reaction teams in the department proper as well as in the offices and
bureaus under it.

The Department of Health organizes Health Service Units in all regions, provinces,
cities, municipalities and barangays.

a. Constitution of Health Service Units


Chairman: Department of Health
Members (suggested as but not limited to):
■ Representatives of the Philippine National Red Cross
■ Medical and allied professionals
■ Chief of public/private hospitals/clinics/institutions
■ AFP medical reserve personnel on inactive status in the community

b. Purpose of Health Service Units


■ To protect life through health and medical care of the populace.
■ To preserve life through proper medical aid and provision of medical facilities.
■ To minimize casualties through proper information and mobilization of all
medical resources.

c. Sub-units of the Health Service Unit


i. Medical and First-Aid Unit
ii. Field Emergency Hospital
iii. Sanitation Service Unit
iv. Health Supply Unit
v. Transportation and Ambulance Unit
vi. Mortuary Unit
vii. Records Unit

d. Responsibilities
■ The DOH Secretary is responsible for organizing, training and supplying all
Health Service elements in the Philippines.
■ The DOH Regional Director is responsible for providing support to the Health
10 Services in the provincial, municipal and city levels.
■ The DOH officials at the provincial, city and municipal levels are responsible for
organizing their respective units.
■ The local government heads are responsible for the operation and support of
Health Services.
■ The Philippine National Red Cross (PNRC) and the Department of Social Wel-
fare and Development (DSWD), within their respective capabilities, are respon-
sible for providing support to the Health Service.

e. Functions of the Health Service Sub-units

i. Medical and First Aid Unit


■ Sorts cases at the scene of the disaster;
■ Administers first aid;
■ Attends to the cases referred to emergency aid and stations;
■ Evacuates patients to emergency hospitals; and
■ Detects and controls communicable diseases in coordination with other
agencies specifically assigned for the purpose.

ii. Field Emergency Unit


■ Pre-determines sites of facilities that may be used as field hospitals;
■ Administers appropriate treatment to less serious patients and attends to all
dispensary cases; and
■ Attends to all medical cases, which should be referred to appropriate medi cal
institutions.

iii. Sanitation Service Units


■ Supervises the sanitary conditions of the community during and after emer-
gency;
■ Enforces sanitary regulations relative to housing facilities and shelter; and
■ Promulgates and implements control measures in contaminated areas and
in evacuation centers.

iv. Health Supply Unit


■ Procures, stores and issues medical supplies and equipment during emer-
gencies; and
■ Keeps an accounting of the medical and first aid instruments and supplies.

v. Mortuary Unit
■ Assists in identifying and tagging the dead;
■ Certifies to the cause of death; and
■ Supervises the proper disposal of the dead.

vi. Records Unit


■ Keeps records of the dead, injured, and sick; and
■ Issues certificates pertaining to persons who were ill, injured and recovered,
or died, pursuant to existing, laws, rules and regulations.

Republic Act No. 7160: The Local Government Code of 1991

The Local Government Code of 1991 provides for the transfer of responsibilities from 11
the national to the local government units (LGUs) thereby giving more powers, authority,
responsibilities and resources to the LGUs. Below are its provisions pertinent to emer-
gency and disaster management.

■ Section 16 – General Welfare

Every local government unit shall exercise the powers granted, those necessarily
implied therefrom, as well as powers necessary, appropriate or incidental for its
efficient and effective governance, and which are essential to the promotion of the
general welfare. Within their respective territorial jurisdiction, local government
units shall ensure and support, among other things, the preservation and enrichment
of culture, promote health and safety, enhance the right of the people to a balanced
ecology, encourage and support the development of appropriate and self-reliant,
scientific and technological capabilities, improve public morals, enhance economic
prosperity, social justice, promote full employment among their residents, maintain
peace and order, and preserve the comfort and convenience of their inhabitants.

■ Allocation of five percent (5%) calamity fund for emergency operations such as re -
lief, rehabilitation, reconstruction and other works of services in connection with the
occurrence of calamities.

■ Section 17 – Basic Services and Facilities Devolved to the Local Government Units

Basic services and facilities shall be devolved from the national government to prov-
inces, cities, municipalities, and barangays so that each local government unit shall
be responsible for a minimum set of services and facilities in accordance with estab-
lished national policies, guidelines and standards.

Among the devolved functions and facilities are: health services which include
hospitals and other tertiary health services; social welfare services which include
programs and projects on rebel returnees and evacuees, relief operations, and
population development services; and infrastructure facilities intended to service
the needs of the residents of the province and which are funded out of pro-
vincial funds, including but not limited to provincial roads and bridges, inter-
municipal waterworks, drainage and sewerage, flood control and irrigation systems,
reclamation projects, and similar facilities.

■ Immediate and direct response to emergencies/disasters is the primary responsibil-


ity of the local government units. However, in cases where disasters have reached
proportions which are beyond the capacity of the local government unit, the national
government takes control (Under Section 105).

■ Section 105 – Direct National Supervision and Control by the DOH

In cases of epidemics, pestilence, and other widespread public health dangers, the
Secretary of Health may, upon the direction of the President and in consultation with
the local government unit concerned, temporarily assume direct supervision
and control over health operations in any local government unit for the duration
of the emergency, but in no case exceeding a cumulative period of six (6) months.

■ Chapter 11 of the Department of Health Rules and Regulations Implementing the


12 Local Government Code of 1991 provides the legal basis for the DOH to establish
and maintain an effective health emergency preparedness and response program.

■ Section 389 and 391 – Powers, Duties and Functions of the Punong Barangay and
Sangguniang Barangay.

■ Section 444 and 447 – Powers, Duties and Functions of the Municipal Mayor and
Sangguniang Bayan.

■ Section 455 and 458 – Powers, Duties and Functions of the City Mayor and Sanggu-
niang Panlunsod.

■ Section 465 and 468 – Powers, Duties and Functions of the Provincial Governor and
Sangguniang Panlalawigan.

Generally, under the above provisions of RA 7160, the local chief executives and
Sanggunian are expected to carry out the following disaster management func-
tions and responsibilities:

Local Chief Executives:

1. Implement the emergency measures during and in the aftermath of a disaster or


emergency.
2. Submit supplemental reports to higher authority or the Office of the President
regarding extent of damages incurred due to the disasters or calamities affecting
the inhabitants.
3. Call upon law enforcement agencies to suppress civil defense/disturbance/
uprising.
4. Promote the general welfare and ensure delivery of basic services.

Sanggunian:

1. Adopt measures to protect the inhabitants from the harmful effects of natural or
man-made disasters.
2. Provide relief and rehabilitation services/assistance to victims.
3. Adopt comprehensive land use plan.
4. Enact/review zoning ordinances.

■ Section 324(d) as amended by R.A. 8185 s.1997 – States that 5% of the estimated
revenue from regular sources shall be set aside as annual lump sum appropriations
for relief, rehabilitation, reconstruction and other works and services in connection
with calamities occurring during the budget year. Provided however, that such
fund shall be used only in the area, or a portion thereof, of the local government
unit, or other areas affected by a disaster or calamity, as determined and declared
by the local Sanggunian concerned.

Requisites for the use of the 5% Local Calamity Fund (LCF):

1. Appropriation in the local government budget as annual lump sum appropriations


for disaster relief, rehabilitation and reconstruction;
2. To be used for calamities occurring during the budget year in the LGU or other
LGUs affected by a disaster or calamity. 13
3. Passage of a Sanggunian resolution regarding declaration of calamity or disaster.
4. In case of fire, the LCF can be used only for relief operations.

It will be noted that the 5% LCF cannot be used for disaster preparedness activities of
the local government units unlike the National Calamity Fund (NCF). One of the rea-
sons given by the authors of RA 8185 was that local government units should already
program their preparedness activities in their respective budgets for the ensuing year.

Procedures for the allocation, release, accounting and reporting of Local Calamity Fund:

1. In case of calamity and upon recommendation of the local chief executive based on
the reports of the local disaster coordinating council (LDCC), the local Sanggu -
nian shall immediately convene within 24 hours from the occurrence of the calamity
and pass a resolution declaring a state of calamity in the area(s) of the LGU
affected by the calamity, and adopt measures to protect lives and properties in the
area and implement disaster mitigation.

The Sangguniang Panlalawigan need not review the Sanggunian Bayan Resolution
embodying the declaration. However, when the whole province is being affected by
a calamity, the Sangguniang Panlalawigan, upon the recommendation of the Provin-
cial Governor, shall declare the whole province under a state of calamity. In such
cases, the Sangguniang Bayan of the respective municipalities need not declare
their areas as calamity areas.

2. The local budget officer shall release the allotment of 50% of the Calamity Fund
within 24 hours from the occurrence of the calamity, provided the following are
present:
Approved disbursement voucher
Sanggunian resolution containing the calamity area declaration
Local Disaster Coordinating Council report on damages

3. Pending the passage of the Sanggunian resolution on the declaration of the calamity
area, the local chief executive may already draw cash advances from the General
Fund which should not exceed 50% of the total Local Calamity Fund, subject to
replacement after receipt of the above Sanggunian resolution.

4. The local treasurer shall submit a utilization report, duly approved by the local chief
executive, to the Sanggunian concerned, Commission on Audit, and the Local
Development Council, with copy furnished to the Local Disaster Coordinating
Council.

5. Unused or unexpended balance of the LCF at the end of the current year shall be
reverted to the unappropriated surplus for reappropriation during the succeed-
ing year, except unused funds for capital outlay which shall be valid until fully spent
or reverted.

Republic Act 8185 of 1997: Emergency Powers of the Local


Government Units

Criteria for Calamity Area Declaration

14 At least two or more of the following conditions are present in the affected areas and
lasting for at least four (4) days:
■ Twenty percent (20%) of the population are affected and in need of assistance,
or 20% of the dwelling units have been destroyed.
■ A great number or at least 40% of the means of livelihood are destroyed (e.g.,
bancas, fishing boats, vehicles).
■ Major roads and bridges are destroyed and impassable thus disrupting the flow
of transport and commerce.
■ There is widespread destruction of fishponds, crops, poultry and livestock and
other agricultural products
■ There is disruption of lifelines such as electricity, potable water system, transport
system, communications and other related systems, except for highly urbanized
areas where restoration of the above lifelines cannot be made within 24 hours.
■ In case of epidemics or outbreak of disease, an area may be declared under a
state of calamity based on the following:
1. There is an occurrence of an unusual (more than the previously expected)
number of cases of a disaster in a given area or among a specific group of
people over a particular period of time. To determine whether the number
is more than the expected, the number should be compared with the number
of cases during the past weeks or months or a comparable period during the
last few years (at least 5 years).
2. There is a “clustering” of cases in a given area over a particular time.

Duration of Calamity Area Declaration

■ One year from the effectivity of the declaration.


■ Exception: When the effects of the disaster is recurring or protracted, in which
case, the declaration shall be a continuing one.
■ Once 85% of the repair and rehabilitation works have been done and services
have been restored, the declaration of a state of calamity may be terminated
or lifted by the President of the Philippines or the local Sanggunian.

Memorandum No. 13 s. 1998 – Amended Policies and Procedures on the


Provision of Financial Assistance to Victims of Disasters

Coverage – Disaster victims who died or got injured during the occurrence of a natural
disaster.

Exception – Victims of man-made disasters such as fires, vehicular accidents, grenade/


bombing incidents, armed conflicts, and air/sea mishaps, unless directed or ap-
proved by the President of the Philippines upon the recommendation of the National
Disaster Coordinating Council (NDCC).

Amount of Financial Assistance:


Php10,000.00 – for dead victims
Php 5,000.00 – for injured victims

Validity of Claim – Within one (1) year from the occurrence of the disaster.

Procedure:

1. All claims for financial assistance shall be filed and processed at the Regional
Disaster Coordinating Council (RDCCs).
2. Claims shall be accompanied with the following documents:
For dead victims:
• Local Disaster Coordinating Council report or police report
• Original death certificate 15
• Certification from the barangay captain
• Proof of filial relationship with the victim
• Endorsement for the payment of claims from the LDDC and RDCC chairmen
For injured persons:
• Medical certificate from the hospital or clinic where victim was confined for
at least three (3) days
• DCC/Police report
• Endorsement for the payment of claims from the LDCC and RDCC
chairmen

PRESIDENTIAL ISSUANCES
Executive Order 948 S. 1994 – Grant of compensatory benefits to disaster volunteer
workers (still for enforcement).

Proclamation No.296s. 1988 as amended by E.O. 137 s. 1999 – Declaring the first
week of July of every year as Natural Disaster Consciousness Week, now, the whole
month of July as National Disaster Consciousness Month.

PMO No. 36 s. 1995 as amended by PMO No. 42 s. 1997 – Establishment of a special


facility for the importation and donation of relief goods and equipment in calamity-strick-
en areas.

Proclamation No. 705 – Declaring December 6, 1995, and December 6 of every year
thereafter, as National Health Emergency Preparedness Day.

RELEVANT EXECUTIVE/ADMINISTRATIVE ORDERS


DOH Administrative Order No. 6-B of 1999: “Institutionalization of a Health Emer-
gency Preparedness and Response Program Within the Department of Health”

■ Institutionalized the Health Emergency Preparedness and Response Program of


DOH.
■ Created the “STOP DEATH” Program as a comprehensive, integrated and re-
sponsive emergency/disaster-related, service and research-oriented program.
■ Aimed to promote health emergency preparedness among the general public
and strengthen health sector’s capability to respond to emergency/disaster.
■ The program likewise gives advice and policy directions regarding health emer-
gencies.

Executive Order No. 102: “Institutionalization of the Health Emergency Manage-


ment Staff (HEMS)”

In view of the re-engineering of the DOH, the Disaster Management Unit (DMU) and
STOP DEATH Program were merged.

The HEMS organizational structure places it directly under the Office of the Secretary.
It has two divisions: the Preparedness Division and the Response Division. Below are
their respective functions:

Functions of the Preparedness Division


■ Develop plans, policies, programs, standards and guidelines for the preven-
16 tion and mitigation of health emergencies.
■ Provide leadership in organizing and coordinating the health sector efforts for
health emergency preparedness.
■ Provide technical assistance, consultative and advisory services to imple-
menting agencies.
■ Facilitate capability building of implementing agencies.
■ Initiate advocacy activities.
■ Maintain/update the information center for emergencies and disasters.
■ Conduct/coordinate studies and researches related to health emergencies.
■ Conduct/facilitate monitoring and evaluation activities.

Functions of the Response Division


■ Maintain a 24-hour Operation Center to monitor health and health events na-
tionwide.
■ Collect emergency and disaster reports nationwide, for the use of the Health
Secretary, NDCC and other agencies and the public.
■ Lead in mobilizing health teams in anticipation of or in response to health
emergencies.
■ Coordinate and integrate health sector response to emergencies and
disasters.
■ Develop networks with government agencies (GAs), nongovernment organi-
zations (NGOs), people’s organizations (POs), and health sector responders.
■ Develop plans, policies, programs, standards, guidelines and protocols for
emergency response.
■ Conduct/coordinate studies and researches related to emergency response.
■ Conduct/coordinate monitoring and evaluation activities.

Administrative Order No. 182 s. 2001: “Adoption and Implementation of Code


Alert System for DOH Hospitals During Emergencies and Disasters”

■ Mandates that all hospitals must get ready to respond whenever disasters are
forseen and/or declared.
■ Introduces organizational shift and code alert system as mechanisms in the hos-
pital set-up for the provision of medical services during emergencies or disasters.
■ Provides general guidelines on disaster codes: Code White, Blue and Red.
■ Defines the organization of the hospital to respond, including hospital manpower
complementation, pre-positioning and mobilization of resources.
■ Advocates the activation of the Hospital Emergency Incident Command System
(HEICS).

Administrative Order No. 168 s. 2004: “National Policy on Health Emergency and
Disasters”

■ Defines the rules of engagement, procedures, coordination and sharing of re-


sources and responsibilities, to include the varying levels of state of prepared
ness and the desired response to emergencies and disasters in the health sector.
■ Applies to all DOH offices, hospitals, and its attached agencies, as well as to
all disciplines and institutions, whether government, nongovernment or private
entities whose functions and activities contribute to health emergency prepared
ness and response.
■ Embodies the framework of Health Emergency Management (HEM), HEM strat-
egies, organizational structure, human resource development, support systems,
and roles and responsibilities of HEMS, DOH offices and attached agencies, and
the health sector.
■ Defines program components as focused on community Risk Reduction for all
phases and all types of disaster. It should cover mass casualty management, 17
mental health and all types of emergencies with a potential to be a disaster,
Table 3. Strategies Used in Health Emergency Management

Strategies Activities
1. Capacity Building (HRD) ● Training on health emergency preparedness at all levels of the
and Facilities health sector from the community to the tertiary hospital level
Enhancement ● Enhancing facilities to improve the capacities of involved
institutions
2. Service Delivery ● Direct services (preventive, curative and rehabilitative services)
● Timely, holistic and appropriate responses in emergency situa-
tions
● Response services provided by competent, compassionate
and dedicated personnel
3. Health Information and ● Activities informing the public on prevention and preparedness
Advocacy for emergencies and disasters
● Basic First Aid in managing emergencies at home, schools,
work place, public places, etc.
● Activities empowering the community through health edu cation
and promotion
● Activities increasing awareness to gain support
4. Policy Development ● Development of plans, (EPRP, WFP/OPlan)
● Development of policies, procedures, guidelines, protocols
● Development of health emergency management systems
5. Networking and Social ● Building up network
Mobilization ● Networking meetings and other activities
● Multi-sectoral activities (drills, benchmarking, etc.)
● Establishment of MOAs and MOUs
● Other collaborating activities
6. Research and ● Conduct of research studies
Development ● Case reports or other paper presentations
7. Resource Mobilization ● Activities pertaining to resource generation and distribution
(logistics, human resources, finances)
● Mobilization of response teams
● Mobilization of ambulance teams
8. Information Management ● Information generation, storage, and dissemination
and Surveillance

9. Standards and Regulation ● Standards setting, accreditation criteria setting


● Activities empowering regulations
10. Monitoring and Evaluation ● Documentation of events and lessons learned
● Post-mortem evaluation
● Activities for sharing of good practices (e.g.,conventions)
● Drills or simulation exercises

Administrative Order No. 155 s. 2004: “Implementing Guidelines for Managing


Mass Casualty Incidents During Emergencies and Disasters”

■ Includes pre-established procedures for resource mobilization, field management


and hospital reception in Mass Casualty Management (MCM).
■ Incorporates links between field and health care facilities through a command
post.
■ Acknowledges the need for multi-sectoral response for triage, field stabilization
and evacuation to appropriate health care facilities.
■ Covers mass casualty incidents related to weapons of mass destruction (WMD).
■ Exemplifies the components of MCM, which are: Policy and Planning; Capability
18 Building; Operation Center/Surveillance System; Facilities Development; Docu-
mentation and Research.
■ Includes roles and responsibilities of various DOH Offices/Bureaus/Units in mass
casualty management.
■ Provides guidelines on emergency response and dispatch.

Administrative Order No. 2007-001B: National Policy on the Management of the


Dead and Missing Persons During Emergencies and Disasters

■ Acknowledges the critical role of government in standardizing and guiding the


tasks of handling the dead bodies, ensuring that legal norms are followed and
guaranteeing that the dignity of the deceased and their families is respected in
accordance with their cultural values and religious beliefs.
■ Articulates the Guiding Principles in handling of the dead.
■ Highlights a multi-sectoral approach for a comprehensive, integrated and coordi-
nated response to Management of the Dead and Missing Persons
(MDM) with the establishment of a coordinated body under the National Disaster
Coordinating Council and led by the Department of Health.
■ Identifies the local health officer of the concerned local government unit as the
leader/ coordinator of MDM.
■ Defines the guidelines and procedures of the five domains of Management of the
Dead and Missing Persons During Emergencies or Disasters, namely: Search
and Recovery; Identification of the Dead; Final Arrangement of the Dead;
Handling the Missing Persons; and Assistance to the Bereaved Families.
■ Includes the Management of Mass Fatality Incidents/MDM in the Emergency
Preparedness, Response and Recovery Plan and as a component of the Emer-
gency/ Disaster Management Program.
■ Applies to all Department of Health offices including its attached agencies, part-
ner agencies, and stakeholders in the MDM.

Administrative Order No. 2007-0009: Operational Framework for the Sustainable


Establishment of a Mental Health Program

■ Highlights goals of the National Mental Health Program with guidelines in service
delivery, financing, regulation and governance.
■ Sets objectives and strategies for the four priority sub-programs, namely: Well
ness of Daily Living, Extreme Life Experience (such as disaster, epidemic,
trauma) which threatens personal equilibrium, Substance Abuse and other forms
of addiction, and Mental Disorder.
■ Adopts nine key approaches and strategies, namely: Health Promotion and Advo-
cacy, Service Provision, Policy and Legislation, Development of Research Cul-
ture and Capacity, Capacity Building, Public-Private Partnership, Establishment of
Data Base and Information System, Development of Model Programs, and
Monitoring and Evaluation.
■ Outlines the composition and functions of the implementing mechanisms – Na-
tional Program Management Committee (NMPC), the Program Development and
Management Teams (PDMT), the Regional Mental Health Teams (RMHT) and the
Local Government Unit Teams for Mental Health (LGUTMH).

Administrative Order No. 2007-0017: Guidelines on the Acceptance and Process-


ing of Foreign and Local Donations During Emergency and Disaster Situations

■ Highlights the critical role of the Secretary of Health in the formal acceptance of
donations.
■ Specifies the items for donations, particularly drugs, to be in accordance with the
Philippine National Drug Formulary, the use of cash donations, and retention of
reference samples. 19
■ Sets criteria for acceptance of items, e.g., food stuffs, and packaging of drugs.
Excludes infant formula items.
■ Reserves the right to distribution with the Department of Health, disallowing its
use for election purposes.

Memorandum Circular, National Disaster Coordinating Council, May 10, 2007:


“Institutionalization of the Cluster Approach in the Philippine Disaster Manage-
ment System, Designation of Cluster Leads and Their Terms of Reference at the
National, Regional and Provincial Level”

■ Designates government cluster leads to serve as main interlocutors for the dif-
ferent clusters and the counterpart Inter-Agency Standing Committee Country
Team as support with defined roles and responsibilities.
■ Identifies deliverables at regional and provincial levels.
■ Forms nine clusters with the Department of Health as lead in four – Health,
Nu trition, Water and Sanitation Hygiene (WASH), and psychosocial clusters.

Administrative Order No. 2008-0024: Adoption and Institutionalization of an Inte-


grated Code Alert System for the Department of Health

■ Contains the implementing guidelines for the conditions, human resource re-
quirements, and other support requirements for each of the tri-color code alert
status – white, blue and red – in the HEMS Central Office, Center for Health
Development, Hospitals and DOH Central Offices.
■ In the declaration, raising, lowering and suspension of code alert status, identifies
the Secretary of Health and Director of HEMS Central Office as key national
authorities, as well as the respective authorized designates for the HEMS Central
Office, Center of Health Development, Hospitals and Medical Centers.

Administrative Order No. FAE 007 s.1998: “Policies and Guidelines on the Trans-
fer and Referral of Patients Between DOH Metro Manila Hospitals”

■ Focuses on Coordination, Networking, and Referral System.


■ Contains guidelines and procedures in transferring emergency room (ER)
patients, as well as in referrals of admitted patients.
■ Applies to all DOH hospitals in Metro Manila and all additional hospitals placed
under DOH.
■ Includes: general guidelines in the emergency room; guidelines in transferring ER
patients; guidelines for inter-hospital referral or request for procedures; guidelines
for transferring in-patients; and guidelines for transferring of patients during disas-
ters and emergencies.

Department Order No. 1-J, s. 2000: “Reporting Mechanism of Health Emergency


Management Staff (HEMS) at the Central Office and Its Units at the Centers for
Health Development and DOH Hospitals”

■ Emphasizes that the Health Emergency Management Staff shall report directly to
the Office of the Secretary.
■ Duplicates the functions of the HEMS as its Units at the Centers for Health Devel-
opment and DOH hospitals, serving as coordinators and reporting directly to the
CHD director and Regional Hospital/Medical Center chief/director, respectively.
■ States that the CHD director shall be the overall coordinator for disaster pre-
paredness and response at the CHD’s geographical jurisdiction.
■ Indicates that hospitals in Metro Manila shall report to the HEMS director through
20 their respective Medical Center or Hospital director/chief during disaster response.
Memorandum No. 120 s. 2003: “Personnel and Ambulance Services for Emergen-
cies and Disasters”

■ Pertains to resource mobilization.


■ Reiterates the ever readiness of hospitals to respond to emergencies.
■ Directs all hospital directors to actively be on top of any untoward event, espe-
cially in mass casualty incidents.
■ States that personnel trained in emergencies, such as BLS, ACLS, EMT, MFR,
MCM and other related trainings, shall be included in the response teams of the
hospital.
■ Orders that an ambulance be assigned for emergencies for easy dispatch of
teams and be furnished with the necessary equipment, medicines, supplies, and
necessary communication for proper coordination.
■ Emphasizes the authority of HEMS coordinators in the dispatch of these ambu-
lances to prevent delays and the authority of any member of the team to drive in
case there is no available driver.

Department Orders on Health Staff/Personnel

Department Order 2004-1679 – Creation of the Health Task Force on Health Emer-
gency Management (DOH-HEMS Task Force)

Department Order 2004 – Creation of the Steering Committee and Technical Work-
ing Groups in the Health Sector Responding to Emergencies and Disasters

Department Personnel Order 205-1324 – Amendment to Department No. 193-D s.


2003,dated October 8, 2003, Designation and Responsibilities of the Health
Emergency Management Staff (HEMS) Coordinators of the Centers for Health
Development and DOH Hospitals

Department Order 2003-193D – Amendment to Department Order no. 136-1 s.


2001 dated May 28, 2001, Designation and Responsibilities of the Health
Emergency Management Staff (HEMS) Coordinators of the Centers for Health
Development and DOH-Retained Hospitals

Department Order 2001-136-1 – Designation and Responsibilities of the Health


Emergency Management Staff (HEMS)-Stop Death Coordinators of the Centers for
Health Development and DOH Hospitals

Administrative Orders on Communications: Cell Phones

Administrative Order 2004-131 – Amendment to Administrative Order No. 164 s.


2000 re: Policies and Procedures for the Acquisition, Operation and Maintenance of
Cellular Phones at the Central Office

Administrative Order 2000-164 – Policies and Procedures for the Acquisition,


Operation and Maintenance of Cellular Phones at the Central Office

Memoranda on Budget

Memorandum 2000 101-A – Amendment to Memorandum No. 82 s. 2000 dated


June 22, 2000, Stop Death Budget for CY 2000

Memorandum 2000 82 – Stop Death Budget for CY 2000


21
22
23
The Health Emergency Management in Hospitals Part II
24
1 Introduction

Every type of natural, human-generated, technological or societal disaster creates its


own particular set of catastrophic features. Some events can be fairly predicted, such as
typhoons, floods, and drought, whereas earthquakes, landslides and flashfloods, given
the suddenness and swiftness of their occurrence, result in unexpected outcomes.

People have continually been vulnerable to natural hazards but have further exposed
themselves to various kinds of self-made disasters, such as war, riots, accidents, fire,
industrial, technological and ecological disasters, and recently to the threat of chemical,
biological, radio-nuclear agents and explosives (CBRNE).

Hospitals play a very vital role in the management of emergencies. The facility should
persist in functioning even if damaged as well by the disaster. Its main objective is to
decrease mortality and morbidity and to prevent disability not only of its patients but also
of its personnel and individuals within the facility or grounds. The hospital’s response in
health/disaster management emphasizes the prioritization of treatment or triage, treat-
ment of mass casualties, and crisis management, in particular increasing the number of
hospital beds to provide services to the most number of patients at a very short notice.

Furthermore, hospital response highlights the need of bringing the right patient to the
right hospital at the right time. Transport of casualties from the disaster impact site to the
hospital must be communicated and coordinated with the receiving hospital. This is part
of the response chain that ensures a smooth turnover of patient care and the choice of
the most appropriate medical facility to render definitive patient care services. No longer
limited to receiving patients, the role of the hospitals has expanded to include delivery of
pre-hospital care.

Institutional preparedness of the hospital enhances the utilization of available resources


during the response. Of crucial value is a thorough, carefully developed and updated
hospital emergency plan that is activated when the need arises.

The hospitals, in crafting their plans, adopt an all-hazard approach that covers all phas-
es of the health emergency/disaster cycle – from preparedness to response to recovery
and rehabilitation. This approach considers the new challenges of natural, human-gen-
erated emergencies, terrorist-related incidents especially the possible use of biological,
chemical, radio-nuclear agents and explosives, and of emerging and re-emerging dis-
eases.

Mass casualty incidents, a constant challenge to hospitals, test the surge capacity of the
facility. Planning therefore centers on preparing the hospital in Mass Casualty Manage-
ment. Equally important, the hospital’s Health Emergency Preparedness, Response and
Recovery (HEPRR) plan should be written, simple, disseminated, tested and updated.
This provides clarity in the identification and the timely and appropriate performance
of roles, functions and tasks, thereby preventing duplication, confusion and chaos and
resulting in having more lives saved, both of patients and hospital personnel.
25
ROLES AND RESPONSIBILITIES OF HOSPITALS

For Health Emergencies and Disasters, the hospitals, based on A.O. 16B s. 2004, are to:

1. Observe all the requirements and standards (hospital emergency plan, HEICS,
Code Alert, etc.) needed to respond to emergencies and disasters.
2. Ensure enhancement of their facilities to respond to the needs of the communities
especially during emergencies.
3. Network with other hospitals in the area to optimize resources and coordinate
transferring of victims to the appropriate facility.
4. Report all health emergencies to the Operation Center, and document all inci-
dents reported.

26
2 Activities During the Emergency Preparedness
Phase

The hospital prior to a health emergency event undertakes development activities to en-
hance its capacity to manage all types of hazards and systematically carry out response
to recovery, ensuring a better level of function in health emergency management. (Go,
2007; DOH-HEMS, 2007a; WHO, ADPC, 2006). These activities are:

1. Development of policies, guidelines, procedures and protocols for health emer-


gency management
2. Development of Health Emergency Preparedness, Response, and Recovery and
Rehabilitation Plans
3. Development of the Organization
4. Physical Infrastructure Development
5. Systems Development

A. Development of Policies, Guidelines, Procedures and Protocols


for Health Emergency Management

For the hospital to set Health Emergency Management as its appropriate priority and
allocate needed resources for it, policies, guidelines, procedures, and protocols must
be formulated consistent with those of the national plan but more importantly, they
must be responsive to local settings. The subsequent sections provide details in the
development process.

A1. DEFINITIONS

Policy is a formal statement by a government, organization or institution that


expresses a set of goals, the priorities within those goals, and the preferred
strategies for achieving those goals. It is primarily based on the mandate of the
institution. It is the statement of what must be done. Guidelines state how to
implement the policy; they deal more with the technical know-how required in
implementation. Procedures likewise explain how to implement the policy but
they are focused more on administrative know-how. Protocols still explain how
to implement the policy, highlighting the observance of certain codes of eti-
quette and precedence. Plan, on the other hand, pertains to who does what
and when in order to implement the policy.

These terms represent an interrelated set of processes in a sequential manner


such that mandates are needed to set policies, policies are needed to define
guidelines and set procedures, and guidelines and procedures are needed to
make plans.

The policy development process requires: the legal mandate of the institution;
the authority (national, regional, hospital, local) of the agency; managerial and
technical competence (such as in technical writing, etc); political will and support
from the head of the agency; and that the policy be acceptable and doable.

27
Examples in the Use of Terminologies
Policy (What must be done)

Every dead victim has the right to be found, identified and returned to his/her
family according to acceptable norm.

Guidelines (Technical know-how to implement the stated policy)

Guidelines must contain the following:


• How to identify the dead
• How to perform autopsy, DNA analysis, etc.
• How to do the tagging and labeling of the dead bodies

Procedures (Administrative know-how to implement the policy)

Procedures must contain the following:


• How to procure the reagents, equipment, the supplies for identification
of the dead
• How to get funds for the procurement
• How to distribute reagents and supplies to all the laboratories

Protocol (Code of etiquette and precedence on how to implement the policy)

Communication protocol must contain the following:


• LGU request for assistance is coursed through the Center for Health
Development, which channels to the HEMS – Coordinator. The response
follows the reverse direction.

Plan (Who does what and when in order to Implement the above-stated policy)

The plan must contain the following:


• Objective
• Strategies and activities
• Person responsible
• Resource requirement
• Time frame
• Performance indicator

A2. POLICY DEVELOPMENT PROCESS

The policy development process includes:

a. Creation of Technical Working Group


b. Review of existing policies at different levels (Republic Acts, Executive
Orders, Administrative Orders, etc)
c. Consultations (Multisectoral)
d. Presentations for approval and signing
e. Dissemination and orientation
f. Monitoring and evaluation

An ad hoc Technical Working Group shall be formally created through an order


(department order, hospital order, or regional order) which states their functions
and outputs. With certain operational or program issues at hand awaiting
directions, the group develops the policy to address these concerns. They re-
28 view existing policies at different levels, such as Republic Acts, Executive
Orders, Administrative Orders, etc. before starting to craft the policy. Multisec-
toral stakeholders are consulted in the whole development process to get their
views through interactive brainstorming and critiquing sessions. The final draft
should be presented for approval prior to the signing by the head of agency.
Policy never serves its purpose unless disseminated to all concerned implement-
ers. Its implementation needs constant monitoring and evaluation to determine
its sustained effectiveness or ineffectiveness, which may require updating or
revision.

A3. POLICY CONTENT

Below is an outline of what a policy should contain:

I. Background/Rationale
II. Definitions of Terms
III. Objectives
IV. Scope and Coverage
V. Framework
VI. Strategies
VII. Policy Statement
VIII. Implementing Mechanism
IX. Separability Clause
X. Repealing Clause
XI. Effectivity

When formulating new policies, the hospital may use the national policies as a
guide. However, policy formulation in the hospital is basically an adaptation
process of the national policies to the hospital context. This may take the form
of memoranda, special orders (regional orders), circulars, guidelines, etc. (Some
details on the content of a policy are in Section 1, Part III of this manual.)

Hospital emergency management policy may be needed in the following areas:

• Interaction between the hospital and other hospitals and medical centers
• Interaction between the hospital and rescue, volunteer, and government
organizations
• Assignment of major responsibilities within the hospital for emergency
prevention, preparedness and response
• Acquisition and maintenance of emergency resources
• Criteria for major evacuation of the hospital and for hospital relocation

B. Development of a Hospital Health Emergency Preparedness,


Response and Recovery (HEPRR) Plan or Hospital Risk Reduction Plan
The Hospital Health Emergency Preparedness, Response and Recovery Plan is
also known as the Hospital Risk Reduction Plan. Considerations in its development
are described below. (Go, 2007; DOH-HEMS 2007a; WHO, ADPC, 2006)

29
B1. RISK MANAGEMENT

The Department of Health adopts the Risk Management Approach in its manage-
ment process to deal with the actual or implied effects of hazards.

Risk Management is a comprehensive strategy for reducing threats and conse-


quences to public health and safety of the community by:
• Preventing exposure to hazards (target = hazards)
• Reducing vulnerabilities (target group = community)
• Developing response and recovery capacities (target group = response
agencies)

Risk management includes the process of: selecting a hazard; identifying the
communities exposed to that hazard; predicting the consequences of that haz-
ard interacting with that community; analyzing each of the five elements of
community in relation to that hazard to identify the factors that will lead to each
consequence (i.e., determining the vulnerabilities of each element); and
identifying the capacities within the community to respond to that hazard.
Analysis of the risk takes into account the relationships as follows:

Vulnerability
Risk = Hazard x
Capacity
This means that risk occurs if hazard affects a vulnerable community with a low
capacity to respond. Even if there is a high possibility of hazard and a high vul-
nerability of the community, if the community’s capacity to manage is also high,
then the probability of risk of a disaster to occur is low. Therefore, the commu-
nity must have enhanced capacity or preparedness to prevent exposure to
hazard, to reduce vulnerability, and to manage risk. Capacity is equated with
preparedness of the community in risk management.

B2. DEFINITIONS

Definition of the seven common terms in risk management:

1. Hazard - Any substance, phenomenon or event that has the potential to


cause disruption or damage to communities.
- Any potential threat to public safety and/or public health.

2. Vulnerabilities - Factors that increase the risks arising from a specific


hazard in a specific community (risk modifiers). Examples of vulnerabilities of
people:
• Access to health care
• Measles vaccination coverage rate
• Under - nutrition rate
• Under-5 mortality rate
• Access to sanitation

3. Risks - Anticipated consequences of a specific hazard interacting with a


specific community (at a specific time).
30
Consequences of hazards (risks):
• Death
• Injury (mental and physical)
• Disease (mental and physical)
• Secondary hazards (fire, disease, etc.)
• Contamination
• Displacement
• Breakdown in security
• Damage to infrastructure
• Breakdown in essential services
• Loss of property
• Loss of income

4. Emergency - Any situation in which there is imminent or actual disruption or


damage to communities, i.e., any actual threat to public health and safety
which the community is able to cope with or manage.

5. Disaster - Any actual threat to public safety and/or public health where local
government and the emergency services are unable to meet the immediate
needs of the community, whereby the event is managed from outside the
affected communities.

6. Capacities - An assessment of the ability to manage to an emergency (a


risk modifier). Total capacity is measured as readiness.

7. Community - People, property, services, livelihood and environment, i.e., the


elements exposed to hazards. There are specific vulnerabilities or risks for
each element of the community.

B3. CONSIDERATIONS

B3.1. General Considerations

In planning the Hospital HEPRR operations, the following general consider-


ations should be taken into account (Stop Death Program, 2000a):

1. Disasters occur at any time without warning or signal. Everyone should


be prepared at all times to render emergency response.
2. Disaster victims often needing quick medical assessment and prompt emer-
gency care should be attended to immediately.
3. Disaster victims, often hurt and confused, should be treated with sensitivity
and compassion.
4. Given that the volume of demand and the urgency of need for medical atten-
tion are unusually high during disasters, every human and material resources
must be available, readily mobilized and organized for quick action.
5. Safety of personnel, patients, victims and the general population is of utmost
importance in the delivery of services.

31
B3.2. Specific Considerations

There are two aspects to hospital hazard and vulnerability assessment: (1) the
vulnerability of the catchment area; and (2) the vulnerability of the hospital as a
service provider. Emergencies can be purely internal, external or combined
internal/external (Stop Death Program, 2000a). Thus, there are three basic
scenarios that hospital emergency planning must satisfy:

• An emergency that disrupts the ability of the hospital to provide its normal
services, but that does not cause harm to the community (an internal
emergency);
• An emergency that causes harm to the community requiring increased
health/medical services, but that does not disrupt the ability of the hospital to
provide medical services (an external emergency);
• An emergency that causes harm to the community requiring increased medi-
cal services, and that also disrupts the ability of the hospital to provide medi-
cal services (an internal/external emergency).

Internal emergencies can be caused by a number of hazards, including fire,


explosion, hazardous material incident, food contamination, or loss of electricity
supply, water supply, or other service. Internal emergencies can quickly
multiply into a number of contingent emergencies. For example, a fire may
cause injury to patients and staff resulting in an overload on hospital services,
hazardous materials incidents may lead to fires or explosions, etc.

Catchment area vulnerability should be assessed to determine the likely


demands on a hospital or hospital system (a series of linked hospitals and medi-
cal centers). The hospital must be prepared for a number of external emer-
gency scenarios that may produce unusual medical demands on its existing
capacity.

The capacity to manage routine emergencies is the foundation for further devel-
oping the capacity to manage the less frequent events of health emergen-
cies which, in turn, provides the working base to build capacity in Mass Casu-
alty Management. This existing capacity is known as surge capacity or the
“health care system’s ability to rapidly expand beyond normal services to meet
the increased demand for qualified personnel, medical care and public health in
the event of large-scale public emergencies or disasters” (a working definition
from the Agency for Health Care Research and Quality, USA, 2005). The essen-
tial components are: trained and skilled staff, equipment, pharmaceuticals, sup-
plies, and both physical structure and management systems such as Incident
Management System. (WHO-WPRO, 2007a)

B3.3. Response Considerations

An overview of risk assessment and health response is presented as two frame


works in Figures 1 and 2. (WHO, ADPC, 2006)

32
Figure 1. Emergencies and Health

Community HEALTH RESPONSE


Search and rescue
First aid
DIRECT Triage
IMPACTS Medical evacuation
Damage Primary care
and
VULNER- Needs Disease surveillance and control
ABILITIES Curative care
Blood banks
CAPACITIES Laboratories
Referral system
Special units (burns, spinal)
INDIRECT
EMERGENCY IMPACTS Evacuation centres
Shelter
Water
Food and nutrition
Energy
ASSOCIATED FACTORS Security

Climate/weather/time of day Environmental health


Location Primary health care
Security situation
Political environment Care of the dead
Economic environment Psychosocial care
Socio-cultural environment Disability care
Morale, solidarity, spirit
Competence, corruption Recovery
Reconstruction

Source: Sixth Inter-regional Course on Public Health and Emergency Management in Asia and the Pacific
(PHEMAP), WHO (WPRO, SEARO) and ADPC, 2006.

Figure 2. Epidemic Emergencies

HEALTH RESPONSE
Specific
morbidity and Case definition
mortality Admission criteria
Case confirmation
Case management
OUTBREAK Discharge criteria
- in the Contact tracing
community Needs Vector control
Spread Environmental controls
of infec-
tion Surveillance system
Referral system
- in health Professional education
facilities Public information and
awareness

Laboratory plans
Hospital plans
Risks for health and lab workers Supplies and equipment

Border controls
Difficult access Quarantine
Animal culling
Agent unknown Commerce/trade

Source: Sixth Inter-regional Course on Public Health and Emergency Management in Asia and the Pacific (PHE-
MAP), WHO (WPRO, SEARO) and ADPC, 2006.

33
Emergencies require a multisectoral response, as presented below. The contribution
of health is highlighted in bold print.

• A Search and Rescue/Search and Recovery plan: In the Philippines, search


and rescue is not a primary responsibility of the Department of Health. The
conditions for its involvement have to be specified and only by request.
• Search and Rescue (Mass Casualty Incident); Search and Recovery (Man-
agement of Dead and Missing)
• An Evacuation/Temporary Shelter plan in coordination with other agencies
• A Mass Casualty Management plan (networking multiple hospitals with the
pre-hospital care system)
• A Security plan
• Specific Sectoral Relief plans (social welfare, public health, energy, shelter,
sanitation, food/nutrition, water, etc.)

B3.4. Recovery Considerations

The recovery phase in the hospital setting centers on the return of the response
personnel and the hospital to normal operations the earliest time possible. Limited
recovery or failure to recover can worsencurrent vulnerabilities or create new ones
to future stressful situations. This is clearly seen when the hospital responds to an
external emergency. The continuity of critical and essential functions of the hospital
is vital, particularly in hazard-prone regions. The restoration may be on a short-term
(i.e., within hours) or long-term basis (when services are disrupted for weeks or
months). In the latter case, the hospital focuses on relocation of services within the
facility or to an alternative facility either temporarily or permanently with construction
of new facilities or change of hospital sites.

Recovery considerations are often described from the community perspective as


shown below (WHO, ADPC, 2006b). This may provide the hospital insights in
determining its contribution to this phase, when involved in external emergencies.
It has to derive similarities and differences that will be useful in crafting its own
recovery plan when affected by an internal emergency.

From Relief to Recovery


• Disasters change social, political, economic and even demographic realities.
• People begin almost immediately to re-house themselves and reestablish
their social and economic networks after a disaster.
• Most people have good ideas of what they want to do to rebuild their lives. It
is essential to take their views into account when planning for recovery.
• There is no clear-cut boundary between relief and recovery processes.

Purpose
• To assist communities in reestablishing themselves quickly and effectively,
recognizing that there will be a short-term need for external support to supple
ment the personal, organizational and social structures which have been
disrupted by the event.

Definition
• Management plan and process – to restore the community to an appropriate
34 level of functioning; to restore emotional, social, financial and physical well-
being.
• Developmental focus –
– Not just a remedial process
– Mitigates future disaster losses
– Results in the creation of new legislation, institutions, programs, codes,
land use regulations, and early-warning systems
• Recovery – a long-term, slow and difficult process, i.e., creates conflicts and
long-term grievance.
• Reconstruction – not just building houses and physical infrastructure but full
redevelopment of the affected area according to the needs of its population;
restoration of emotional, social, economic, and physical well-being.

Process
• Begins from the moment of the disaster impact.
• Continues throughout the development process.
• Is best when treated as a developmental activity.
• Considers existing activities.
• Takes into account services and structures.
• Links to other processes: reflects on social processes and physical recon-
struction.

A well-managed recovery process helps a community/health care facility to return


not only to its normal functions but to a better level of functioning and capability
to address future disaster. Full recovery with satisfactory coping may be prolonged in
hazard-prone and highly vulnerable communities.

The transition between response and recovery is a recognized gray area. Hospi-
tals of the DOH need to be familiar with the existing definition of the local
government to determine implications to its recovery plan. Republic Act. 8185 of
1997: Emergency Powers of the Local Government Units states the duration of Ca-
lamity Area Declaration to be one year from the effectivity of the declaration.
The declaration of the state may be terminated “once 85% of the repair and
rehabilitation works and services have been restored.” However, when the “disaster
effects are recurring or protracted, the declaration shall be a continuing one.”

In practice, recovery is often viewed to be more within the function of the Depart-
ment of Social Welfare and Development.

B4. PLANNING

B4.1. Process

Planning in health emergency management is a sequence of steps, listed as follows:

1. Determine the authority responsible for the process.


2. Establish a planning committee.
3. Conduct a risk analysis – hazards and community vulnerabilities.
4. Set the planning objectives.
5. Define the management structure for the process.
6. Assign responsibilities.
7. Identify and analyze capacities and resources.
8. Develop the emergency management systems and arrangements. 35
9. Document the plan.
10. Test the plan.
11. Review and update the plan on a regular basis.

These steps are generic to a planning process. Specific for risk management are
the tools used in Steps 3 and 7 that focus on risk assessment, risk analysis and
risk reduction.

B4.2. Outputs

In Risk Management, three plans are of utmost importance:

a. A set of Health Emergency Preparedness or Risk Reduction plans – how


can we prevent emergencies from occurring in the community. These
include:
• A Hazard Prevention plan
• A Vulnerability Reduction plan
• A Capacity Development plan (commonly referred to as Prepared-
ness Plan)

In the Philippine setting, the Capacity Development plan centers on the


elements of successful Health Emergency Management or the 10P’s,
namely:
• Policies, protocols, guidelines, procedures
• Plans
• People
• Partnership building
• Program development
• Physical infrastructure development
• Practices
• Peso and logistics
• Promotion of health
• Package of services at the community, evacuation centers, hospi-
tals, regional offices

b. A set of Health Emergency Response plans – who does what when, using
existing capacity:
• Organization
• Activation of systems
• Mobilization of resources – human and logistics (e.g., flow charts)
• Partnership

c. A set of Health Emergency Recovery plans - who does what when after
the termination or simultaneous with response operations:
• Damage assessment and needs analysis
• Psychosocial support
• Restoration of utilized/ damaged resources and services
• Post-incident evaluation

Every region, community or agency should have the three sets of plans with the
36 sub-plans, collectively known as the “Emergency Preparedness, Response and
Recovery Plan.” For the Health Sector, this plan becomes the “Health Emer-
gency Preparedness, Response and Recovery (HEPRR) Plan.”

At the national level, the Health Emergency Management Staff develops its: (1)
National Strategic and Developmental Plan, (2) Annual Work and Financial/Opera-
tional Plan, (3) Emergency Preparedness Plan in support of its Emergency
Preparedness Program, (4) National Response Plan, (5) Recovery/Reconstruction
Plan, and (6) Contingency Plan.

Contingency planning is a management tool used to analyze the impact of potential


crises and to ensure that adequate arrangements are made in advance. It involves
a predictive response element to an impending emergency by ensuring the
availability of financial, human and material resources, and by installing a mecha-
nism for decision-making that can shorten disaster response. (UNICEF, 2007)

All plans promote greater coordination, networking, resource mobilization, dis-


patching of response teams for local and international humanitarian assistance, and
logistics management (such as management of donations).

Hospital HEPRR planning is an integral part of both the multisectoral community


emergency plan and the health sector emergency plan.

Hospital HEPRR Plan has two aspects:


• Protection of the hospital, hospital services, patients and hospital staff from
harm caused either internally or externally; and
• Provision of hospital services to the community before, during and after an
emergency.

B4.3. Outline of Hospital Health Emergency Preparedness, Response and


Recovery Plan

The planning committee formulates and documents the HEPRR Plan as guided by
the following suggested format. (Details of the formulation of an HEPRR Plan are in
Section 2 in Part III of this manual.)

37
Outline of Hospital Health Emergency
Preparedness, Response and Recovery Plan

I. Background
II. Plan description
III. Goals and objectives
IV. Planning group
V. Management structures
VI. Roles and responsibilities
VII. Hospital Emergency Preparedness Plan
A. Hazards prevention
B. Vulnerabilities reduction
C. Capacity development
VIII. Hospital Response Plan
A. Organization
B. Systems activation
C. Resource mobilization
D. Partnership
IX. Hospital Recovery and Reconstruction Plan
A. Damage assessment and needs analysis
B. Psychosocial support
C. Restoration of utilized/damaged resources and services
D. Post incident evaluation
X. Annexes
A. Glossary
B. Abbreviations
C. Directory of contact persons
D. Inventory of resources/assets of the hospital and partner
agencies
E. Hospital policies, guidelines, protocols, and other issuances
relevant to emergency or disaster management

B4.4. Next Steps

In Health Emergency Management, the process of plan formulation is the sec-


ond critical step to save more lives, both of victims and of responders. To ensure
that the consensus reached takes its form, is understood by all, is validated and
practiced in its evidence-based mode, the hospital takes the following steps, an
elaboration of Steps 9 to 11 in B4.1 Planning Process above.

1. Write the Hospital HEPRR Plan and have it approved by the Chief of
Hospital. The Plan is not a plan until written and approved by the highest
authority. A plan should be documented so as not to be forgotten.

2. Disseminate the plan to all the stakeholders and all the hospital staff.
Everyone needs to know the plan so that in an emergency no one would
say “he does nothing because he knows nothing.” A plan should be
simple to be understood. A plan should be disseminated to be in the
hands of those who will implement it.

3. Test the plan. A plan is believed to be effective only when it is tested, i.e., to
38 know its functionality, acceptability, and doability in the hands of the imple-
menters. A plan should be tested to know the gaps and problems.
4. Implement the plan.

5. Monitor and evaluate the implementation of the plan.

6. Review and update. A Plan should be updated regularly to conform with


the times.

Pointers in Formulating a Health Emergency Management Plan


■ Write it down or it will not be remembered.
■ Make it simple or it will not be understood.
■ Disseminate it or it will not be in the hands of those who need it.
■ Test it or it will not be practical.
■ Revise it or it will not be up-to-date.

(Source: Banatin, 2005)

C. Development of the Organization

C1. PREPAREDNESS PHASE

C1.1. Planning Group/Committee


Health Emergency Preparedness, Response, Recovery and Reconstruction
planning is a local activity carried out by end-users and it applies to specific
circumstances. It is done by a group of authorized key individuals or imple-
menters and not by a single person. The Planning Group/Committee of the
hospital shall consist of all the hospital’s major decision-makers, including
a representative from the community. The community representative may be
a member of the Disaster Coordinating Council, a local official, NGO or
volunteer group, or a member of a health professional society (e.g., medical
or nursing society).

The planning group may be an “ad hoc group” convened specifically for the
formulation of new plans or for the update of existing plans after drills or after
the emergency/disaster post-event evaluation.

Composition of the Hospital HEPRR Planning Group/Committee:

• Hospital director
• HEM coordinator/assistant coordinator
• Representative from the areas of hospital operation
• Representative from the hospital’s administrative unit (the administrative
officer or finance and logistics officers, or their representatives)
• Representative from the hospital’s planning unit
• Representative from the community (representative from the Disaster
Coordinating Council, from the medical society, or from any nongovern-
ment organization)

39
Figure 3. Example of a Hospital HEPRR Planning Group/Committee Structure

Chief of Hospital/
HEM Coordinator

Representa- Represen- Represen- Representa-


tives from tative from tative from tive from the
the Areas Administra- Planning Community
of Hospital tive Unit Unit
Operation (finance/
logistics
officer,
transport)

Functions of a Hospital HEPRR Planning Committee:

1. Develops, reviews and updates the Hospital HEPRR plan after every drill or ac-
tual disaster.
2. Gathers required information and gains the commitment of key people and orga-
nizations.
3. Initiates testing of the plan for its functionality and revises/updates it according to
adaptability to the current situation.
4. Develops an Annual Operation Plan and other plans relevant to Health
Emergency Management.

C1.2. Management Structures

The management structures in Health Emergencies and Disasters in the Hospital


are provided for in A.O. 168 s. 2004 (Section V. Policy Statements, A. Organizational
Structure) which states that:

1. All health facilities should have an Emergency Preparedness and Response Plan
and a Health Emergency Management Office/Unit/Program. Such offices, units
or programs shall be under the supervision of the highest officer, such as the
Regional Director, Chief of Hospitals or the equivalent officer so as to ensure
faster decision-making in times of emergencies and disasters.

2. All health facilities shall establish a Crisis and Consequence Management Com-
mittee to handle major emergencies and disasters, composed of people from
operations, logistics and finance group.

3. An emergency coordinator shall be designated in all health facilities. He/she


40
should be an integral member of any crisis or consequence management in his/
her respective facility or institution. As such, he/she shall coordinate directly with
higher officials for technical aspects during emergencies, and administratively,
shall be answerable to his/her mother unit. He/she shall be given proper authority
and support (personnel and material) by the management during operations.

4. An official spokesperson who is accessible and available to the media shall also
be designated. He shall be responsible for disseminating information that is
accurate and updated.

C1.2a. Crisis and Consequence Management Committee

The Crisis and Consequence Management Committee is a lower committee that


will provide technical as well as operational support to the Executive Committee
and provide inputs for decisions and policy directions in crisis, emergency and
disaster. Given the legal basis, a suggested composition of the Crisis and Conse-
quence Management Committee is as follows:

Membership
1. Medical Center Chief II/Hospital Director
2. HEM Coordinator/Assistant Coordinator
3. Chief of Clinics
4. Chief Administrative Officer
5. Chief of Nursing Service
6. Head of Emergency Department
7. Public Health Unit/Epidemiology
Optional membership
8. Chief of Surgery
9. Chief of Anesthesia
10. Chief of Medicine
11. Chief of Orthopedics
12. Chief of Pediatrics
13. Chief of Obstetrics/Gynecology
14. Chairperson of Security on Critical Infrastructure Program
15. Chief Security
16. Head of Maintenance Section
17. Chairperson of Hospital Center of Wellness Program

Health emergency function is a concurrent function of the assigned hospital


staff. Under normal conditions, the assigned hospital Health Emergency Staff
Coordinator/Assistant Coordinator may be part of a department (e.g., Medicine,
Emergency Room, Surgery).

The Medical Center Chief/ Hospital Director shall exercise discretion in the for-
mation and composition of the committee to fit the organization (such as in the
case of Special Hospitals). Where feasible, he/she optimizes the use of existing
structures, e.g., Executive Committee, to reduce the existence of multiple struc-
tures with duplicate functions and avoid concomitant operational issues such as
attendance in meetings. To illustrate, the Crisis and Consequence Management
Committee may be part of the Executive Committee.

41
C1.2b. Hospital Health Emergency Management Staff (HEMS) Coordinator

As stated in Department Order No. 136-I s. 2001 and affirmed in Department


Personnel Order No. 2005-1324 dated June 14, 2005, the responsibilities of the
Hospital HEMS Coordinator and the Assistant Coordinator are:

Coordinator
1. Reports directly to his respective director in the hospital or CHD, and coordi-
nates with the HEMS Director in times of emergencies and disasters.
2. Takes the lead in the preparation of the Emergency Preparedness Plan of the
CHD/hospital, duly approved by his chief, disseminated to all the staff, and
regularly tested, evaluated and updated.
3. Prepares the annual work and financial plan and takes the lead in the imple-
mentation of the health emergency activities.
4. Responsible for the organization and dispatching of teams to respond to
emergencies and disasters as embodied in the plan. The team coming from
the CHD should lead in the rapid assessment, monitoring, social advocacy
and other public health activities. The hospital team should be prepared for
but not limited to trauma-related disasters.
5. Make himself available and accessible in times of emergencies and disasters;
hence must equip himself with the necessary communications.
6. Responsible for the training of the HEMS members in the region (CHD, hos-
pitals) and the communities relative to health emergency skills and manage-
ment.
7. Ensures that the necessary drugs, medicines, supplies and other necessary
equipment are available and properly stocked for emergencies and disasters.
8. Takes the lead in public information and awareness concerning disasters and
emergencies.
9. Networks with members of the Health Sector responding to emergencies and
disasters within the hospital’s/CHD’s region/zonal catchment areas and the
communities, as well as with other agencies responding to emergencies and
disasters.
10. Follows the HEARS Plus reporting and coordinates with the DOH Central
Operation Center for all emergencies and disasters.
11. Fully responsible for the implementation of the Memorandum Order, Circular,
Administrative Order and Department Order issued by the Health Secretary
and the Director of HEMS, especially in extreme emergencies.
12. Documents all related activities; this includes the preparation of a Postmor-
tem Evaluation of each event responded to and submission of the report to
the Director of the CHD/hospital with copy furnished the HEMS Director.
13. Develops research proposals that would aid the service in policy direction,
implementation and improvement.
14. Submits quarterly reports to the HEMS Director.

Assistant Coordinator
1. Assists the HEMS coordinator in all his/her activities.
2. Acts as an action officer on health emergency and disaster.
3. Acts on behalf of the coordinator in the latter’s absence.
4. Acts as training officer in relation to health emergencies and disasters.

42
C2. HEALTH EMERGENCY RESPONSE PHASE

During emergency response, management structure is of prime importance as it


shows the specific chain of command, control and coordination. Reflecting the roles,
functions and responsibilities of all key players involved, the management structure
shows the flow of reporting, coordination and communication. The structure is best
represented and explained with diagrams.

C2.1. Hospital Emergency Incident Command System (HEICS) vis-à-vis the


Incident Command System (ICS)

Incident Command System (ICS) is a management system used in responding


to an incident. There are two types of ICS: Single Command involving only one
agency, and Unified Command involving several agencies responding to the
incident. This is a generic nomenclature and can be applied to any facility (WHO
and ADPC, 2006). Hence, if the facility is a hospital where all responders are
coming from the same agency, it is a single command type of ICS.

The hospital in responding to an incident at Code Blue alert now activates the
Hospital Emergency Incident Command System (HEICS) which involves an
organizational shift to an emergency mode. While the basic structure of an
Incident Command System is the same for all facilities, the command,
coordination and control system can be adapted to the hospital conditions.
During an emergency/disaster, as the hospital is in an emergency mode,
other staff of the hospital may assume roles and functions as needed in an
emergency. The HEMS Coordinator may assume the role of the Incident
Commander, an operations head or a spokesman as deemed necessary by the
hospital chief.

C2.2. Hospital Emergency Incident Command System

C2.2a. Hospital Emergency Incident Command System Structure

The HEICS is the prescribed organizational structure for command, control


and coordination as stated in A.O. 168 s. 2004. It is a system which employs
a logical management structure, defined responsibilities, clear reporting chan-
nels, and a common nomenclature to help unify hospitals with other emergen-
cy responders.

HEICS, the standard for health care disaster response, offers the following
features (HEMS, 2000a):

• Predictable chain of management


• Flexible organizational chart which allows flexible response to spe
cific emergencies
• Prioritized response checklists
• Accountability of position function
• Improved documentation for improved accountability and cost
recovery
• Common language to promote communication and facilitate outside
assistance 43
• Cost-effective emergency planning within health care organizations
The HEICS has five basic personnel consisting of an Incident Commander, Op-
erations Officer, Planning Officer, Finance Officer and Logistics Officer. Three
other personnel – Security Officer, Liaison Officer and Public Information Officer
– serve as staff to the Incident Commander and altogether compose the
command staff. (See Figure 4.)

Figure 4. Basic Hospital Emergency Incident Command System (HEICS) Structure

INCIDENT COMMANDER

Security Officer Public Information Officer

Liaison Officer

Operations Logistics Planning Administrative


and Finance

The hospital may revise the structure according to the need of the facility and
available human resources. If the facility is not affected by the disaster, a
designated group shifts to an emergency/disaster mode for the HEICS, while the
rest of the staff conduct normal or regular hospital transactions/services.

If the hospital raises its alert status to Code Blue, normal office transactions are
suspended and the hospital is shifted to emergency/disaster mode.

C2.2b. Job Action Sheets

The Job Action Sheets (JAS) or job descriptions tell responding staff “what they
are going to do; when they are going to do it; and, who they will report it to after
they have done it.” Of the JAS content, the job title and the mission statement
should not be changed under any circumstances. These are universal state-
ments which allow emergency responders from different organizations to com-
municate quickly and clearly with other practitioners of the Incident Command
System (WHO, ADPC, 2006). With regular use, the content may be updated or
modified to the hospital conditions. The JAS for the Department of Health
facilities are presented in Section 3. Of the 16 sheets, half (A-H) are for the
command post, and the rest for the key response officers.

Job Action Sheets


A. Incident Commander
B. Safety and Security Officer
C. Public Information Officer
D. Liaison Officer
E. Logistic Section Chief
F. Planning Section Chief
G. Finance Section Chief
H. Operations Section Chief
I. Treatment Team Leader
44 J. Triage (Initial) Team Leader
K. Transport Group Supervisor
L. Staging Officer
M. Field Medical Commander
N. Morgue Manager
O. Medical Controller
P. Incident Medical Commander (for pre-hospital incident)

In Mass Casualty Incidents, there are two positions for medical concerns at the
Command Post (pre-hospital) based on A.O. 155 s. 2004. These are the Medical
Controller and the Incident Medical Commander.

The Medical Controller is a designated senior Department of Health officer ap-


pointed to assume the overall direction of the medical response to mass casualty
incidents and disasters. Control is established from a designated Operations
Center either in the Central Operations Center or the Regional Operations Center
and whose main responsibility is to coordinate all the services of the sector.

The Incident Medical Commander is the highest representative of the Depart-


ment of Health or the local health office as designated by the local chief ex ecu-
tive depending on the extent of the disaster. He serves as the liaison officer of
the Health Sector to the Command Post headed by the Incident Commander.
For regional disasters, the Incident Medical Commander should be the highest
representative from the DOH CHD.

For quick retrieval and repeated use of the Job Action Sheets, the hospital
specifies the appropriate presentation and storage within its facility, which in-
cludes having JAS inside plastic sheets, with clear plastic clipboard or lami -
nated in plastic. One option is to have the JAS in a pocket size booklet
with other useful information, such as a telephone directory and maps, follow-
ing a declared emergency. Organizing and storing the materials may use
color codes and suitable placement areas, such as location by hospital units
for a “user-friendly” approach, thereby increasing efficiency in the accomplish-
ment of tasks.

C2.2c. Organizational Chart

A comprehensive HEICS Organizational Chart for a hospital is presented in


Figure 5 (Stop Death Program, 2000a). The positions are filled up based on
the priorities created by the emergency/disaster and their importance to
minimizing the harmful consequences. The first assignments are given to
those immediately needed while some are for later hours (particularly if the
emergency occurs at night) or even for succeeding days. Some positions
need not be filled up or a person may assume two or more positions depend-
ing on the human resources available and the capability of the hospital.

Cognizant of the uniqueness of each health emergency/disaster and of the


limitation of human health resources, the plan has to provide for delegation of
more than one job to an individual or for re-prioritization of needs given the
emergency’s evolving conditions.

45
Figure 5. Comprehensive Hospital Emergency Incident Command System Organiza-
tional Chart

INCIDENT COMMANDER

Public Information Officer Liaison Officer

Safety and Security Officer

Logistics Chief Planning Chief Finance Chief Operations Chief

Facility Unit Situation Status Time Medical Care Ancillary Ser- Human Services
Leader Unit Leader Unit Leader Director vices Director Director

Damage Labor Pool Unit Procurement Medical Staff Laboratory Staff Support
Assesment Leader Unit Leader Director Unit Leader Unit Leader
and Control
Officer
Radiology Psychological
Sanitation Medical Staff Claims In-Patient Areas Treatment Areas Unit Leader Support Unit
and Unit Leader Unit Leader Supervisor Supervisor Leader
Systems Dependent
Officer Pharmacy
Nursing Unit Cost Unit Leader Care
Leader Unit Leader Surgical Services Triage Unit Unit Leader
Communications Unit Leader Leader
Unit Leader Cardiopulomonary
Patient Unit Leader
Tracking Maternal Child Immediate Treat-
Transportation Officer Unit Leader ment Unit Leader
Unit Leader
Patient
Information Critical Care Delayed Treat-
Materials Supply Officer Unit Leader ment Unit Leader
Unit Leader
General Nur-
sing Care Minor Treatment
Nutritional Supply Unit Leader
Unit Leader Unit Leader
Out-Patient
Services Unit Discharge Unit
Leader Leader

Morgue Unit
Leader

C2.3. Roles and Responsibilities of the Hospital

In Mass Casualty Management, the hospital can be a responding facility, a


receiving facility, and can be both a responding and receiving facility. This
would depend on the classification, designation and capability of the hospital.

To become a responding facility, the hospital must have a competent re-


sponse team always available and ready to be dispatched in times of emer-
gency. The response team is composed of a physician (or Hospital HEM Co-
ordinator), a nurse, Emergency Medical Technician (EMT), trained non-medi-
cal staff, and an ambulance driver with an equipped ambulance. The team
must have the capability to undertake the following:
a. Incident Command System - Team Leader or the HEM Coordinator must
46 have the capability to establish command, control and coordination in the
field, or must be capable of becoming an Incident Commander
b. Rapid Health Assessment
c. Triaging
d. Life support – Basic Life Support (BLS), Standard First Aid, EMT, or
Advanced Cardiac Life Support (ACLS)
e. Proper communication
f. Proper coordination
g. Establishment of Emergency Operations Center on-site
h. Evaluation and provision of medical/health care to the victims

The hospital as a receiving facility must possess the following capacities:


a. Emergency room equipped for emergency care to handle all types of
MCI
b. Equipped critical areas to accommodate and provide necessary defini-
tive care to the victims (Operating Room, Recovery Room, Burn Unit,
Trauma Unit, Morgue, ICCU/CCU, Ancillary Services, Pharmacy, etc)
c. Competent staff to provide definitive care to the victims
d. Pre-identified rooms or wards to accommodate influx of patients

As a receiving hospital it must be able to manage the surge of victims/patients


through the following:
a. Expansion of key services to accommodate influx of patients.
b. Having operating rooms which can serve beyond their normal load of
patients.
c. Handling additional laboratory and radiological procedures, and other
support services requirements.
d. Postponement/cancellation of elective operations.
e. Facilitation of rapid turnover of patients or coordination with other hos-
pitals for patients’ transfer.
f. Mobilization of additional human resources within the area or tapping
the HEMS’ system using the entire DOH network.

The hospital can be both a responding and receiving facility if it pos-


sesses both of the above capacities and capabilities.

C 2.4. Response Teams

C 2.4a. In-Hospital Response Team

The In-Hospital Response team provides the definitive medical care to the
mass casualty incident victims who are either brought in or have walked in
to the hospital.

While this is essentially the Emergency Unit/Department staff with the ad-
mission area as the frontline, the rest of the hospital personnel on duty are
also members of the In-Hospital Response Team (Refer to the Code Alert
System for human resource requirements). But at the minimum, the key
staff would consist of:
a. Head of Emergency Unit/Department
b. Triage Officer and team
c. Treatment Officer and team
d. OR personnel 47
C2.4b. On-Scene Response Team

This is a small group of competent and certified physicians, nurses, ad-


ministrative workers (utility workers) and drivers deployed to the emer-
gency/ disaster site outside the hospital for external emergencies and/or
inside the hospital for internal emergencies. They are responsible for the
management of the field/on-site activities from assessment, triage, treat-
ment, evacuation and transport in coordination with the Command Post/
Hospital Operation Center, Receiving Hospital Facility and the CHD and
HEMS Operation Center. (Other details are in Section 4. Deployment of
Response Teams.)

The on-scene response team is composed of:


a. On-scene Response Officer (Team Leader)
b. Surgeon/Anesthesiologist
c. Internal Medicine
d. Nurses/EMT
e. First Aiders/Helpers
f. Driver

D. Physical Infrastructure Development

The physical infrastructure is a critical resource to be examined in the hospital’s


preparedness for health emergencies. The relevant sections of the WHO-WPRO
Field Manual for Capacity Assessment of Health Facilities in Responding to Emer-
gencies may serve as a guide in such a review process for the hospital in general
and for particular sites. (WHO-WPRO, 2006)

The physical infrastructure involved are:

1. Health Emergency Management Unit/Office

The HEM unit/office is in compliance with A.O. 168.s 2004, “The National Policy
on Health Emergencies and Disasters,” which provides that, where feasible, the
hospital may provide separate physical space for a Health Emergency Manage-
ment Office/Unit/Program under the supervision of the Chief of Hospital. Often,
the unit/office is located in the mother unit of the designated emergency coordi-
nator and assistant coordinator who perform these roles as concurrent functions.

2. Hospital Operations Center (Hospital OpCen)

This is the Nerve Center with the ability for command, control, coordination and
communication in dealing with emergency or disaster situations. This is where
the Incident Commander and his staff are located, and thus constitutes the head-
quarters or focal control point from which the hospital emergency response plan
is directed and coordinated. (Details of the physical design and functions are in
Section 5.)

3. Hospital Service Areas

48 It is essential that certain areas of the hospital be designated for specific functions
such as reception of casualties, treatment, and discharge of patients (DOH-SDP,
2000b). The plan should be specific as to the function of these areas, staffing re-
quirements, basic supplies to be utilized, and other necessary features like venti-
lation, alternative sources of energy, communication, and waste disposal. Some
considerations in hospital design, energy source and communications are given
in Annex 1. The development of these areas may involve either the improvement
and/or upgrading of existing areas or construction of new ones as deemed ap-
propriate for the hospital in compliance with the technical requirements of such
areas. The hospital must have the following areas for managing health emergen-
cies:

a. Emergency Room – Most important area for reception of mass casualties,


triage and treatment. The emergency room must have:

■ Reception Area/Admission – The area should be available on short notice


to receive multiple casualties for registration and admission.

■ Triage Area – The primary function of a triage area is rapid assessment


of all incoming casualties, the assignment of priorities for management,
and distribution of patients to various other patient care areas in the hos-
pital. Without a triage area to manage the patient flow, the major treatment
area may become overloaded.

■ Decontamination Area – Physically located before the entrance of the


emergency room, the decontamination area is provided with facilities for
security and privacy of the patient, bathing of the patient, disposal of con-
taminated clothing and other materials, contaminated water disposal/drain-
age, and draping of decontaminated patients and decontamination team.
The decontamination team members should be provided with the appropri-
ate personal protective equipment. Decontamination is not routinely done

Figure 6. Patient Care Stations


Establishing a Mass Casualty Management System

Hospital Reception -- Flow of Victims


Operating
Accident Command Theatre
and “E” Post
Department
Yellow
Red Area
Red
Triage Yellow
Area
Green

Holding Area

Provision for Secondary Evacuation Green

Source: Sixth Inter-regional Course on Public Health and Emergency Management in Asia and the Source: Sixth Inter-regional 49
Course on Public Health and Emergency Management in Asia and the Pacific (PHEMAP), WHO (WPRO, SEARO) and ADPC, 2006.
to all patients. It is specifically used only if there is a high index of suspi-
cion for biological, chemical and radionuclear incidents.

■ Patient Care Stations – One suggested method of organizing patient


care stations is the designation of areas physically located in the Emer-
gency Department for color-tagged patients (See Figure 6) (WHO and
ADPC, 2006). Stations may be designated as:
Red – Immediate Care Area: red tag patients
Yellow – Urgent Care Area: yellow tag patients
Green – Delayed Care Area: green tag patients

b. Admission Pre-surgical Holding

Most trauma patients stabilized in the Red Area (emergency department)


will be sent to the Admission Pre-surgical Holding area.

c. Operating Room

The number of operating rooms that can be staffed is the main limiting fac-
tor in the provision of definitive care for a large number of severely injured
casualties. The most senior surgeon available must take the responsibility to
prioritize and assign cases as rapidly as possible.

d. Intensive Care Units (Coronary/Medical/Surgical)

e. Special units
■ Burn Unit
■ Toxicology Center
■ Infectious Units (isolation rooms for SARS, etc)
■ Disability Care

f. Ancillary units
■ Laboratory
■ X-ray/other Radiologic Services (CT Scan, MRI, etc.)
■ Blood Bank Facilities

g. Psychosocial Care Area

This is physically located in a designated area in the out-patient department for


individual and group consultations. Hysterical and difficult to control persons,
whether patients, visitors or staff, who can be extremely disruptive to hospital
disaster operations shall be placed in a separate isolated area and later trans-
ported to Regional Centers and/or the National Center for Mental Health.

h. Morgue

Many disasters can result in a large number of fatalities. This may require that
present morgue capacities be expanded or other outside facilities (such as
a church or stadium) be temporarily utilized. The disposal of the dead shall
follow the existing standard operating procedure for hospitals and the relevant
50 guidelines from the National Policy on Management of the Mass Dead.
i. Family Waiting Area

A separate area must be pre-designated for family members seeking information.


Previous experiences with disasters have shown that families and friends would
converge en masse to the hospital seeking information about victims. This con-
vergence can seriously interfere with efforts of the hospital to respond effectively
to the situation. This area may also be utilized to discharge in-hospital patients
and victims of the disaster.

j. Social Worker Office/Area

Given the confusion and the anxiety of converging families and friends of the
victims, an area is designated to allow prompt, systematic and compassionate
technical assistance for families inquiring about and seeking access to support
from government and nongovernment resources.

k. Accommodations for Responders

Sleeping/rest areas are provided to responders in-between duty shifts.

l. Media Room

There should be a designated area to hold and brief the media. The room should
not be near the area where patients are treated like the Emergency Room or the
Operating Rooms. Furthermore, provision should be made to conduct regular
press conferences or give out press releases.

E. Systems Development

The effectiveness and efficiency of Health Emergency Preparedness and Response


of a health facility entail an understanding of a system’s perspective – the develop-
ment of “connected parts functioning together for a common goal.” Given the com-
plex nature of an all-hazard approach, some of the component systems by them-
selves are unique to the approach (such as the Early Warning and Alert System and
Mass Casualty Management). The others are existing ones that need to be modified
to support the approach (such as Training, Logistics, and Information Management).

These systems, guidelines and protocols specific to the hospital setting need to be
described in the plan (Go, 2007). The hospital shall review and adapt the following
components (presented in the indicated sections in Part III of this manual) as appro-
priate to their vulnerability assessment and defined level of function:

1. Early Warning and Alert System Section 6


2. Damage Assessment and Needs Analysis/
Rapid Health Assessment Section 7
3. Emergency Operations Center Section 5
4. Mass Casualty Management System Section 8
5. Management of Mass Dead and Missing Section 9
6. Public Health Services Section 10
7. Mental Health and Psychosocial Support Section 11
8. Coordination and Networking Section 12 51
9. Human Resource Development Section 13
10. Logistics Section 14
11. Information Management Section15
12. Health Promotion and Advocacy Section 16A
Risk Communication and Media Management Section 16B
Risk Communication in Hospitals Section 16C
13. Health Systems in Emergency/Disaster Section 17
14. Evaluations Section18
15. Research and Development Section 19

In the design of these systems, the hospital develops or adapts the policies, guide
lines and protocols that have been set at the national level for activation during the
Emergency Response, as follows:

1. For Adoption/Adaptation

■ Early Warning System/Code Alert System/Integrated Code Alert System


(A.O. 182 s. 2001; A.O. 2008-0024)
■ Health Emergencies and Disasters (A.O. 168 s. 2004)
■ Logistics Management System – on Donations (A.O. 2007-0017)
■ Mass Casualty Management (A.O. 155 s. 2004)
■ Management of the Dead and the Missing (A.O. 2007-001B)
■ Health Information Management System (D.O. 1-J, s. 2003)
■ Coordination, Networking, and Referral System (A.O. FAE 007 s.1998)
(for Metro Manila only)
■ Resource Mobilization – (A.O, 13 s. 199; Memo No. 120 s. 2003)
■ Manual on Treatment Protocols of Common Communicable Diseases
and Other Ailments During Emergencies and Disasters
■ Guidelines on WMD Response for the Philippines (A.O. 155)
■ Key Health Messages for Emergencies (compendium)

The policies cover specific provisions for operations such as emergency dis-
patch, identification of the dead, etc. and for organizational structure, human
resource development, logistics, communication, information management,
networking and collaboration, and finance in support of the response operations.

2. For Adaptation from Other Offices

■ Epidemiology and Surveillance


■ Guidelines on Control of Communicable Diseases
■ Guidelines on SARS, Emerging and Re-emerging Infections
■ Guidelines on Infection Control (Hospital SOP)

3. For Development

■ Guidelines and Procedures in Evacuation


■ Public Information System and Management of the Media
■ Guidelines on Risk Communication
■ Guidelines on Communication
■ Guidelines and Procedures on Emergency Response
52 ■ Guidelines on Biological, Chemical, Radio-Nuclear and Explosives
■ Others
The hospital should not be limited to developing/adapting its policies and guidelines to
the aforementioned existing ones. It should be continuously vigilant in identifying con-
cerns that can be addressed by policies/standard procedures.

Overall Framework for the Health Emergency Management System: 10 P’s

The ten essential elements known as 10P’s derived from the two landmark administra-
tive orders A.O. 168 and A.O. 155 provide an overall framework for the hospital in the
establishment and enhancement of the Health Emergency Management System. The
standards and targets set for each element are shown in Table 4.

Table 4. 10 P’s of Health Emergency Management (Based on A.O. 168 and A.O. 155)

10 Ps Standards Targets

1. Policies Organizational Structure > All Health Care Facilities (HCF) have
> HEM Office/Unit HEM Office/Unit under the head of office
> HEM Coordinator > All HCF have HEM Coordinator/Assistant
> Crisis and Consequence Coordinator
Management Committee > All HCF have Crisis Management Com-
> Official Spokesperson mittee
> All HCF have Official Spokesperson

Systems on: > All HCF have support systems for efficient
> Logistics Management and effective emergency management
> Public Information
> Information Management
> Communication
> Crisis Management
> Code Alert
> HEICS/REICS
> HEARS
> MCM and MDM
> Documentation of lessons learned
Protocols > Resource Mobilization > Resource Mobilization
Procedures > Public Information and Media > Public Information and Media Management
Guidelines Management > Information Management
> Information Management > Communication
> Communication > Code Alert and Early Warning
> Code Alert and Early Warning > HEICS/REICS
> HEICS/REICS > HEARS
> HEARS > Networking and Referral
> Networking and Referral > MCM and MDM
> MCM and Management of Dead > Documentation
and Missing (MDM)
> Documentation

2. Plans HEPRR Plan or Risk Reduction Plan > All HCF have written, accessible, available,
■ Emergency Preparedness Plan applied, and tested HEPRR Plans
- Hazard Prevention Plan > HEPRRP approved and disseminated
- Vulnerability Reduction Plan > HEPRRP reviewed and updated at least
- Capacity Development Plan once a year after a drill
■ Emergency Response Plan
- Search and Rescue/Recover
- Evacuation/Temporary Shelter
- MCM and MDM
- Security
■ Emergency Recovery Plan

3. People Human Resource Development > Hospital Response Teams composed of


Human Resource Trauma and Mental Health personnel 53
Continuation of Table 4
10 P’s Standards Targets

> Organized Response Teams > Regional Response Team composed of Public
Health Personnel from Surveillance, Nutrition,
Environmental, Water and Sanitation

Capability Building (Training) > All health workers


> Basic Training on HEM > All health workers
> BLS-CPR > All ER medical staff
> ACLS > All ER medical staff
> PCLS > All responders
> EMT-B > All responders
> MCM > All emergency managers (Public Health)
> PHEMAP > All emergency managers (Hospitals)
> HOPE/ HEART

Responders’ Welfare/Safety > All responders have Identification documents


> Proper identification and and uniform
uniform > All responders have personal protective
> Proper personal protective equipments (PPE’s)
equipment > All responders have orientation on risks and
> Orientation before deployment hazards involved in the operation
> Simulation exercises, stress management,
> Physical & psychological respite care for all responders
fitness

Recognition of Outstanding > Given to all responders for outstanding perfor


Performance mance
> Rewards and incentives

Knowledge and Skills > Mechanism for certifying, updating and con
Enhancement ducting refresher courses

Inventory of Expertise > Developed inventory of available human


resources based on expertise

4. Partnership > Establishment of HE Network > Establishment of internal network (within


Building DOH)
> Establishment of external network (Health
Sector)
> Established national and regional health,
water and sanitation and hygiene (WASH),
and nutrition clusters
> Established national and regional health
sector
> Established hospital network including blood
network in emergency
> Conduct of regular coordination meetings,
> Networking Activities forums
> Conduct of sectoral activities like drills, skills
bench-markings, Post- Incident Evaluation (PIE)
> Referral System > Establishment of Network Referral System

5. Program > Development/integration of > Risk Reduction Programs


Develop- programs in support of HEM 1 Mental Health and Psychosocial Support
ment 2 Nutrition Program
3 Environmental Sanitation Program
4 Hospital Poison Control Program
5 Weapons of Mass Destruction (WMD)
Program, etc.
> DOH Health Programs related to HEM
- Safe Hospital Program
- Blood Network in Emergency
> Research and Development Program
> Advocacy Programs
54
Continuation of Table 4
10 P’s Standards Targets

6. Physical Infra- > Upgrading of health facilities > All HCF have 24/7 OpCen
structure > All HCF have HEMS Office
Development > All hospitals have equipped emergency rooms
(ER’s)
> Tertiary hospitals have special units based on
designation:
- Burn Unit
- Trauma Unit
- Psychosocial Care Ward
- Infectious Ward (Isolation Ward)
- Decontamination Area
- Ward for Biological, Chemical, Radio-
nuclear and Explosives (BCRNE) cases
- Laboratories to support designated functions
- Blood Banks to address needs for MCI
> All responding hospitals equipped with
ambulances
> Receiving hospitals have equipped ER to
respond to at least 5 red-tagged patients

7. Practices > Documentation of HE > Case Reports


experiences, good and > Research Studies
innovative practices > Publications
> Post-Incident Evaluation

8. Peso and > Allocation of funding for HE > Allocation for Preparedness activities from
Logistics activities annual budget
> Allocation of fund for emergency operations
> Available petty cash for emergency purchase
of drugs, medicines, supplies, etc.
> Developed DOH Emergency Health Kit
> Buffer stocks of medicines (10%) of available
stocks

> Communication equipment > HEM Coordinators entitled to cell card


al lowance
> HEM Coordinators in Metro Manila and
nearby regions have hand-held radios/base

> Transport > Hospitals have designated ambulance for


emergencies with equipment, supplies and
communication

> Supplies/materials > All CHDs/hospitals have mannequins and


training manuals for training

> Drugs and medicines > All HCF have stockpile of drugs and medi-
cines for emergencies
> Pre-positioned medicines, drugs, medical
supplies, and DOH Emergency Health Kits

9.Health > Advocacy/IEC > HE-related posters, flyers, advisories, stickers


Promotions > Public information prototypes
> HEM orientations and trainings for leaders,
managers, responders, OpCen staff, trainers,
community and media
> Radio plugging
> TV interviews
> Speakers’ bureau and kit with key messages
> Audio-visual presentations
> Celebration of National Disaster Conscious-
ness Month (July)
> Disaster Prevention Week (December)
55
Continuation of Table 4
10 P’s Standards Targets

10. Package > Identified package of services for the > Developed/adapted packages
of Services community, evacuation centers,
regions, hospitals, etc.; direct service/
technical assistance
- Patient care
> Public health services delivered

56
3 Activities During the Response Phase
Guided by the hospital HEPRR plan, the Response Phase deals with resource mobili-
zation for the consequences of the hazard that has occurred or will occur (impending
typhoon, civil disturbance, etc). It is aimed at the following (WHO, ADPC, 2006c):

• Preventing or reducing the exposure of the hospital staff and patients to the con-
sequences of the hazard (e.g., isolation measures).
• Enhancing the resistance of the casualties and general population to a hazard
after exposure (e.g., immunization).
• Promoting healing of mass casualty incident victims and the general population
from the consequences of a hazard (e.g., provision of definitive care, mental
health and psychosocial services).
• Providing culturally acceptable care of the fatalities and the bereaved.

The mobilization involves a sequence of activities for the activation and termination
process and a dynamic interplay of activities for the management of operations and cor-
responding support. Some examples of Standard Operating Procedures are provided in
selected activities.

A. Activation

1. Activation of the Alerting Process

1.1 Declaration

As provided in the Integrated Code Alert System, 2008 (See Section 6.1),
the Hospital Code Alert shall be declared by the Secretary of Health or by the
Director of HEMS in cases of external emergencies; and by the Medical Cen-
ter Chiefs, Chiefs of Hospital or Hospital HEMS Coordinator, for emergencies
within their catchment area. The alert level is raised, lowered or suspended by
these authorities or their designates. The designates who receive and give the
initial notification have been pre-assigned on a 24-hour basis per day to en-
sure notification during the evening hours, weekends and holidays.

Conditions to raise or suspend the alert level


• Raise - arrival of patients in the hospitals to warrant raising; increase in
threat.
• Suspend/terminate – when threat is no longer present; when no signifi-
cant incident is monitored and the hazard or condition (typhoon, elec-
tion, bombing, etc.) is finished and/or contained

1.2 Notification

Notification is carried out within the hospital following the prescribed process,
which specifies the chain of command in notifying those on duty and other
appropriate hospital staff of the hospital’s status. In case of problems in the
system, the alternative system of notification, which is adapted to the hospi-
tal’s realities of people, equipment and procedures, is activated. Example: In
the case of fire, any person with knowledge of the situation immediately
activates the fire alarm system of the hospital. Although there are guideline
57
for the code alert, each hospital shall develop their own procedures for
activating, elevating and suspending the code.

2. Activation of the Plan

With the declaration of the code alert, the plan is activated. Depending on the
alert level status, corresponding human resource and other requirements are
mobilized.

3. Activation of the Hospital Operations Center

For the Operations Center, the earliest response mechanism is established at


the lowest alert level – Code White. Non-permanent centers are activated within
one hour and secured. This serves as the Command Post when Code Blue is
raised.

The Hospital Operations Center continuously reports and coordinates with the
Regional and National HEMS Operations Center and with Regional/Provincial
Disaster Coordinating Councils. In the event of failure of existing communication
system, the alternatives are activated.

4. Activation of the Hospital Emergency Incident Command System (HEICS)

Under Code Blue, the HEICS is immediately established using the six-step
response for critical incident management.

Step 1. Assume command. Someone should immediately assume command.


Step 2. Assess situation. Assess magnitude of the incident from sources and
the network.
Step 3. Identify critical areas. These include emergency rooms, decontamina-
tion, triage, treatment, security, media, etc.
Step 4. Activate or identify the Operations Center. Coordinate with HEMS
Opcen; assign staff and ensure communication system is in place.
Step 5. Identify the Safety Officer. The Safety Officer is the one to go around
the compound to ensure safety of the staff, the hospital, and patients.
Step 6. Secure the hospital and critical areas. Identify area for ambulances,
points of ingress and egress.

Job actions sheets are distributed to designated officers. The Incident Commander
initiates the incident management process which describes an ordered sequence of
actions that (WHO, ADPC, 2006):

• Establishes incident goals (where the system wants to be at the end of re-
sponse).
• Defines incident objectives (how to get there) and strategies to meet the de -
fined goals.
• Adequately disseminates information, including the following, to achieve co -
ordination throughout the incident:
– Response goals, objectives and strategies
– Situation status reports
58 – Resource status updates
– Safety issues for responders
– Communication methods for responders
• Evaluates strategies and tactics for effectiveness in achieving objectives and
monitors ongoing circumstances.
• Revises the objectives, strategies and tactics as dictated by incident cir-
cumstances.

The outputs of these actions are:


• Incident Action Plan
• Establishment of:
- Gold or Strategic Command – These are the people managing the
event, providing strategic direction as well as policy direction. In the
hospital, this is the Incident Commander together with the heads
of the Operations, Planning and Administration. Their role is to plan,
assess and give directions, respond to media, etc. They should not
micromanage.
- Silver or Tactical command – These are the people receiving orders
from the gold. They carry out the orders by supervising their people.
In the hospital setting this could be the heads of the emergency room,
the Logistics Officer, the Administrative Officer, etc. They ensure that
the needs and requirements are met.
- Bronze or Operational Command – In the hospital setting, these are
the doctors treating the patients, the social workers listening to the
relatives, the psychosocial worker doing debriefing, etc.

B. Operations/Support Management

5. Implementation of the Response Standard Operating Procedures/Protocols


for Internal and External Emergencies

These procedures/protocols include (WHO, ADPC, 2006):

5.1. Callback/management of staff

The notification process of staff mobilization – deployment or stand-by – is


carried out as prescribed according to the alert status level. The staff should
have the proper identification to gain access to the hospital when called back
on duty.

5.2. Management of field/on-site activities

a. Deployment of on-scene response team


(SOP I: Standard Operating Procedure on Information and Dispatch)
b. Predetermination of field areas by the first responding team
c. Assessment of scene using Rapid Health Assessment
d. Establishment of Command Post or linkage with Command Post through
Field Medical Commander as Incident Medical Commander (Unified
Medical Command); assignment of a Field Medical Commander in cases
of multiple on-scene response teams
e Conduct of measures for site safety
f. Establishment of Advance Medical Post 59
(SOP II: Site Selection, Signage and Logistics)
g. Evacuation and transport
h. Establishment of Field Hospital/evacuation site or temporary shelter
i. Triage (second at Advance Medical Post, third during evacuation/transport)
j. Evaluation, care (first aid, medical care, etc) and stabilization of casual-
ties at impact site, Advance Medical Post, and during evacuation/
transport
(SOP III: Handling off Equipment Attached to Patient)
k. Continuing coordination/monitoring with Regional/ DOH Central Opera-
tions Center and receiving hospital
l. Extension of services/termination of operations
m. Post-mission debriefing
n. Accomplishment of reporting forms – HEARS Field Report, Rapid Health
Assessment Forms, Inventory Checklist, List of Casualties, Patient List,
Mass Casualty Case Record, Health Situation Updates, Post-Mission
Reports, Final Reports

5.3. Management of Emergency Department /Unit

This includes designation of area and provision of skilled personnel and


logistics for handling multiple casualties.

5.4. Management of casualties

• Availability of Emergency Unit/ Department at short notice to receive mul-


tiple casualties who are identified, registered, triaged and treated in des-
ignated treatment areas, and admitted or transferred (SOP III: Handling of
Equipment Attached to Patient)
• Implementation of procedures for:
- clearance of all non-emergency patients and visitors from the emer-
gency department;
- cancellation of all elective admissions and elective surgery;
- determination of rapidly available or open beds; and
- determination of the number of patients who can be transferred or
discharged

5.5. Timely provision of 24-hour services by the following:

• Administration
• Emergency
• Nursing
• Radiology
• Laboratory including Blood Bank
• Pharmacy
• Critical Care
• Central Supply
• Maintenance and Engineering
• Security
• Dietetics
• Housekeeping and Laundry
60 • Psychosocial/Pastoral
• Mortuary

These services are for mass casualties, patients, hospital staff and responders.

5.6. Maintenance of 24-hour supply of drugs, medical supplies, diagnostic sup-


plies (e.g., X-ray films, laboratory reagents), and equipment; also including
management of donations

5.7. Management of logistic and personnel support by concerned units for:

• Beds
• Retention and safekeeping of personal items removed from casualties
• Isolation of victims with communicable diseases
• Segregation/isolation of victims contaminated with hazardous materials

5.8.Management and use of ambulance

5.9. Assessment and maintenance of security services, particularly the protec


tion of critical services

5.10. Assessment and maintenance of communication services, including the


activation of an alternative communication system

5.11. Management of Internal and External Traffic Flow and Control, including
secured traffic access to the Emergency Department and controlled access
to allow timely ambulance turnaround

5.12. Management of Hospital Evacuation/Relocation of Patients and Staff, in


cluding use of alternative sites when original area is unavailable

5.13. Management of volunteers for medical and other services

6. Provision of the Public Health Services of the hospital which includes:

6.1. Damage Assessment and Needs Analysis/Rapid Health Assessment


6.2. Establishment and maintenance of Epidemiologic Surveillance System
6.3. Immunization
6.4. Therapeutic Nutrition Services
6.5. Laboratory Services (diagnostic)
6.6. Provision of Blood Services
6.7. Communicable Disease Prevention and Control
6.8. Management of the Dead (Identification of the dead/Mortuary)
6.9. Health Promotion and Advocacy/Risk Communication in Public Informa-
tion and in Media Management

7. Initiation and maintenance of coordination and networking for referral of


cases

8. Initiation and maintenance of Mental Health and Psychosocial Support


Services for casualties, patients, hospital staff, other responders, and the
bereaved 61
9. Management of information – Monitoring of Plan

- Recording and reporting procedures, e.g., accomplishment of reporting


forms (Inventory Checklist, Health Situation Updates, Post-Mission Reports,
Final Reports)
- Documentation of processes

10. Activation of plan in the event of complete isolation of hospital for


auxilia ry power, water and food rationing, medication/dressing rationing,
waste and garbage disposal, staff and patient morale

C. Extension/Termination

11. Declaration and Notification Process for:

- Continuation of or change in alert status (extension of services)


- Termination/closedown of Command Post/Operation Center

12. Conduct of Post-Incident Evaluation

13. Review and Updating of Plan including amendments to policies and


procedures

62
4 Activities During the Recovery/Reconstruction
Phase

The recovery phase is aimed at the return of the response personnel and the hospital to
normal operations the earliest time possible. The activities for this phase are described
below.

A. Activation

1. Activation of the Recovery Plan. There is no identified time for the activation
of the Recovery Plan. It may start immediately after the response. Unlike the re-
covery plan for the communities, the hospital can initiate activation as soon as
possible. Hence the recovery plan can be activated right away.

B. Operations/Support Management

2. Suspension of the HEICS. This is done as soon as possible as the code alert is
lifted, then the hospital returns to its pre-disaster situation.

3. Implementation of the Recovery Standard Operating Procedures/ Protocols


for Internal and External Emergencies. These include (WHO, ADPC, 2006e):

3.1. Assessment – Damage Assessment and Needs Analysis

3.2. Provision of services

a. Provision of mental health and psychosocial services for both acute and
long-term physical and mental health effects sustained by mass incident
casualties and hospital staff during the response.
b. Continuing provision of hospital medical services.
c. Continuing surveillance – water and sanitation, food safety, emergent and
re-emergent endemic diseases, nutritional status.

3.3. Management of hospital facilities/logistics

a. Evaluation, clean-up and/or repair of damages to the hospital building/fa-


cilities/equipment; may include, where necessary, relocation of hospital
site/facilities.
b. Accounting and recording of available and utilized materials, medicines,
supplies and equipment, indicating also their respective sources.
c. Estimating cost of damages and response.
d. Requisitioning and replenishment of utilized materials and logistics.
e. Decontamination of areas, ambulance and equipment.

3.4. Management of Human Resource

a. Awarding and recognition rites for responders.


b. Provision of overtime compensation for responders.
c. Provision of assistance to hospital staff. 63
d. Re-training of hospital on technical and administrative procedures.

3.5. Maintenance of Coordination

Continuing coordination with HEMS and with the Regional Office is main-
tained to report the return of hospital to normal operations and the completion
of its recovery.

3.6. Information Management

a. Monitoring of Plan
b. Recording and reporting procedures
c. Documentation of processes

C. Termination

4. Conduct of in-depth evaluation of how the response system functioned


under stress. Based on the identified strengths and weaknesses, strategies are
proposed to improve the hospital’s capacity to respond to future emergencies
and disasters, particularly in hazard-prone regions.

5. Review and update of the Hospital HEPRR plan and procedures. The modifi-
cation reflects the application of the lessons learned.

64
65
Guidelines Part III
66
SECTION 1
Policy Formulation Guide

Policy ensures that common goals and practices are followed within and across orga-
nizations and activities. It provides the legal basis for actions and protects people from
liability. Policies may vary in form, from legislations to decisions by the executive gov-
ernment to inter-organizational agreements, depending on the scope of the policy and
the level of authority required.

There are certain requirements in policy development, such as: the legal mandate of
the institution; the authority (national, regional, hospital, local) of the agency; manage-
rial and technical competence (as in technical writing, etc); political will and support from
the head of the agency; and acceptability and doability of the policy (WHO and ADPC,
2006).

POLICY CONTENT

The parts of a policy are described below. To illustrate, examples from Administrative
Order No. 168 s. 2004: “National Policy on Health Emergencies and Disasters” are
given for some parts.

• Background/Rationale – the present situation or condition of the country, re-


gion, community or hospital-relevant emergencies or disasters, leading to the
reasons that triggers the development of the policy
• Definition of Terms – list of words or terminologies seen in the policy which are
not commonly used, or which are highly technical, and merit explanation
• Objectives – itemized reasons why this policy is being developed; everything
stated in the policy must address or attain the objectives
• Scope and Coverage – the extent and limitations of who will implement and the
application of the policy
• Framework of Health Emergency Management – includes the vision, mission,
goals/objectives
• Strategies – detailed scheme for reaching a goal or intention which will be the
basis for making activities
• Policy Statements – broad statements that express a set of goals, the priorities
within those goals, and the preferred strategies for achieving those goals; give
direction in achieving the goal

Example:

A.O. 168 policy statements cover:


■ Organizational Structure
■ Human Resource Development (Capability Building)
■ Support System (Logistics, Media Management, MIS,
Communication, System of Documentation, etc)
■ Program Development
■ Program Components
■ Networking and Collaboration
■ Finance 67
• Implementing Mechanism – includes the roles and responsibilities of the imple
menters in achieving the goal

Example:

A.O. 168 s. 2004 implementers consist of:


■ Department of Health
■ Hospitals
■ Centers for health development
■ Other government agencies
■ Nongovernment organizations
■ DOH central offices

PROCESS

The policy development process may be a sectoral task, i.e., within the Department of
Health, as the crafting of Administrative Order 168 s. 2004. Or it may be a multi-sectoral
undertaking with key partner agencies of the Department of Health, such as the formu-
lation of Administrative Order No. 2007- 001B: “National Policy on the Management of
the Dead and Missing Persons During Emergencies and Disasters.”

These two policies, milestones in the country’s Health Emergency Management work,
are used as policy prototypes to guide the hospital in formulating its own policy. Table
S1.1 compares the content of these two policies where A is A.O. 168 s. 2004 and B is
A.O. 2007-001B. Policy A, providing the overarching policy, is focused on roles and
responsibilities, while B, an amplification of one element in Health Emergency Manage-
ment (i.e., management of the dead) provides details of guidelines and procedures.

Note that the policy identification number follows the existing standard within the Depart-
ment of Health. Earlier practice had the year indicated as the series, e.g., Series 2004.
The sequence was modified in 2007 with the first four figures representing the year of
issuance.

While seven elements are constant (namely, Background, Objectives, Scope and Cov-
erage, Definition of Terms, Separability Clause, Repealing Clause and Effectivity), the
number of sections representing the main body (e.g., Sections V to VI in A.O. 168 and
Sections V to VIII in A.O. 2007-001B) varies depending on the subject of the policy. An-
other difference is the description of details for a given section. To illustrate, the eighth
section on Implementing Mechanism may contain a general description of a structure
established by the policy (A.O. 2007-001B) or if there is no new structure, the roles and
responsibilities of specific units/groups (A.O. 168).

68
Table S1.1. Comparison of Policy Content of A.O. 168 s. 2004 and A.O. 2007-001B

NATIONAL POLICY
A B

Administrative Order 168 s. 2004: Administrative Order No. 2007- 001B:


“National Policy on Health Emergen- “National Policy on the Management
cies and Disasters” of the Dead and Missing Persons Dur-
ing Emergencies and Disasters”

ELEMENTS

I. Background and Rationale I. Background and Rationale


II. Definitions II. Objectives
III.Objectives III.Scope and Coverage
IV. Scope and Coverage IV. Definitions of Terms
V. Framework of Health Emergency V. Guiding Principles and Operational
Management Framework
- Vision - Guiding Principles
- Mission - Operational Framework
- Goals/Objectives - Emergency Preparedness, Re-
- Strategies sponse and Recovery Plan
V. Policy Statements VI. Key Components
VI. Implementing Mechanism VII. Guidelines and Procedures
- Roles and Responsibilities
VII. Separability Clause VIII. Implementing Guidelines
-Structure
- Roles and Responsibilities
VIII. Repealing Clause IX. Separability Clause
IX. Effectivity X. Repealing Clause
XI. Effectivity

69
SECTION 2
Guide to Formulation of Hospital HEPRR Plan

The planning committee formulates and documents the HEPRR plan guided by the fol-
lowing outline (Go,2007; WHO and ADPC, 2006). Detailed instructions on how to pre-
pare each part of the plan, as well as illustrative examples, are provided throughout the
outline.

I. BACKGROUND

Write a narrative on the background of your hospital and its catchment area, location
with reference to national geography, and location of the facility in the community/
LGU, using the template below. Present the qualitative or quantitative data/infor
mation either as narratives or as tables, graphs, illustrations and maps for easy, fast
and better understanding of the reader.

1. Name of the hospital, category and address

2. Geographic description of the hospital and its catchment area


■ Description of the community/catchment area – total land area
◆ Along the coastal area
◆ Location in relation to a fault line (e.g., West Valley)
◆ Low-lying area
◆ Location in relation to other hazardous elements like oil depot,
industrial establishments, military camps, etc.
■ Distribution and concentration of vulnerable populations (squatters
area, land-locked or water-locked area, etc.)
■ Characteristics of the location of the hospital – total area, terrain, built
on a hill, along the river bank, along the railroad, etc.

3. Demographic profile
■ Of the hospital’s catchment area – provinces, municipalities and cities
◆ Population
◆ Population density
◆ Number of households
◆ Number of barangays
◆ Number and names of health emergency-related agencies in the
catchment area (e.g., BFP, private EMS, DSWD, other government
agencies, and NGOs)
■ Of the hospital
◆ Category of the hospital (primary, secondary, tertiary)
◆ Authorized bed capacity
◆ Government or private
◆ Services delivered
◆ Other relevant information to reflect capacity of the hospital to
manage emergencies

4. Health statistics
70 ■ Of the catchment area - provinces, cities, municipalities
◆ Leading causes of morbidity and mortality
◆ Infant mortality rate
◆ Maternal mortality rate
◆ Malnutrition rate
◆ Vaccination coverage
◆ Indicators for basic hospital services, basic health services and
preventive health programs
■ Of the hospital
◆ Leading causes of morbidity and mortality
◆ Leading causes of consultation
◆ Leading causes of discharge
◆ Infant mortality rate
◆ Maternal mortality rate
◆ Malnutrition rate
◆ Vaccination coverage
◆ Indicators for basic hospital services
◆ Indicators for basic health services and preventive health programs

5. Health facilities
■ In the catchment area – provinces, cities, municipalities indicating if
government or private
◆ Hospitals (private, LGU; category – primary, secondary or tertiary)
◆ Lying-in clinics, birthing places
◆ Laboratories
◆ Blood banks
◆ Halfway houses
◆ Health centers, etc.
6. Health facilities (hospitals) with special areas/services
◆ Burn unit
◆ Trauma unit
◆ Isolation rooms
◆ ICU, CCU, NICU
◆ Decontamination area
◆ Reference laboratories
■ Inventory of resources or assets of hospital in all various services
◆ Emergency Room
◆ Operating Room
◆ Nuclear Medicine
◆ Radiological Service
◆ Laboratory
◆ Others

7. Health human resource


■ Of the catchment area by facility and administrative area – province, city,
mu nicipality
◆ Physicians
◆ Nurses
◆ Midwives
◆ Sanitary engineers
◆ Sanitary inspectors
◆ Nutritionists/dieticians 71
◆ Health promotion officers
◆ Dentists
◆ Laboratory technicians
◆ X-ray technicians
◆ Psychologists
◆ Barangay health workers
■ Of the hospital
◆ Physicians
◆ Nurses
◆ Midwives
◆ Institutional workers
◆ Engineers
◆ Nutritionists/dieticians
◆ Health promotion officers
◆ Social workers
◆ Dentists
◆ Medical technologists
◆ Laboratory aides
◆ Radiologic technologists
◆ Psychologists

8. Disasters that have occurred, including the lessons learned and the gaps in re -
sponse
■ In the hospital
■ In the catchment area

9. Legal basis whereby the hospital is authorized to act in disaster situations


■ Law creating the existence of the hospital (R.A.; E.O.)

10. Legal issuances detailing the roles and functions of the hospital in managing all
phases of emergencies or disasters (i.e., A.O. 168, A.O. 155, D.O. for Critical
Infrastructure, etc.)

II. PLAN DEFINITION


Briefly describe the content of the plan, the particular intent relevant to set goals and
objectives, coverage, scope and limitations. Include the legal basis, the authority for
the hospital to act in disaster situations, with the legal issuances detailing the roles
and functions of the hospital in managing all phases of emergencies or disasters
(i.e., A.O. 168, A.O. 155, etc.)

EXAMPLE: PLAN DEFINITION

The (Name of Hospital) Health Emergency Preparedness, Response and Recov-


ery Plan defines the direction of the hospital in preparing for effective and effi-
cient response and recovery in any event of emergency or disaster within its
facilities and/or its catchment area. This embodies a set of strategies and activi-
ties based on the hazards and vulnerabilities or risk analysis of the hospital and
its catchment area.
72
Content of the Plan

The (Name of Hospital ) Preparedness Plan contains strategies and activities


that the hospital will carry out to build and enhance its capacity to respond to
emergency or disaster, whereas its Response Plan lays down the strategies
and activities in utilizing hospital resources for effective and efficient response
during an emergency or disaster. Policies, protocols, guidelines and procedures
pertaining to various emergency management systems for more efficient re-
sponse are included. The third plan, the Recovery or Rehabilitation Plan contains
the strategies and activities in mainstreaming and/or restoring the facility and its
services back to its prepared position for any forthcoming eventuality.

The (Name of Hospital) Health Emergency Preparedness Response and Recov-


ery Plan contains the inventory of its internal and external resources, in the form
of inventory lists and directories, in the context of human resources, logistics,
financial sources, existing systems and services. These are all in the annexes of
the plan.

Scope of the Plan

This Plan shall be implemented by (Name of Hospital) together with, but not lim-
ited to, all the members of the health sector concerned with emergency or disas-
ter management in the catchment area.

III. GOALS AND OBJECTIVES

Write a statement of the purpose of the plan from broad to more specific perspec-
tives. A hierarchy of the intent is described through goals and objectives. Well-written
objectives are simple, measurable, attainable, realistic and time-bound (SMART).

EXAMPLE: GOAL AND OBJECTIVES

Goal:

To enhance the hospital’s capacity for prompt and effective attendance to the
largest possible number of people requiring medical and health care in a health
emergency or disaster ultimately reducing mortality, morbidity and disability and
promoting their recovery.

Objectives:

• To provide policy for effective response to both internal and external disaster
situations that will affect the operation of the hospital and its staff, patients
and the community.

• To identify the hospital’s capability to handle mass casualty.

• To identify responsibilities of individuals and departments in a disaster situation.

• To identify Standard Operating Guidelines for emergency activities and 73


responses.
• To document best practices and lessons learned during simulation exer
cises, emergencies and disasters.

IV. PLANNING GROUP/COMMITTEE

Describe the composition of the Planning Group/Committee and its functions, con-
sidering the realities of the existing committees and available human resources. This
part is one of the initial steps in the planning process.

V. MANAGEMENT STRUCTURES

Conduct a review of the existing committees and their performance of functions to


finalize the appropriate structure, i.e., use existing structures or develop new ones
for the Crisis and Consequence Management Committees and the Hospital Incident
Command System (HEICS).

VI. ROLES AND RESPONSIBILITIES

Describe adequately the capacity of the hospital either as a responding facility, a


receiving facility or both, indicating the bases for such capacity.

VII. HEALTH EMERGENCY PREPAREDNESS PLAN

A. HAZARD

A1. HAZARD ASSESSMENT

A1.1. Definition

Hazard assessment is the process of identifying all the possible hazards


with the potential to affect the community. This is done in order to have an
idea of the possible areas to be affected, to predict the vulnerabilities of
such areas, and to anticipate the possible consequences or risks of such
hazards in these areas. There are four types of hazards that may affect the
community and the hospital:
• Natural: Typhoon, earthquake, flood, landslide, tsunami, drought,
etc.
• Biological: Disease outbreak (dengue, cholera, SARS, avian influ-
enza, red tide, etc.)
• Technological: Chemical spill, food poisoning, fire, gas explosion,
mercury poisoning, etc.
• Societal: Rallies, stampede, war, armed conflict, etc.

Prioritizing the hazards is important for the purpose of equitable utilization


or distribution of existing meager resources in doing hazard prevention
activities. Hazards can be prioritized based on the following considera-
74 tions:
• Severity
• Frequency
• Extent
• Duration
• Manageability

A1.2. Mechanics of Hazard Assessment

1. Identify the all possible hazards that have affected or have the potential to
affect the catchment area and the hospital facility. Catchment area data
can be taken from the Center for Health Development. The hospital pro -
vides details based on observations of the locality.
2. Prioritize the hazards based on severity, frequency, extent, duration and
manageability. (A1.3.1.)

Example:

On a scale of 1-5 with 5 as the highest, rate each hazard by Severity,


Frequency, Extent, Duration, and Manageability. To get the total score for
each hazard, get the sum of the scores for Severity, Frequency, Extent
and Duration minus the score for Manageability [(A+B+C+D) – E]. Arrange
the hazard scores from the highest to the lowest. The highest score repre-
sents the highest priority, least manageable, and highest risk-developing
hazard while the lowest reflects the more manageable and least priority
hazard.

3. Prepare a hazard map. Indicate all the hazards that can possibly affect all
the areas. (A1.3.2.)
- Of the catchment area (CHD data)
- Of the hospital

A1.3. Format

A1.3.1. Hazard Assessment Matrices


Hospital Catchment Area and Hospital Facility
Hazard Severity Frequency Extent Duration Manageability Total
Natural
Biological
Technological

Societal
Hospital Service Areas
Hazards Vulnerable Hospital Areas
Fire
Earthquake
Volcanic eruption 75
A1.3.2. Hazard Map

• Layout/map all service areas of the hospital.


• Identify areas likely to be exposed to hazard.
• Pinpoint areas exposed to specific hazards.
• Place the code of hazard in each service area (numbers or color
codes).
• Place a legend.

EXAMPLE 1: HOSPITAL HAZARD MAP (NUMBER-CODED)

MEDICAL WARD
1,2,4

MAINTENANCE
2 PEDIA WARD
1,2,4

SURGICAL WARD
1,2,4

OB-GYNE WARD
RADIOLOGY DIETARY LAB 1,2,4
DEPT. 2,4,7 1,6 1,2,3,4

HOSPITAL LOBBY NUCLEAR MED.


2,5 DEPT.1,2,7

OPD
1,2,4,5

EMERGENCY ROOM
1,2,3,4
Legend:
1. Fire
2. Earthquake
3. Disease outbreak
4. Typhoon
5. Mass action
6. Food poisoning
7. Radio-nuclear incident
76
EXAMPLE 2: HOSPITAL HAZARD MAP (USING SYMBOLS)

MEDICAL WARD
✪,✸,❍
MAINTENANCE

PEDIA WARD
✪,✸,❍

SURGICAL WARD
✪,✸,❍

OB-GYNE WARD
RADIOLOGY DEPT. DIETARY LAB ✪,✸,❍
✪,❍,✰ ✪,✦ ✪,✸,■,❍

HOSPITAL LOBBY NUCLEAR MED. DEPT.


✸,❖ ✪,✸,✰
OPD
✪,✸,❍,❖ Legend:
✪ Fire
✸ Earthquake
■ Disease outbreak
❍ Typhoon
❖ Mass action
EMERGENCY ROOM ✦ Food poisoning
✪,✸,■,❍ ✰ Radio-nuclear incident

A2. HAZARD REDUCTION/PREVENTION PLAN

A2.1. Definition

A Hazard Reduction/Prevention Plan contains strategies and activities meant


to reduce or prevent the occurrence of hazards in the community and in the
hospital. The plan targets the hazard. To check if the plan is done correctly,
one must be able to answer this question: “If you carry out the strategy/activ-
ity you planned, will the hazard no longer occur in your community? In your
hospital?”

A2.2. Mechanics of Hazard Reduction/Prevention Planning:

Using the Hazard Prevention Plan Matrix below (A2.3):


1. List the identified hazards.
2. Identify the prevention strategies and the activities.
77
3. Write the time frame – when the activities will be carried out and finished.
4. Specify the resource requirements – the required resources, those
available, and the gaps or deficits, if any. Indicate the sources to fill the
gaps.
5. Assign the person responsible to carry out each activity and to source
out the lacking resource requirements.
6. Write the performance indicators, i.e., outcomes or evidences that ac-
tivities have been carried out or done successfully. These are the areas
for monitoring.

A2.3 Format

Hazard Reduction/Prevention Plan Matrix


Hazards Preventive Time Resource Person Indicators
Strategies/ Frame Requirements Responsible
Activities
Required Available Source

B. VULNERABILITY

B.1. VULNERABILITY ASSESSMENT

B1.1. Definition

In vulnerability assessment, it is important to identify the factors that increase


the risks arising from specific hazards. The presence of vulnerable areas
decreases the ability of the hospital to cope with the hazards. This process
determines the likely harm to the hospital. It determines the health needs
before, during, and after an emergency or disaster.

Example:

The Laboratory Room is vulnerable to fire with the use of volatile and
flammable gases or reagents in the routine examinations.

Hazard Fire
Vulnerable area Laboratory Room
Vulnerability of property Use of volatile and flammable gases or re-
agents in routine laboratory examination
Vulnerability of people Lack of knowledge on proper storage of
reagents
Vulnerability of services No alternate place of service delivery
Vulnerability of environment Lack of proper waste management

78
The details of a vulnerability assessment are provided in WHO-WPRO, A Field
Manual for Capacity Assessment of Health Facilities in Responding to Emergen-
cies, 2006. Vulnerability is categorized as:

• Structural – Related to construction of the facility.


• Non-structural – The non-structural elements of a building include ceilings,
windows, doors, mechanical, electrical, plumbing equipment and instal -
lations.
• Functional – There are three aspects: (1) deals with general physical lay-
out of facility, including location, accessibility and distribution of areas
within the facility; (2) individual services: medical (supplies and equipment)
and non-medical (utilities, transportation and communication vital to con-
tinuous operation of facility); and (3) public services and safety measures.
• Human Resources – Includes: organization of the health facility (e.g.,
emergency planning group, subcommittees); inventory and mobilization of
personnel; and preparedness activities for the personnel (e.g., hazard and
vulnerability analysis, drills and training, community involvement and
evacuation).

The guide provides an assessment of preparedness for specific emergencies


such as industrial emergency preparedness, infectious disease outbreak, etc.

B1.2. Mechanics of Vulnerability Assessment

Using the Vulnerability Assessment Matrix below (B1.3):


1. List the hazards that may affect the hospital, based on the hazard map
made.
2. Identify the vulnerabilities of the hospital (See earlier matrix).

B1.3. Format

Vulnerability Assessment Matrix


Hazard Vulnerable Vulnerabilities
Areas
Structural Non-structural Functional People

B2. VULNERABILITY REDUCTION PLAN

B2.1. Definition

The Vulnerability Reduction Plan is developed purposely to reduce the conse-


quences of exposure to hazards. The vulnerabilities specific to the four elements
of the facility and of the hospital catchment area are identified and this serves as
the basis for building the resilience of the hospital to withstand the impact and
consequences of a hazard.
79
B2.2. Mechanics of Vulnerability Reduction Planning:

Using the Vulnerability Reduction Plan Matrix below (B2.3):


1. List all the identified hazards of the catchment area and the hospital.
2. State all the areas vulnerable to the hazards.
3. Spell out all the vulnerabilities of the facility – structural, non-structural,
functional, and the assessment of human resources.
4. List the strategies/activities to reduce the vulnerabilities.
5. Specify the time frame, when the activities will be carried out and done.
6. Identify the resource requirements, what is required, what is available in
the community, and the gaps or deficits. Identify sources to fill the gaps.
7. Indicate the person responsible for carrying out each activity and for
looking for the source of deficient hospital requirements.

B2.3. Format

Vulnerability Reduction Plan Matrix


Hazards Vulnera- Prevention Time Resource Requirement Person
bility Strategies/ Frame Responsible
Activities
Required Available Source
Earth- Structural
quake
Non-struc-
tural

Functional

Human
Resources

C. RISK ASSESSMENT
C.1. Definition

Risk assessment is a process of analyzing or anticipating the possible conse-


quences of hazard once it has affected the hospital and the catchment area. This
is the basis in developing the capacity development plan of the hospital.

C.2. Mechanics of Risk Assessment

1. Identify the risks or probable consequences to public health and safety of the
catchment area and of the hospital being exposed to hazard:
● Probability of death
● Probability of disease or injury (mental, physical)
● Probability of secondary hazard (fire, disease, etc.)
● Probability of contamination
● Probability of displacement
● Probability of loss of lifelines
80
● Probability of loss of income or property
● Probability of breakdown in security
● Probability off damage to infrastructure
● Probability of breakdown in essential services

2. Describe why the risks or consequences of the hazard happen.

D. HEALTH EMERGENCY CAPACITY DEVELOPMENT PLAN

D1. Definition

From the risk assessment, problems may surface why the risks or consequences
of the hazard happen. These must be addressed in the Capacity Development
Plan, commonly referred to as Preparedness Plan. This is a plan with strategies
and activities geared towards building the capacity of the hospital to effectively or
efficiently respond to emergency or disaster in terms of the 10 P’s Elements of
Successful Health Emergency Management. The 10 P’s are: Policy, Procedures,
Protocols and Guidelines; Plans; People; Health Promotion; Partnership Building;
Physical Infrastructure Development; Program Development; Practices; Peso
and Logistics; and Package of Services. As in the other plans, a resource analysis is
done and written in the plan.

• What resources are required for response and recovery


• What are available in the hospital? In the catchment area?
• What are the differences between the required and available resources or
what are lacking?
• Where can one get the resource to fill the deficit
• Who is responsible for acquiring these resources

D.2. Mechanics of Capacity Development Planning

Using the Capacity Development Planning Matrix below (D.3):


1. List all identified risks.
2. Identify the capacity of the hospital needed to manage the risk.
3. Develop strategies and activities to come up with these needed capacities.
4. Write the time frame when to carry out such activities.
5. Identify the required resources, what are available in the hospital and in the
catchment area, the deficit and the source of the resources to fill the deficit.
6. Assign the responsible person to carry out the activities and to source out the
deficient resources.
7. Identify the indicators to prove that the activities have been carried out.

D.3. Format

Hospital Health Emergency Capacity Development Plan Matrix

Risks Capacity Prepared- Time Resource Requirement Person Indica-


needed ness Strate- Frame Respon- tors
gies/Activi- sible
ties Required Available Source
81
VIII. HEALTH EMERGENCY RESPONSE PLAN

A. POLICIES, GUIDELINES, PROTOCOLS FOR ACTIVATION OF


THE DEVELOPED SYSTEMS

B. JOB ACTION SHEETS

C. HOSPITAL EMERGENCY RESPONSE PLAN

C.1. Definition

An Emergency Response Plan is meant to utilize the existing capacities to


deliver relief or response. Using the developed systems for emergency
management, it entails resource mobilization. It involves the actual imple-
mentation of guidelines for the developed systems.

Basic conditions that the Emergency Response Plan must satisfy:

1. Internal Emergency/Disaster

a. Assignment of personnel with a system for notification and recall.


b. Use of alarm and sign systems, including availability and accessi-
bility of instructional materials/protocols on response to all types of
hazards.
c. Rapid assessment of extent of damage to buildings and structures
and threat to safety of patients and personnel.
d. Protection of critical facilities and lifelines.
e. Evacuation procedures and routes (include patients and facilities).
f. Quick restoration of facilities and lifelines (maintain service opera-
tion).
g. Maintaining communications and security of hospital and patients.
h. Firefighting methods and directions (location of equipment).
i. Networking and coordination.
j. Search and rescue operations.

2. External Emergency

a. Evaluation of hospital’s autonomy in terms of its services, source


of electricity, gas, water, food and medical supplies.
b. Efficient systems of alerts and staff assignments.
c. Unified command.
d. On-scene response team (team leader, surgical resident, internal
medicine resident, aides/helpers and driver)
e. Conversion of usable space into clearly defined areas ((triage,
observation and immediate care)
f. Prompt removal of casualties when necessary (after preliminary
medical and surgical services have been performed) to the places
where medical care facilities are more appropriate and definitive.
g. Special medical census – disaster-related cases.
h. Procedures for prompt transfer within hospital.
i. Security arrangement.
82 j. Prior establishment of Emergency Operation Center, Public Infor-
mation System and for Media/VIP’s
3. Internal/External Emergency

Apart from planning for Mass Casualty, the hospital has to deal with the
continuity of operations- essential functions of the hospital, regardless of
size, during internal or external emergencies that may disrupt usual, nor-
mal operations. This is critical in hazard prone regions of the country.
It focuses on the recovery of critical and essential operations including
security and evacuation concerns on either:
• Short-term basis, like a power failure, where having a backup capabil-
ity (systems, personnel, processes, files, and etc.) can quickly resolve
the situation.
• Long- term such as in typhoons, fire or earthquakes where services
are affected for several days, weeks or even months. In this case, the
hospital needs to plan for relocation to an alternative facility – tempo-
rary hospital or construction of new facility or change of hospital site.

C2. Mechanics

Using the Emergency Response Plan Matrix below (C3):


1. For the following response time – first 2 hours, 2-12 hours, 12- 24 hours,
Expanded Response – identify the capacity of the hospital to address spe-
cific concerns.
2. Develop strategies and activities to come up with these needed capaci-
ties. The activities during the response phase as discussed in Part II are
the ones actually carried out in an emergency response operation.This
becomes part and parcel of the Emergency Plan which is activated in the
event of an emergency or a disaster.
3. Write the time frame when to carry out such activities.
4. Identify the required resources, what are available in the hospital, the defi-
cit and the source of the resources to fill the deficit.
5. Assign the responsible person to carry out the activities and to source out
the deficient resources.
6. Identify the indicators to prove that the activities have been carried out.

C3. Format

Emergency Response Plan Matrix

Re- Capacity Strategies/ Time Resource Requirement Person Indica-


sponse Activities Frame Respon- tors
time sible
Required Available Source

0-2 hour
2 – 12
hours
12 – 24
hours
Expanded
Response 83
IX. HEALTH EMERGENCY RECOVERY AND RECONSTRUCTION PLAN

A. Definition

A Recovery and Reconstruction Plan in Health for a facility or a defined geograph-


ical area, as in the other sectors of Public Works, Education, and Agriculture, lays
down the activities needed to restore services and replace damaged elements.

The hospital recognizes that an updated plan is implemented to repair the dam-
ages and/or reconstruct facilities so as to ensure the return of health services
to pre-disaster status or advancement to a better level of access and/or perfor-
mance. This underscores the importance of the damage assessment and needs
analysis. The following activities are planned for:
• Damage Assessment and Needs Analysis to include cost (including man-
power). This is very important especially if you are asked to estimate the
financial cost of the event, but it is also an opportunity to request funds.
• Psychosocial interventions for direct/indirect/hidden victims
• Repair of damaged hospital facilities and lifelines
• Relocation of hospital site/construction of new facility
• Post-mortem evaluation
• Documentation of lessons
• Research and development
• Review and update of Hospital Health Emergency Preparedness and
Response Plan
• Inventory, return and replenishment of utilized health resources
• Awarding and recognition rites for the major key players
• Provision of overtime compensation, as well as respite, to the responders

B. Mechanics

Using the Recovery/Reconstruction Planning Matrix below (C):


1. List all recovery/reconstruction activities.
2. Write the time frame when to carry out such activities.
3. Identify the required resources, what are available in the hospital/commu-
nity, the deficit and the source of the resources to fill the deficit.
4. Assign the responsible person to carry out the activities and to source out
the deficient resources.
5. Identify the indicators to prove that the activities have been carried out.

C. Format

Recovery/Reconstruction Planning Matrix

Dam- Recovery/ Time Resource Requirement Person Indicators


ages and Reconstruction Frame Responsible
needs Activities Required Available Source

84
X. Annexes

● Glossary
● Abbreviations
● Hazard maps
● Flow charts
● Directory of contact persons
● Inventory of resources or assets of hospital and partner agencies
● Hospital/Regional/Office orders for health emergency management

85
SECTION 3
Job Action Sheets:
Incident Command System Organization
A - INCIDENT COMMANDER
(Field or Facility)

Mission Perform overall direction for the field and/or facility operations
and if needed, authorize evacuation.

Qualifications ● Must be an Emergency Manager for Field; CHD Director, Hospital


Director for Facilities or his designate.
● Preferably has experience in handling “on-scene” Mass Casualty
Incident for Field; has experience in management situations for
facilities.
● Must possess good communication skills.
● Must have leadership qualities.
● Must be a good coordinator; must have good command and con-
trol abilities

Functions & ● Initiate the Incident Command System (ICS) by assuming the role
Responsibili- of the Incident Commander and put any identification mark.
ties ● Designate a Command Post to include required logistical needs.
● Carefully assess the situation and the magnitude of the casualties.
● Secure the area, preventing entry of unauthorized people and des-
ignate staging and transport area for Field Operations.
● Depending on the number of responders and the magnitude of the
emergency, fill up the organization assignment list, the needed
positions relevant to the situation.
In major MCI, the following should be filled up: Safety Officer, Liai-
son Officer, Public Information Officer, Operations Manager, Triage
Officer, Treatment Officer, Staging Officer, Transport Officer and
Morgue Officer.
The Planning Officer, Logistic Officer and Administrative Officer
complements and completes the positions in severe MCI neces-
sitating the support of major agencies and requiring long period of
operations.
● Announce an action plan meeting and identify the general objec-
tive of the operations including alternatives, and the incident com-
munication plan.
● Assign someone as Documentation Recorder/Aide.
● Authorize resources as needed or requested by managers.
● Designate routine briefings with managers to receive status re-
ports and update the action plan regarding the continuance and
termination of the action plan.
● Communicate status to higher authority.
● Approve media releases.

Identification ● Proper signages (hard hat with mark of Incident Commander or


86 a vest)
B - SAFETY AND SECURITY OFFICER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Monitor and have authority over the safety of rescue


operations and hazardous conditions. Organize and
enforce scene/facility protection and traffic security.

Qualifications ● Knowledgeable on safety precautions, procedures.


● Preferably with various training in emergencies relating
to bombing, fire, hazardous materials, structural assess
ment, security procedures and safety of responding
personnel.
● Has had experiences in emergencies and disasters.
● Good decision-making abilities.
● Has sound knowledge in evacuation procedures.

Functions & ● Obtain appointment and briefing from the Incident Com-
Responsibilities mander.
● Implement the emergency lockdown policy and person-
nel identification policy.
● Establish Security Command Post.
● Remove unauthorized persons from restricted areas.
● Establish ambulance entry and exit route in cooperation
with Transportation and Staging Officers.
● Secure the Command Post, Advance Medical Post, Triage
and Treatment Areas including the Morgue Area and all other
sensitive or strategic areas from unauthorized access.
● Fully understand the importance of his roles especially in
the safety of the responders.
● Secure and post non-entry signs around unsafe areas.
● Always alert to identify and report all hazards and unsafe
conditions to the Incident Commander.
● Secure areas evacuated to and from, to limit unauthor-
ized personnel access.
● Initiate contact with fire, police agencies through the Liai-
son Officer, when necessary.
● Advise the Incident Commander and others immediately
of any unsafe, hazardous or security-related conditions.
● Confer with Public Information Officer to establish areas
for media personnel.
● Establish routine briefings with Incident Commander.
● Provide vehicular and pedestrian traffic control.
● Secure food, water, medical, and blood resources.
● Document all actions and observations.
● Can order stoppage of operation if unsafe.

Identification ● Use of any identification hat or vest.

87
C - PUBLIC INFORMATION OFFICER (P.I.O)

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Provide information to the public and the media.

Qualifications ● Knowledgeable on communication aspects es-


pecially in collating relevant information needed.
● Knowledgeable in media handling.
● Preferably with experience in emergencies and
disasters.
● Preferably with understanding of Mass Casualty
Management.
● Good communication skills and interpersonal
relationships.
● Sensitive on restrictions in contents of news and
patient care activities.

Functions & Responsibilities ● Obtain appointment and briefing from the Inci-
dent Commander.
● Ensure that all news releases have the approval
of the Incident Commander.
● Responsible for collating relevant information
needed to inform the public and for media
releases; obtain progress reports from respec-
tive areas as appropriate.
● Issue an initial incident information report to the
news media especially on the casualty status
and the actions being done.
● Schedule press conferences on a regular basis.
● Inform on-site media of the physical areas that
they have access to, and those which are restrict -
ed. Coordinate with Safety and Security Officer.
● Contact other scene agencies to coordinate
released information.
● Direct calls from those who wish to volunteer to
Liaison Officer. Contact Operations to de-
termine requests to be made to the public via
the media.

Identification ● Proper signages (hard hat with a mark of Public


Information Officer or a vest).

88
D - LIAISON OFFICER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Function as incident contact person for representatives from


other agencies (government or private).

Qualifications ● Preferably with experience in liaison procedures and coordination.


● Good or excellent public relations skills.
● Preferably with understanding of Mass Casualty Management.
● Understands the bureaucracy and working relationships of the
different government as well as private agencies responding to
emergencies and disasters.
● Good grasp of patient care and management in mass casualty
situations; informed on inter-hospital emergency communica-
tion network, municipal operation centers and/or province, region
or national as appropriate.
● Knowledge on the inventory of resources available in the area/
country.
● Understands municipal (provincial, regional, national) organiza-
tional charts to determine appropriate contacts and message routing.

Functions & ● Obtain appointment and briefing from the Incident Commander.
Responsibilities ● In coordination with the Public Information Officer should always
be knowledgeable on the following:
■ The number of “Immediate” and “Delayed” patients that
can be received and treated immediately (Patient Care Ca-
pacity); also the status of all other victims, especially in
mass dead situations.
■ Any current or anticipated shortage of personnel, supplies,
etc.
■ Number of patients transferred to hospitals.
■ Any resources which are requested by each area (i.e., staff,
equipment, supplies).
● Establish contact with liaison counterparts of each assisting and
cooperating agency.
● Keep appropriate agency Liaison Officers updated on changes
and development of response to incident.
● Request assistance and information as needed through the differ-
ent networks of government and private organizations responding
to emergencies and disasters.
● Respond to requests and complaints from incident personnel re-
garding inter-organization problems.
● Prepare to assist Labor Pool with problems encountered in the
volunteer credentialing process.

Identification ● Use of any identification (hat or vest).


89
E - LOGISTIC SECTION CHIEF

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Organize and direct those associated with maintenance


of the physical environment, and adequate levels of food,
shelter, supplies and other resources needed to support the
objectives of the incident.

Qualifications ● Preferably with experience in logistics management.


● Preferably with experience in emergencies and disasters.
● Understands the bureaucracy and working relationships of
the different units in government especially in procurement
and emergency purchases.
● Good grasp of procurement procedures; knowledgeable in
accessing supplies, medicines and equipment needed during
emergencies.
● Good coordination with pharmaceuticals, companies and
suppliers and knowledgeable on database of available
resources in the market.

Functions & ● Obtain appointment and briefing from the Incident


Responsibilities Commander.
● Establish Logistics Section Center in proximity to the
Command Post.
● Brief all his staff on current situation; outline action plan and
designate time for next briefing.
● Attend damage assessment meeting with Incident Com-
mander.
● Coordinate with companies regarding stock level, available
supply and equipment.
● Anticipate needed logistical requirements.
● Obtain information and updates regularly; maintain current
status of all areas; communicate frequently with Emergency
Incident Commander.
● Obtain needed supplies with assistance of the Finance
Section Chief and Liaison Unit Leader.

Identification ● Proper signage (hat or vest).

90
F - PLANNING SECTION CHIEF

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Organize and direct all aspects of Planning Section


operations. Ensure the distribution of critical informa-
tion/data. Compile scenario/resource projections from
all areas and effect long-range planning. Document all
activities.

Qualifications ● Preferably a senior official with adequate knowledge in


planning and decision-making.
● Has had experiences in emergencies and disaster situ-
ations in addition to crises management.
● Adequate knowledge of the government bureaucracy
and the role of the different government entities
responding to emergencies and disasters.
● Good coordination and networking skills.

Functions & ● Obtain appointment and briefing from the Incident Com-
Responsibilities mander; have regular updates as appropriate.
● Brief members of the staff after meeting with Incident
Commander.
● Provide for a Planning/Information Center.
● Recruit a documentation aide from the Labor Pool. Ap-
point Planning Unit Leaders, Situation Status Leader,
Labor
● Pool and other appropriate positions as needed. Ensure
that all appropriate agencies are represented in this
section.
● Ensure the formulation and documentation of an in-
cident-specific action plan. Distribute copies to Incident
Commander and all areas.
● Call for projection reports (Action Plan) from the Plan-
ning Unit Leaders for scenarios 4, 8, 24 and 48 hours
from time of incident onset. Adjust time for receiving
projection reports as necessary.
● Instruct staff to document/update status reports from all
areas for use in decision-making and for reference in
post-disaster evaluation and recovery assistance appli-
cations.
● Schedule planning meetings to include Planning Sec-
tion Unit Leaders, Section Chiefs and the Incident Com-
mander for continued update of the Action Plan.
● Coordinate with the Liaison Officer and Labor especially
with regards to manpower requirements.

Identification ● Proper signage (hat or vest).


91
G - FINANCE SECTION CHIEF

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission: Monitor the utilization of financial assets. Oversee the


acquisition of supplies and services necessary to carry out
the objective of the incident. Supervise the documentation
of expenditures relevant to the emergency incident.

Qualifications ● Preferably a senior official with adequate knowledge in


financial management.
● Had experiences in emergencies and disaster situation
● Adequate knowledge on the government bureaucracy and
the role of the different government entities responding to
emergencies and disasters.
● Good resource manager; knowledgeable on tapping other
resources

● Obtain appointment and briefing from the Incident Com-


Functions & mander.
Responsibilities ● Appoint members of his staff preferably the following: Time
Unit Leader, Procurement Unit Leader, Claims Unit Leader,
Cost Unit Leader and other appropriate positions as he de-
sires.
● Establish a Financial Section Operations Center. Ensure
adequate documentation/recording personnel. His station
need not be within the area of incident.
● Confer with Unit Leaders after meeting with Incident Com-
mander and develop an action plan.
● Approve a “cost-to-date” incident financial status report
eight hours summarizing financial data relative to person-
nel, supplies and miscellaneous expenses.
● Obtain briefings and updates from Incident Commander as
appropriate. Relate pertinent financial status reports to ap-
propriate chiefs and unit leaders.
● Schedule planning meetings to include Finance Section unit
leaders to discuss updating the section’s incident action
plan and termination procedures.

Identification ● Proper signage (hat or vest)

92
H - OPERATIONS SECTION CHIEF

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Organize and direct aspects relating to the Operations.


Carry out directives of the Incident Commander.

Qualifications ● Knowledgeable on Operation Procedures; understands


well the organizational chart in MCI.
● Preferably has experience in handling “on-scene” Mass
Casualty Incident with varied knowledge of all types of
operations (Search and Rescue, Fire, Medical etc.)
● Must be a crisis manager and with leadership skills.
● Good communicator and can stand pressures.
● Must know capabilities of people for proper assignments.

Functions & ● Obtain appointment and briefing from the Incident Com-
Responsibilities mander.
● Responsible for all specific sections of the operations (ex.
Medical, Search and Rescue, Fire Suppression and oth-
ers) depending on the incident.
● Establish Operations Section in the Command Post pref-
erably with the Incident Commander.
● Brief all Operations Officers on current situation and de-
velop the section’s initial plan.
● Designate times for briefings and updates with all Opera-
tions Officers to develop/update section’s action plan.
● Ensure that all areas are adequately staffed and supplied.
● Brief the Emergency Incident Commander routinely on the
status of the Operations Section especially on the status
of all patients, problems encountered, resources needed,
etc.
● Ensure that all actions and decisions are documented.
● Observe all staff and personnel for signs of stress and
inappropriate behavior and report concerns to Psycho-
social Supervisor. Ensure rotation of all personnel to
prevent burnout among personnel.

Identification ● Proper signage (hat or vest).

93
I - TREATMENT TEAM LEADER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Responsible for the management of the Treatment Area and


assigning of responsible supervisor for specific areas (Red,
Yellow and Green subsections). Assure treatment of casualties
according to triage categories. Provide for a controlled patient
discharge and transfer to appropriate hospitals.

Qualifications ● Preferably a general surgeon/trauma/emergency/anesthesia/


family medicine physician.
● Knowledgeable on Mass Casualty Management and the or-
ganization chart.
● Should have “on-scene” experience in MCI; knowledgeable
on triaging and skilled in field care and field operation.
● Skilled in emergency procedures, especially in life sustaining
and stabilization of patients.
● Good in personnel management, especially in stress situations.

Functions & ● Receive appointment and briefing from Incident Commander/


Responsibilities Operations Chief/ Field Medical Commander.
● Organize the treatment area assigning all members to their
specific assignments and responsibilities. In cases of WMD,
treatment area should be at the cold zone.
● Appoint unit leaders for the following treatment areas in
pre-established locations: Second Triage; Immediate
Treatment (Red); Delayed Treatment (Yellow); Minor
Treatment (Green); Discharge.
● Supervise the receiving of patient from the Initial Triage from
the site, re-triage the victims and institute measures to sta-
bilize the victims; ensure that all victims are continuously
monitored.
● Assess problems and treatment needs, and customize the
staffing and supplies in each area.
● Receive, coordinate and forward requests for personnel and
supplies to the Field Medical Commander and/or Staging officer.
● Contact the Safety and Security Officer for any security
needs in the area.
● Establish 2-way communication (radio or runner) with Field
Medical Commander, Triage, Transport and Staging Officers.
● Coordinate with Transport Officer, decide on the order of
transfer of victims, the mode of transport, escort and place of
transfer.
● Document everything with regards to every individual patient
brought to the area using the individual treatment form.
● Regularly report to the Field Medical Commander.
● Observe and assist any staff that exhibits signs of stress and
fatigue. Report any concerns to Psychological Supervisor.
Provide for staff rest periods and relief.

94 Identification ● Proper signage (hat or vest).


J - TRIAGE (INITIAL) TEAM LEADER

Position assigned to:


You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________

Mission: Sort casualties at the site according to priority of injuries, and


transfer (according to tagging priorities) to the treatment area.

Qualifications ● Any of the following:


✔ Doctor of Medicine preferably trained in emergency
medical care and triaging.
✔ Nurse, paramedic with appropriate training in emergency,
medical care and basic triaging.
● Knowledgeable on mass casualty management and has had
experience in “on-site” mass casualty incident; skilled in field
care and field operations.

Duties & ● Receive appointment and briefing from the Field Medical Com-
Responsibilities mander or previously designated by the Incident commander.
● Assess first the safety in entering the incident area; note abnor-
malities in the surrounding, any untoward manifestations of the
victims and approximate number of casualties and the type of
injuries.
● Protect self by using the appropriate Personal Protective
Equipment (PPE).
● In cases of WMD, ensure that decontamination is present before
entering the incident site.
● Report first to authority and request for additional help before
proceeding to actual triaging.
● Quickly brief members of the Triage Team and assign areas for
triaging.
● Tag the appropriate color to every patient as follows:
✔ RED – immediate stabilization necessary
✔ YELLOW – close monitoring, care can be delayed
✔ GREEN – minor; delayed treatment or no treatment
✔ BLUE – near or almost dead
✔ BLACK – dead
● Document important things to consider in the site for purposes
of evidence by use of camera, by mapping or sketching, etc.
especially in WMD.
● Ask first all walking wounded to go to an identified place.
● Provide and administer life sustaining support to the patient in
extreme cases (only for bleeding and respiratory problems).
● Bring patients to the Treatment Area according to priority.
● Assess problem, triage treatment needs relative to specific
incident.
● Identify a Morgue Manager and a Morgue Area for black-coded
patients.
● Coordinate with Field Medical Commander and Treatment Team
Leader to report number and types of casualties, including
equipment needs.
● Contact the Safety and Security Officer regarding security and
traffic flow needs in the Triage Area.
● End his services once all patients are out of his area and receive
another assignment from the Field Medical Commander.

Identification ● Proper signage (hat or vest). 95


K - TRANSPORT GROUP SUPERVISOR

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Coordinate the transfer of patient received from the Treat-


ment Area to the appropriate hospitals

Qualifications ● Preferably a paramedic, nurse or doctor with basic training


in Basic Life Support.
● Experienced and knowledgeable in Mass Casualty Man-
agement.
● Skilled in ambulance traffic control; skilled in radio commu-
nications.
● Sound knowledge of country’s transportation resources.
● Sound knowledge of access routes to health care facilities.
● Familiar with terrain, road maps, alternate routes.
● Has sufficient knowledge in the return time of the ambu-
lance.

Duties & ● Receive appointment and briefing from the Incident Com-
Responsibilities mander/ Field Medical Commander.
● Establish immediately an ambulance loading zone, observ-
ing principles on way traffic flow; identify access routes
and communicate traffic flow to drivers.
● Coordinate and supervise transport of victims from the
Treatment Area.
● Ascertain all information relating to receiving hospital (as
to type of facility, bed availability, hospital capability,
contact ER medical officer, etc.).
● Supervise all available ambulance drivers; assign appro-
priate vehicle in accordance with status of patients.
● Receive requests for transportation; Maintain a log of the
whereabouts of all vehicles under his control.
● Ensure all patients transferred are tagged and with their
treatment form.
● Brief ambulance crew as to the condition of the patient,
care required, access routes, traffic flow, location of the
receiving hospital and the procedures in the endorsement
of the patient.
● Coordinate regularly with the Treatment Team Leader/
Staging Officer and report all patients transferred and
when the last person is transported.
● Document all activities in his area, including a complete
record of all patients.

Identification ● Proper signage (hat or vest).

96
L - STAGING OFFICER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Coordinate all resources arriving at the scene. For


manpower resources, referring them to appropriate
area of assignment. For transportation resources,
organizing them and dispatching them as required.

Qualifications ● At least a paramedic or an EMT.


● Preferably with knowledge in Mass Casualty Manage-
ment and understands the organizational chart.

Duties and ● Receive appointment and briefing from the Incident


Responsibilities Commander/ Operations Section Chief.
● Identify suitable place for the Staging Area usually
away from the incident.
● Organize, classify all transportation resources.
● Coordinate with Transport Supervisor.
● Dispatch appropriate vehicle as requested by Trans-
port Supervisor.
● Coordinate with appropriate agencies with regards to
traffic flow and access routes within the site.
● Direct all incoming responding teams to the Field
Medical Commander.
● Document all resources.

Identification ● Any identification mark (hats or vests).

97
M - FIELD MEDICAL COMMANDER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Organize, prioritize and assign officers under it’s jurisdiction to


areas where medical care is being delivered. Advice the Op-
erations Section Chief/Incident Commander on issues related
to handling of the victims.

Qualifications ● Must be a Doctor of Medicine.


● Must possess managerial skills in disaster.
● Preferably with training and experience in MCI management
situations.
● Knowledgeable in the hospital capability and networking; having
sound knowledge of country’s health resources.
● Skilled in pre-hospital care; skilled in radio communications.
● Skilled in staff management; skilled in logistical operations.
● In the absence of the above the first who arrives at the scene
preferably one of the following:
a. Municipal Health Officer, City Health Officer, any Emer-
gency Health Physician
b. Emergency Critical Nurse (in the absence of an MD)
c. Private MD with experience in emergency care
● Can first assume the position and later endorse (face to face)
providing an orderly transfer of command to the next incoming
qualified medical personnel.

Duties & ● Receive appointment from the Incident Commander/Operations


Responsibilities Section Chief.
● Identify the suitable site for the Advance Medical Post and in
form everybody.
● Responsible for the different members of his team (if not yet
identified): Triage Officer, Treatment Officer, Transport Officer,
Mortuary Officer.
● Responsible that all the needed medical resources be mobilized
and available.
● Report and coordinate with the Operations/Incident Command-
er; likewise attend meetings and press conferences.
● Ensure the welfare and safety of the medical team, including
relief and sustenance (decking, scheduling, pullback, etc.)
● Conduct regular meetings with his designated officers in the area.
● Anticipate other concerns and regularly confer with the Opera-
tions Officer/Incident Commander.
● Responsible that all the necessary recording of the events be done
and all required reports to all the authorities be submitted on time.
● Evaluate the whole activity and make the necessary recommen-
dations to improve future responses.
● Coordinate and regularly report to the Medical Controller of the
DOH Operations Center/Regional Operation Center.

Identification ● Proper signages (hat or vest).


98
N - MORGUE MANAGER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission: Collect, protect and identify deceased patients

Qualifications ● Doctor of Medicine aided by a social worker, a psychosocial


support officer.
● For medico-legal cases forensic experts from the PNP Crime
Laboratory or the National bureau of Investigation will be part
of the team.

Duties & Respon- ● Receive appointment and briefing from the Triage Officer/Field
sibilities Medical Commander.
● Identify and establish the Morgue Area; coordinate with the Tri-
age Officer and Treatment Officer.
● Maintain master list of deceased patients with time of arrival.
● Assure that all personal belongings are kept with deceased
patients and are secured.
● Assure that all deceased patients in Morgue Area are covered,
tagged and identified when possible.
● Provide a system or procedures for identifying and endorsing
the body of the deceased to authorized members of the family.
● In medico-legal cases consult with PNP and NBI with regards
to procedures necessary for proper identification and for evi-
dence collection and preservation.
● Keep Triage/Treatment officers appraised of number of de-
ceased.
● Contact the Safety and Security Officer for any morgue secu-
rity needs.
● Arrange for frequent rest and recovery periods as well as relief
for staff.
● Schedule meetings with the Psychological Support Unit Lead-
er to allow for staff debriefing.
● Observe and assist any staff that exhibits signs of stress or
fatigue. Report any concerns to the Treatment Area Supervi-
sor.
● Review and approve the area documenter’s recording of
actions/decisions in the Morgue Area.

Identification ● Proper signage (hat or vest).

99
O - MEDICAL CONTROLLER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission: Coordinate all activities of the Department of Health/


Health Sector in response to the Mass Casualty Situation

Qualifications ● Doctor of Medicine/Nurse familiar with the Operation


Center (Central, Regional and Hospital).
● Good knowledge of the DOH organization as well as
members of the Health Sector responding to emergencies
and disasters.
● Good resource mobilizer.
● Knowledgeable on the manpower resources, hospital
capabilities, dispatching and radio communications.
● Articulate and good spokesperson.
● Excellent coordinator.

Duties & ● Designated by the office and assume the position in case
Responsibilities of Mass Casualty Situations.
● Supervise the Operation Center and make all decisions in
relation to the dispatch and subsequent fielding of addi-
tional teams.
● Assist in the scheduling of rotation of the medical teams
at the site in the event of prolonged operations in coordi-
nation with the Field Medical Commander.
● Coordinate with the different receiving hospitals to pre-
pare their facilities.
● Coordinate with other agencies, DCC agencies, response
units, etc.
● Review resources not only within the DOH OPCEN but of
the other facilities of the DOH; likewise mobilize
resources if needed.
● May respond to queries by officials, media in relation to
DOH response.
● Update superiors especially the Secretary of Health.
● Document and record the event.
● Evaluate the proceedings and make some necessary
input for policy amendments or recommendations.
● Schedule and lead postmortem evaluation within one
week of the event for the Health Sector.

Identification ● Proper signage (hat or vest).

100
P - INCIDENT MEDICAL COMMANDER

Position assigned to:

You report to: _____________________________________ (Incident Commander)

Command Post: ______________________________ Telephone: ______________

Mission Represent the Department of Health in the Field Command


Post and coordinate all health activities/requirements in
cases of Regional Emergencies/Disasters.

Qualifications ● Highest official designated by the Regional Health Office.


● Good knowledge of the DOH organization as well as mem
bers of the Health Sector responding to emergencies and
disasters; sound knowledge of the region’s health
resources.
● Knowledgeable in Mass Casualty Management and its
organization.
● Skilled in logistical operation and staff management.
● Knowledgeable in both public health and pre-hospital care.

Duties & ● Designated by the CHD and assume the position in case of
Responsibilities Mass Casualty Situations.
● Report to the Incident Commander in the Command Post.
● Usually will be part of the Planning Committee.
● Keep constant coordination with the Field Medical Com
mander and the Medical Controller.
● Anticipate other concerns such as public health concerns
(sanitation, nutritional needs, needs of evacuees) or psy
chosocial concerns, especially in situations of Mass Dead.
● Lead in public health information and the provision of
needed IEC materials.
● Organize all reports coming from the Field Medical Com
mander and attend all press briefings and conferences.
● Document and make his own evaluation of the incident.

Identification ● Proper signage (hat or vest).

101
SECTION 4
Deployment of Response Teams

CONDITIONS BASED ON A.O. 155 SEC. VI-B: IMPLEMENTING


GUIDELINES, OPERATIONS AND DISPATCH CENTER

a. All hospitals and Regional Operation Centers shall dispatch teams within their
catchment area upon monitoring or receiving a call confirming a Mass Casualty
Incident.

b. Any hospital and/or CHD team can also be dispatched even outside their catch
ment area upon a request of help from neighboring facilities or upon instruction of
the HEMS Central Operation Center.

c. The HEMS Central Operation Center, upon instruction of the HEMS Director,
can dispatch teams from any hospital and CHD offices upon monitoring events
that necessitate response from the Department of Health or upon request of
agencies of government with authority over certain events (NDCC, NSC, etc).

While the initial team is dispatched, the Operation Center anticipates the scenario and
alerts additional teams that might be needed and nearby hospitals, especially the receiv-
ing hospitals, and starts to review the logistics.

COMPOSITION AND FUNCTIONS OF THE TEAM/S

From the Integrated Code Alert System 2008, the teams for dispatch from the hospital
and CHD are shown in Table S4.1.
Table S4.1. Human Resource Requirements by Alert Level Status in Hospital and
CHD for On-scene Response
ALERT HOSPITAL CHD
LEVEL
STATUS
Code First response team ready for dispatch One Rapid Assessment Team ready for
White to include the following: dispatch to include the following:
• 2 doctors preferably surgeon, • DOH representative
internist, anesthesiologist • Nurse
• 2 nurses • Driver
• First aiders/ EMT May coordinate with Regional Hospitals
• Driver for backup teams.
Second response team should be on call

Code On-Scene Response Team Mobilize Rapid Assessment Teams


Blue (RAT) and other appropriate teams.
Three (3) teams on standby. (environ-
mental/ surveillance/ medical)
Health Promotions Officer as necessary
Driver
All DOH REPS in the affected area
should be available at the LGU.
All other regional staff on standby for
102 immediate mobilization.
COMPETENCIES

For responders, the HEMS Training Needs Assessment identified the competency re-
quirements and the required training course/package, as shown in Table S4.2.

Table S4.2. Competency Requirements and Required Training Course/Package for


Responders
Responders’ Competency Requirement Required Training
Position, Roles/ (Functional) Course/ Package
Functions

a. Pre-hospital • Rapid Assessment skills • Basic Life Support


• Responds to • Basic knowledge in hos- (BLS), Standard First
emergencies pital system; Basic Life Aid
(patient manage- Support (BLS); Stan- • Medical First Responder
ment) dard First Aid; Medical (MFR)
• Decontamination First Responder (MFR) • Emergency Medical
• Triage • Emergency Medical Tech- Technician (EMT)
nician (EMT) • Advanced Cardiac Life
• Advanced Cardiac Life Support (ACLS)
Support (ACLS) • Advanced Trauma Life
• Mass Casualty Incident Support (ATLS)
(MCI) • Mass Casualty Incident-
• Health Emergency Man- Incident Command Sys-
agement tem & Weapons
• Decontamination skills of Mass Destruction
• Incident Command Sys- (MCI- ICS- WMD)
tem (ICS) skills • Basic Health Emergen-
cy Management
• Ambulance care • Ambulance traffic control (HEM)
(patient manage- • Radio communication
ment) • Sound knowledge of ac-
cess routes to health care
facilities
• Networking/coordination
• Safe driving skills

b. Hospital Knowledge and skills in: • Basic Life Support


• Decontamination/ • Basic Life Support & Stan- (BLS), Standard First Aid
isolation dard First Aid • Medical First Responder
• Patient manage • Advanced Cardiac Life (MFR)
ment/triage Support (ACLS) • Emergency Medical
• Specific case • Advanced Trauma Life Technician (EMT)
management Support (ATLS) • Advanced Cardiac Life
- Burns • Triage Support (ACLS)
- Weapons • Mass Casualty Incident , • Advanced Trauma Life
of Mass Incident Command Support (ATLS)
Destruction System & Weapons of • Mass Casualty Incident,
(WMD) Mass Destruction Incident Comman Sys-
- Radiological, (MCI-ICS- WMD) tem & Weapons of Mass
Biological & • Specific Case Manage- Destruction (MCI-ICS-
Chemical (RBC) ment WMD)
- Poisoning • Radiological, Biological
& Chemical (RBC)
Courses
• Basic Health Emergen-
cy Management(HEM) 103
Depending on the available human resources, the response team may have the full
human resource complement or may have few health staff but with multiple functions.
Upon dispatch, the teams are equipped with the following:
• Emergency kits and equipment (Refer to Sec 4.1. Ambulance Services)
• Communication equipment
• Food and water
• Personal protective equipment (PPE), mask, goggles (A.O. 155)
• Flashlight, whistle
• Writing supplies – report forms/pens/clipboard
• Reference materials, e.g., Directory, Pocket Emergency Tool 2nd edition, etc.
• Contingency Funds

Emergency Manager Deployment Checklist

YES NO
1. Did you receive your orders?
2. Is/are the mission objective/s clear?
3. Did you inform your family?
4. Do you have with you
a. Mission order?
b. Identification card?
c. Emergency call number directory?
d. Mission area map?
e. List of contact persons/ numbers?
f. Communication equipment?
g. Cell phone? Mobile phone?
h. Handheld radio and accessories?
i. Pocket notebook and ballpen?
j. Laptop computer?
k. Transistor radio (with extra batteries)?
l. Basic PPE (cap, mask, gloves)?
m. Cash and reimbursement vouchers?
n. Water canteen?
o. Food provisions?
p. First aid kit?
q. Backpack with clothing and blanket?
r. Flashlight/candles and matches?
s. Portable tent (if available)?
t. Mosquito repellant?
u. Pocket knife?
v. Digital camera?
w. Pocket Emergency Tool?

Source: Pocket Emergency Tool, 2nd edition. Department of Health -Health Emergency Management
Staff, Emergency Humanitarian Action, World Health Organization Regional Office for Western Pacific.
p. 78.

104
SECTION 4.1
Ambulance Services for Emergencies and Disasters

The hospital must be ready at all times to immediately dispatch the emergency medical
response team with an ambulance to the disaster site, in accordance to: Administrative
Order No. 13 s. 1997: Policy and Guidelines on the Management and Use of Ambulanc-
es; Memorandum No. 120 s. 2003; and Administrative Order 155 s. 2004: Implementing
Guidelines for Managing Mass Casualty Incidents During Emergencies and Disasters.

An update of the ambulance team composition lists the following:

1. Licensed physician – trained and certified in Advance Cardiac Life Support


2. Licensed nurse – trained and certified in Basic Life Support, Advanced Cardiac Life
and Standard First Aid
Ambulance driver – trained and certified in Basic Life Support and First Aid; and
as proposed: Basic Emergency Medical Technician, Emergency Vehicle Driving
Course
3. Utility workers – trained in handling and transport of patients

According to A.O. 155, the responding medical team must be properly equipped to treat
a minimum of 10 serious casualties and the responding team in their ambulance must
have the capability for treating and transporting a minimum of 3 to 5 serious patients.
These policies affirm the need for an assigned ambulance for easy dispatch with equip-
ment, medicines, supplies and necessary communication devices for coordination. The
hospital can be guided by the steps in the request for use of the ambulance provided
in A.O. 13 Section 4.4 and the Memo 120 amendment which includes the HEMS-Stop
Death Coordinator as a dispatch authority.

The Hospital needs to examine the authorization of any member of the HEMS team with
a driver’s license in case there is no available driver, given the implications of the GSIS
insurance coverage.

All ambulance vehicles must be cleaned and decontaminated after every response ac-
tivity by the response team, particularly the driver. It is the assigned driver’s responsibil-
ity to keep the ambulance always clean, in good running condition with enough gasoline,
and properly equipped at all times for prompt response.

Due to reemerging diseases as SARS and avian flu, there is a need to review the pro-
cedures in the use of ambulances, especially in transporting patients who are suspected
cases. Furthermore, each hospital should come up with its procedure in requesting or
assigning ambulances for emergency response.

Following is the list of equipment that the assigned ambulance for emergency response
must have:

Evacuation/Transport
1. Wheel type stretcher with straps
2. Scoop stretcher
3. Spine board with straps
105
Medical Equipment/Supplies and Monitoring Devices
4. Cardiac monitor, portable
5. Automated external defibrillator (AED) with ECG, portable
6. Portable pulse oximeter with monitor
7. Sphygmomanometer and stethoscope
8. Diagnostic set (otoscope, opthalmoscope)
Other equipment
9. Portable suction machine
10. Portable emergency case – 3 layers
11. Emergency kit containing drugs
12. Medical supplies and equipment
13. Manual resuscitators/bag valve mask
14. Portable oxygen tank with regulator and oxygen meter
15. Tracheostomy set with disposable tracheostomy tube
16. Splints and bandages
17. Cervical-collar (adult and pediatric)
18. Minor surgical set
19. Flashlights
20. Personal Protective Equipment (PPE) for Response Team, including
appropriate HEMS identification (e.g., vests, etc.)
Communication
21. Handheld radio
22. Public address communication system

106
SECTION 5
Hospital Operations Center

The hospital designs the Operations Center (OpCen) location, facility and size based
on the level at which it will function, the nature of its activities, and the size of the staff
needed for its effective operation. The activities include activation of the plan, coordina-
tion of hospital activities with those at the disaster site, and adjusting the plan as neces-
sary. A good communication system must be in place to ensure smooth coordination
and execution of operational activities.

A. FUNCTIONS OF A HOSPITAL OPCEN

Administrative Order 155 describes the functions of an Operations and Dispatch


Center as follows:
1. Receives all warning messages via connections with all major offices/ser-
vices that are monitoring and responding to emergencies through telephone,
fax machines, radio, etc.
2. Serves as dispatch center in times of emergencies.
3. Anticipates scenarios and alerts additional teams needed by receiving hospitals.
4. Reviews required logistics.

In an update of these functions, the following were added:


1. Monitors ongoing operations.
2. Mobilizes resources as needed by the On-scene Response Team or Emer-
gency Room.
3. Coordinates with DOH-OpCen.
4. Documents events and responses and submits reports.
5. For Code Blue and Code Red, runs as the Center of Control, Command and
Coordination of the hospital (Command Post).

B. PHYSICAL FACILITIES

• Hospital identifies a dedicated space within its offices as the Operations Center
(OpCen) which is periodically checked for serviceability and readiness.
• However, if the hospital decides for a non-permanent OpCen, when Code Blue is
raised, the facility should be easily converted within one hour and easily secured.
• An alternative OpCen should be earmarked for use in the event the original
Op Cen is affected or damaged.
• The Operations Center must have the following:
❍ Adequate communication facilities, with a message center with the telephone
numbers of all agencies responding to emergencies/disasters (e.g., RDCC,
hospitals, Central Office, fire, police, etc.)
❍ Arrangements for receiving, collating and assessing information and for facili-
tating decision-making.
❍ Display facilities (e.g., maps and wall facilities) for presenting an “information
picture” of the disaster situation, resources, available tasks being undertaken,
tasks to be undertaken, etc.
❍ Working space with office furnishing and supplies for OpCen staff.
Designated area for conference/briefing room(s) for briefing officials and other
107

important persons and for progress meetings and discussions.


❍ Information room (preferably separate from the main OpCen) for briefing
media representatives and releasing information to the public.
❍ Designated areas for rest facilities.
❍ Emergency power supplies and back-up facilities/supplies.
❍ Other aspects, such as storage space, vehicle access and parking facili-
ties, and any other requirements to meet specific circumstances.

The considerations for the design are described in detail in the Manual of Guide-
lines for the Operations Center.

C. HUMAN RESOURCES
With the raising of Code Alert White, the hospital should activate the Operations
Center and assign Emergency Officers on Duty (EOD) to manage the coordina-
tion and monitoring activities of the Hospital OpCen on a 24/7 basis. The hospital
may refer to the Manual on Operations Center for the competency requirements and
training of the EOD.

D. COMMUNICATIONS
For adequate and effective communication facilities necessary for any emergency/
disaster setting, the considerations are as follows:
• Provide adequate facilities for the normal day-to-day functioning of the organization.
• Be capable of extending from the day-to-day role into the wider and more
demanding functions of response operations.
• When necessary, provide a mobile capability.
• Have adequate reserve or back-up capacity to meet emergency demands.

Given financial and other constraints, the provision of a special communications


facility to fulfill the above needs may not be possible. This may mean utilizing the
most proficient available network (e.g., a police communication system and
other communications networks) and supporting this with other networks for back-up
or standby emergency purposes.

E. STANDARD OPERATING PROCEDURES


The matrix in Table S5.1, which is suitable for a non-permanent type of Operations
Center, provides an overview of the standard operating procedures for the activation,
operation and closing-down of a Hospital Operations Center. Of these procedures that of
opening and closing are not applicable for a 24/7 OpCen. The hospital may adapt the
written procedures and protocols in the Manual of HEMS Operations Center.

Table S5.1. Standard Operating Procedures for Emergency Operations Centers (EOCs)
Activation Operation Closing-down
Open EOC Message flow File messages and other docu-
Mobilize staff Information display ments
Activate communication systems Information processing Release staff
Prepare/post up maps and Control of resource mobilization and deployment Close down communications
display boards Drafting of situation reports Close down EOC
Draw up support staff roster Decision-making Organize operational debriefing
Briefings
Reporting to higher authority
108 Source: Stop Death Program. Department of Health. Guidelines on Hospital Preparedness and Response Planning.
Manual of Operations for Hospital, 1st edition, July 2000.
Key Information : Readily Available and Regularly Updated
(Source: Adapted from the Pocket Emergency Tool, 2nd edition, Department of Health -Health Emergency
Management Staff, Emergency Humanitarian Action, World Health Organization Regional Office for Western
Pacific. pp. 9- 10)

Hospital Catchment Area Maps


• Topography
• Population size and distribution
• Hazard
• Disaster profile
• Location of
o Health facilities and services provided
o Potential evacuation areas
o Stocks of food, medicine, health and water treatment and other sanitation
supplies in government stores, commercial warehouses and international
agencies and major NGO’s

Directory
• Key people and organizations responsible for Response Phase (names, con-
tact phone numbers and addresses)
• Individuals with special competencies and experiences who may be mobi-
lized on secondment from their institutions or as consultants in case of
need (names, contact phone numbers and addresses)
• Regular resource persons ready to translate technical information into local
dialects (e.g., traditional healers, indigenous health workers, barangay cap-
tains, etc.)

Resources Available for Use at All Times


• Vehicles
• Communications equipment
• Back-up power supplies
• Computers, printers, facsimiles and photocopying machines
• Water-testing sets
• Food supplements
• Temporary shelter capacities
• Funding requirements
• Personal protective equipment

Suggested Guidelines for the Hospital Operations Center

The Hospital Operations Center shall be organized with the following arrangements:

• All Hospital Operations Centers should be ideally manned by at least two Emer-
gency Officers on Duty (EO1 and EO2) under the supervision of the Hospital
HEM Coordinator/Assistant Hospital HEM Coordinator or Supervising Nurse.

• During emergencies and disasters (alert codes), all Hospital Operations Center
staff should be on a 24/7 duty. The Hospital HEMS Coordinator can mobilize all
other members of the health emergency disaster team to augment OpCen staff.

• All hospitals must ensure that hazard protocols, flow charts, SOPs and guide 109
lines on health emergency and disaster are available and such are strictly
followed/observed and implemented by all staff.

• Hospitals must ensure that it has established communication links with DOH-
OpCen, Centers for Health Development (Regional Office), and other members
of the health networks for prompt response to emergencies and disaster.

• All hospitals must ensure that data, information, and reports coming from the
hospital (internal emergencies) and field (external emergencies) are received,
collected and verified promptly and are analyzed and evaluated for correctness
and completeness before transmission and submission to the Regional Director,
DOH-HEMS and other health partners when needed.

• All reports submitted to the HEMS OpCen should follow the HEMS forms. Fur-
thermore, all responses, such as sending response teams to the site, assisting
the LGU and other hospitals, should be documented and submitted.

110
SECTION 6
Early Warning and Alert Systems

CODE ALERT SYSTEM

The Code Alert System of the Department of Health is a mechanism for the provision of
health services during emergencies and disasters which describes the conditions that
govern the expected levels of preparation and the most suitable responses by all con-
cerned, particularly during mass casualty situations.

The first code alert system provided by A.O. 182 s. 2001 was directed to the Depart-
ment of Health hospitals given that “most emergencies and disasters are unpredictable
but are not totally unexpected.” The tri-color system has been revised to expand beyond
the hospital, paving the way for the harmonization of the code alert of the hospitals,
regional offices, key central offices and the HEMS Central office. The code starts its
lowest level of alert at Code White, then Code Blue and Code Red.

The Integrated Code Alert System of 2008 (Administrative Order No. 2008 - 0024)
describes the conditions for adopting the alert status, the human resource requirements
and other requirements (e.g., logistics) with the procedure in implementing the Code
Alert.

ALERT SIGNALS

It is a known fact that the occurrence of all hazards cannot be predicted.


• Earthquakes may occur without warning.
• Some hazards can be predicted as to
❍ Occurrence
❍ Impact on the community
❍ Outcome whether emergency or disaster
Consequences or risks

Hazards such as typhoons, volcanic eruptions, or threats of civil disorders, can


be anticipated several hours before they occur, giving at least ample time to get
ready to respond before emergencies or disasters are foreseen and/or declared.

Guidelines for Effective Early Warning and Alert Systems

Basic considerations in understanding a warning and alert system are described below
(Carter, 1991; SDP, 2000).

Timely warning of an imminent or probable hazard with a potential to cause an emer-


gency or a disaster will possibly prevent the occurrence or lessen the severity of its
consequences. The extent of such reduction depends upon the interaction of three ele-
ments, namely:
• Accuracy of warning
• Length of time between the warning being raised/declared and the expected
onset of the event
• State of Emergency/Disaster Preparedness
111
Requirements for Effective Warning include the capability to:

• Receive international warning


Example: cyclone warnings from Tropical Cyclone Warning Centers in various lo-
cations; meteorological indications from weather satellites of possibly developing
threats
• Initiate in-country warnings necessary in cases such as floods, landslides, volca-
nic eruptions, earthquake
• Transmit warning from national level and other key government levels; mostly
done by radio links or broadcast systems
• Transmit warning at local community level; may be done by local radio stations,
sirens, loud hailers, bells, messengers
• Receive warning and act upon it. This requires:
❍ possession of or access to a radio receiver or similar facility
❍ being in hearing/seeing distance of signals
❍ knowing what various warnings mean
Alerting consists of a number of response phases, namely:

Alert The period when it is believed that resources may be required


to enable an increased level of preparedness

Standby The period normally following an alert when the controlling or-
ganization believes that deployment of resources is imminent
– personnel are placed on standby to respond immediately

Call-out The command to deploy resources

Stand-down The period when the controlling organization has declared


that the emergency is controlled and that resources may be
recalled

To implement these phases, there needs to be:

• A protocol of which organizations to alert for which emergencies and what tasks;
• A contact list for all organizations;
• Duty officer rosters in all organizations to ensure that the organization can be
contacted during off hours; and
• A description of the type of information that should be supplied in the various
phases of alerting.

Warnings should be transmitted using as many media as available. These may origi-
nate from:
• The scene or the potential scene of the emergency and passed upwards; or

• The national government and passed down to the scene of the impending emer-
gency.
112
A community warning should cause appropriate public responses to minimize harm.

Warning messages should:


• Provide timely information about an impending emergency.
• State the action that should be taken to reduce loss of life, injury and property
damage.
• State the consequences of not heeding the warning.
• Provide feedback to response managers on the extent of community compliance.
• Be short, simple and precise.
• Have a personal context.
• Contain active verbs.
• Repeat information regularly.

The different alert signals for typhoons, earthquakes, tsunami, floods, lahar and volca-
nic eruptions are given in Section 6.2.

113
SECTION 6.1A
Code Alert System for DOH Central Offices

CODE WHITE

1. Conditions for adopting Code White:

● Strong possibility of a military operation, e.g., coup attempt/armed conflict which


has a national implication
● Any planned mass action or demonstration which has a national implication
● Forecast typhoons (Signal No. 2 up)
● National or local elections and other political exercises
● National events, holidays or celebrations with potential for MCI
● Notification of reliable information of terrorist/attack activities
● Any other hazard that may result in emergency
● Unconfirmed report of reemerging diseases, e.g., bird flu, SARS

2. Human resource requirements for responding to the code:

● Concerned directors or designates of the following offices should be on


standby:
• Material Management Division
• Finance Service
• Administrative Service
• Procurement and Logistics Service
• National Epidemiology Center
• National Center for Health Promotion
• Media Relations Unit
• National Center for Disease Prevention and Control
• National Center for Health Facilities and Development
• Bureau of Quarantine & International Health Surveillance
• Bureau of Food and Drug

CODE BLUE

1. Conditions for adopting Code Blue

● Any condition mentioned in Code White plus any of the two below:
• Mobilization of DOH resources is needed (manpower, materials, etc.)
• 30-50% health facilities in the area affected or damaged.
• No capability of the LGU and/or lack of resources of the region to respond to
the affected area.
• Magnitude of the disaster based on geographic coverage and number of
affected population (more than 30%).
• Any Mass Casualty Incident (MCI) with 50-100 casualties (mortalities plus
injuries) irrespective of color code.
• High case fatality rate for epidemic or confirmed/documented report of re-
emerging diseases (SARS, human to human Avian flu).
114
2. Human resource requirements for responding to the code:

● Director or designate to be present at the respective offices:


• Material Management Division
• Finance Service
• Administrative Service
• Procurement and Logistics Service
• National Epidemiology Center
• National Center for Health Promotion
• Media Relations Unit
• National Center for Disease Prevention and Control
• National Center for Health Facilities and Development
• Bureau of Quarantine & International Health Surveillance
• Bureau of Food and Drug

3. Other requirements:

Activate the following offices:

● Material Management Division


• Ensure availability of staff to prepare all medicines and supplies needed.
• Ensure that the medicines and supplies be transferred to the affected area via
NDCC arrangement or other means.
• Ensure the presence of the inspection team (DOH and BFAD Teams).
● Finance Service
• All unit heads must be available to facilitate release of funds.
• Petty cash must be in place.
• Facilitate travel arrangements and other requirements in case of local or inter-
national teams to be sent.
● Administrative Service
• Should ensure availability of vehicles with drivers, gasoline/diesel, etc.
• Should ensure the provision of electricity/ generator in all services responding
to the emergency/disaster at the Central Office.
• Should ensure availability of other communication lines specially PABX.
• Security Force to institute measures and stricter rules at the DOH Compound.
• Assist MMD in the preparation of medicines and supplies and transfer of these
to airports, etc.
• Facilitate arrangement with the airport for the travel of medical teams.
● National Epidemiology Center
• Ready surveillance and outbreak investigation team and experts to be de-
ployed as needed.
● Procurement Division
• Should ensure the availability of list of qualified & responsible pharmaceutical
companies and other suppliers for emergency procurement of drugs and
medicines.
• Should facilitate procurement of emergency drugs/supplies as needed.
● National Center for Health Promotion (NCHP)
• Should ensure their availability to assist and provide technical assistance to
HEMS and Regional Offices in the conceptualization and development of
behavioral messages and IEC materials.
• Should assist Regional Offices in the conduct of health education activities. 115
• Assist in documentation of events.
● Media Relations Unit (MRU)
• Anticipate any untoward media reports and recommend necessary response.
• Prepare press releases and/or press statement.
• Recommend and organize press conference and other media blitz like radio
and television appearances.
• Coordinate with HEMS/NCDPC and other offices for technical inputs.
● National Center for Disease Prevention and Control (NCDPC)
• All Program Managers with concerns in disaster should be available for their
technical support, such as those for communicable disease, environmental,
nutrition, sanitation, psychosocial concerns, etc.
• Provide treatment protocol as necessary.
• Standby experts to be mobilized to affected area.
● National Center for Health Facilities Development
• Technical support for hospitals should be readily available especially for infra-
structure concerns.
• There should be protocols in the movement of blood requirements for emer-
gencies especially for Mass Casualty Incidents. Blood intended for elective
cases can be realigned for the use of victims.
• Provide technical support, especially for hospital management.
● Bureau of Food and Drug
• Ensure the presence of the inspection team to issue certificate of clearance for
drugs and medicines.
• Facilitate requirements and certification for donated medicines, etc.
● Bureau of Quarantine and International Health Surveillance
• Will only be activated in the presence of cases of reemerging diseases such
as SARS and Avian Flu which needs international surveillance in all ports
of entry and other emergencies related to incoming and outgoing transporta-
tions.

All offices/bureaus to have regular coordination with DOH-HEMS.

CODE RED

1. Conditions for adopting Code Red:

Any natural, man-made, technological or societal disaster where all of the


fol lowing are present:
● Declaration of disaster in the affected area.
● 100 or more casualties in one area.
● Health personnel in the region not capable of handling entire operation.
● Mobilization of health sector needed.
● Mobilization of key offices of Department of Health.
● Uncontrolled human to human transmission of SARS/avian flu in any region.

2. Human Resource requirements for responding to the Code:

All services should ensure the availability of staff for 24 hours to address all requests
for technical as well as other logistical support.

3. Other requirements
116
● Each office to deploy one personnel to augment HEMS Central Operations
Center and NDCC Operations Center.
● DOH Crisis Committee to convene and provide overall support, direction and
policy directions to affected regions. Likewise, they can call on any other office for
technical and management support.
● All directors or designates mentioned above to report 24/7 to operations until
Code Red is lifted.
● Other offices/units shall be on call or required to report to the Operations Center
as identified or needed by the Crisis Committee.

Guidelines in implementing the Code

● The Central Code Alert shall be declared by the Secretary of Health upon the rec-
ommendation and evaluation of the Director of HEMS for natural and man-made
emergencies with national implications; and for epidemics and reemerging diseases
by the directors of NEC and NCDPC.
● This will be disseminated through a Department Memorandum. HEMS OpCen may
call through a telephone brigade all offices concerned. This will also be followed
in lifting the code alert.

117
SECTION 6.1B
Integrated Code Alert System for the Health Sector
as per A.O. 2008-0024
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT
CODE 1. Conditions for adopt- 1. Conditions for adopt- 1. Conditions for adopt-
WHITE ing Code White: ing Code White: ing Code White:
• Strong possibility of • Strong possibility of a • Strong possibility of a
a military operation, military operation within military operation, e.g.,
e.g., coup attempt/ the area/region, e.g., coup attempt within the
armed conflict which coup attempt region
has a national implica- • Any planned mass • Presence of hazards that
tion action or demonstration pose a public threat such
• Any planned mass ac- within the catchment as epidemics, chemical,
tion or demonstration area biological and radiologi-
which has a national • Forecast typhoons cal threat, etc.
implication (Signal No. 2 up) the • Notification of ongoing
• Forecast typhoons path of which will affect epidemic by LGU, with
(Signal No. 2 up) the area adequate measures by
• National or local elec- • National or local elec- local health personnel
tions and other political tions and other political • Any planned mass action
exercises exercises or demonstration in the
• National events, holi- • National events, holi- area
days or celebrations days, or celebrations in • Forecast typhoons
with potential for MCI the area with potential (Signal No. 2 up) the
• Any emergency with for MCI path of which will affect
potentially 10-50 • Any emergency with the region
casualties (deaths, potentially 10-50 casu- • National or local elec-
injuries) alties (deaths, injuries) tions and other political
• Notification of reliable • Any other hazard that exercises
information of terror may result in emergency • National events, holidays
ist/attack activities • Unconfirmed report of or celebrations with
• Any other hazard that reemerging diseases, potential for MCI
may result to emer- e.g., bird flu, SARS • Any emergency with
gency potential 10-50 casual-
• Unconfirmed report of ties (deaths, injuries)
re-emerging diseases, • Any other hazard that
e.g., bird flu, SARS may result in emergency
• Unconfirmed report of
reemerging diseases,
e.g., bird flu, SARS
CODE 2. Human Resource re- 2. Human Resource re- 2. Human Resource re-
WHITE quirements for res- quirements for re- quirements for re-
ponding to the Code: sponding to the sponding to the Code:
• Emergency Officer on Code: • 2 Emergency Officers
Duty (EOD) 1 and 2 • First response on Duty
• Driver and Security team ready for dispatch • Driver
Guard to assist at the to include the following: • Regional HEMS Coordi-
Operation Center ✔ 2 doctors preferably nator on call and on
• Reliever 1 and 2 (next Surgeon, Internist, proactive monitoring
day EOD’s) on standby anesthesiologist, • One Rapid Assessment
• Response Division Chief etc. Team ready for dispatch
or alternate on continu - ✔ 2 nurses to include the following:
118 ous monitoring and will ✔ DOH Representative
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT
CODE serve as Medical Con- ✔ First Aider/EMT ✔ Nurse
WHITE troller for Mass Casualty ✔ Driver ✔ Driver
Incident • Second response team
should be on call
• The following should
be available for immedi-
ate treatment of incom-
ing patients:
✔ General Sur-
geons
✔ Orthopedic Sur-
geons
✔ Anesthesiolo-
gists
✔ Internists
✔ O.R. Nurses
✔ Ophthalmologists
✔ Otorhinolaryngolo-
gists
✔ Infectious Special -
ists
• Emergency service
personnel, nursing
personnel and admi-
nistrative personnel
residing at the hospital
dormitory shall be
placed on call status
for immediate mobiliza-
tion.
CODE 3. Other requirements: 3. Other requirements: 3. Other requirements:
WHITE • EOD 1 to check all medi- • The Hospital Operations • The Regional Operations
cines, supplies available. Center should be acti- Center should
• EOD 1 & 2 to do proac- vated. It should continu- be activated on 24 hours
tive monitoring. ously report and coordi- and continuously report
• EOD to alert the region, nate with the Regional and coordinate with
hospitals and other facili- and DOH Central Opera- HEMS Operations
ties that might be affect- tions Center. Center.
ed or needed to respond- ■ Medicines and Supplies • Do proactive monitoring
or receive patients. • Ensure that emergency for any development.
• Response Division Chief medicines (especially • Report to HEMS-OpCen
or HEMS Director to alert for trauma needs) be daily and as necessary.
key officials as needed. made available at the • Require update from
• EOD to inform National emergency room. field as necessary.
Epidemiology Center • Medicines and sup- • Finance division to en-
regarding outbreaks for plies in the operating sure availability of funds
confirmatory report. rooms should likewise in cases of emergency
be reviewed and in purchases and the like.
creased to meet sudden • Supply section to coordi-
requirements. nate with possible sup-
• Other needs such as pliers for additional re -
X-ray plates, laboratory quirements.
requirements, etc. • Transport section to en-
should be made avail- sure availability of ve- 119
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT

able and not required to hicles.


be purchased by victims. • Monitor and assess con-
• Personnel department to tinuously for require
prepare for mobilization ments of other teams
of additional staff. (medical, surveillance,
• Finance department to environmental, health
ensure availability of promotion, psychosocial
funds in cases of emer- etc.). These teams are
gency purchases and on standby/on call for
the like. immediate mobilization.
• Logistics department • Intensify IEC campaign
to coordinate with pos- through health adviso-
sible suppliers for addi- ries.
tional requirements. • Coordinate regularly with
• Dietary department to affected LGUs.
open and meet the need • Coordinate with regional
of the victims as well hospitals for back-up
as the health personnel teams.
on duty. • Monitor stock level of
• Security force to institute needed drugs/supplies,
measures and stricter pre-position as needed.
rules in the hospital. • Activate Bird Flu Plan.
• Activate Bird Flu Plan/ • Mobilize RESU team
SARS Plan, etc. to conduct investigation
• Enforce and monitor use for outbreaks.
of personal protective
equipment (PPE) for all
health personnel.
• Triage system should be
activated.
CODE 1. Conditions for Adopt- 1. Conditions for Adopt- 1. Conditions for Adopt-
BLUE ing Code Blue ing Code Blue: ing Code Blue:
■ Any condition men- ■ Any of the following ■ Any of the following
tioned in Code White conditions: conditions:
plus any of the two • When 20-50 casual- • 50-100 casualties irre-
below: ties (red tags) are sud- spective of tags for MCI.
• Mobilization of DOH denly brought to the • Declaration of epidemic.
resources is needed hospital. • Declaration of calamity
(manpower, materials, • Any internal emergen- in any province in the
etc.). cy/disaster in the hospi- region.
• 30-50% health facilities tal which brings down • Presence of evacuation
in the areas affected or their operating capac- centers estimated to last
damaged. ity (i.e., vital areas) to for more than a week
• No capability of the LGU 50% or which would re- which has public health
and/or lack of resources quire evacuation of implications.
of the region to respond patients and setting up • Magnitude of the disas-
to the affected area. of a Field Hospital. ter based on geographic
• Magnitude of the disas- • For conditions other than coverage and number
ter based on geographic MCI, the influx of pa- of affected population
coverage and number of tients is beyond the (more than 30%).
affected population (more capacity of the hospital • Any conditions that
than 30%). to handle. would require mobi-
• Any Mass Casualty • Confirmed/documented lization of resources of
120 Incident (MCI) with 50- report of reemerging the entire region.
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT
100 casualties irrespec- diseases (SARS, human
tive of color code. to human avian flu)
• High case fatality rate for within the catchment
epidemics. area.
• Confirmed human to hu-
man for avian flu or
SARS.
CODE 2. Human Resource re- 2. Human Resource re- 2. Human Resource re-
BLUE quirements for re- quirements for re- quirements for re-
sponding to the Code: sponding to the Code: sponding to the Code:
• Response Division Chief • HEMS Coordinator to • RHEMS Coordinator
or HEMS Director should be physically present at to be physically present
be physically present at the hospital. at OPCEN.
OPCEN. • On-scene Response • Rapid Assessment
• EOD 1 and 2 Team Teams and other
• Driver and security guard • Medical Officer in charge appropriate teams
to assist at the Opera of the Emergency Room (RAT)
tions Center. • All residents of the De- • Three (3) teams on
• Incoming EODs on call partment of Orthopedics standby (environmental/
for immediate mobiliza- • Medical Officer in charge surveillance/medical)
tion. of the Operating Room • EOD 1 and 2
• Logistics Officer or alter- • Surgical Team on duty • Logistics Officer
nate to go on duty. for the day • Finance Officer as nec-
• At least one DOH rep- • Surgical Team on duty essary
resentative to go on duty the previous day • Health Promotions
to NDCC if required • Mental health profes- Officer as necessary
and/or requested. sionals • Driver
• All anesthesiology resi- • All other regional staff
dents on standby for immedi-
• Toxicologist, chemical ate mobilization
experts for poisoning • All DOH REPS in the
and/or chemical cases affected area should be
(if available) available at the LGU.
• All third and fourth year
residents
• Administrative Officer or
designate
• Nursing supervisor on
duty
• All OR nurses
• Social workers
• Dietary personnel
• Officer in charge of sup-
plies at the CSR
• The entire security force
• Institutional workers on
duty
CODE 3. Other requirements: 3. Other requirements: 3. Other requirements:
BLUE • Coordinate with the fol- All those mentioned in All those mentioned in
lowing: Code White plus: Code White plus:
✔ Implementing agen- • Activate Hospital Emer- • Activate the Regional
cies (hospitals, gency Incident Com- Emergency Incident
region, central 121
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT

office) for possible mand System (HEICS). Command System


dispatching of teams • Other needs of victims (REICS).
or experts apart from medicines • Operations Center on
✔ NDCC and other and supplies depending 24/7 with adequate per-
sectors for other con- on the disaster should sonnel and logistical sup-
cerns, e.g., trans- as much as possible be port to receive, evaluate
portation, etc. made available. and analyze all reports.
✔ MMD regarding sup- • The Chief of Hospital/ • Mobilize teams to affect
plies available at Medical Center or his ed areas for Rapid As-
DOH designate should make sessment in coordination
✔ Different DOH Cen- proper coordination with the DOH Rep.
tral Offices for per with other hospitals for • Regional Director or his
sonnel augmentation networking and/or pos- designate to make
to the Operations sible transfer of patients. proper coordination with
Center and for other • Incident Commander RDCC and other agen-
technical support should assign a Safety cies like DSWD, DepEd,
• Prepare possible drugs Officer, Liaison officer etc. for networking and
and medicines needed to coordinate with other other requirements.
for movement to agencies, and Public • Incident Commander
affected area. Information Officer to should assign needed
• If needed drugs/medi - serve as the spokesper- staff in Operations, Lo-
cines not available, pre- son of the hospital. gistics, Planning and
pare emergency pur- • Social Service section Administrative sections
chase. should prepare assis- to assist affected LGUs.
• Check all possible tance to victims in coor- • Public Information Of -
means of transportation, dination with mental ficer to prepare and have
e.g., with NDCC, air health professionals regular media confer-
cargo, etc. of the hospital, if avail- ences or press releases.
• Anticipate need of able, and the Depart- • Continuous IEC cam-
medical teams and ment of Social Welfare; paign through health
other experts. in addition they should advisories, especially in
• Prepare all needed lead in providing infor- evacuation centers.
reports and presenta- mation to relatives of • May need to activate
tions required, espe- victims. also a Field EOC as
cially for emergency • Mortuary section should needed to coordinate
NDCC meetings. anticipate dead victims health activities.
• Orient staff to be brought to the hospital • Oversee operation of
deployed to NDCC and for proper care and iden- Management of Mass
those additional staff tification. Dead together with the
to augment the OpCen. • The security team, in health unit of the LGU
• In cases of long term anticipation of possible concerned.
emergencies, plan for influx or patients, rela- • Lead in coordinative
support to the affected tives, responders, meetings of the cluster
region. police, press, etc. should under the DOH: Health,
• Activate Code Blue for ensure smooth flow of Nutrition and WASH.
HEMS and prepare traffic inside the com- • Provide technical sup-
necessary documenta- pound especially for the port to LGUs.
tion. ambulances. • Mobilize other require-
• Initiate the conduct • Should report regularly ments as needed, such as
of coordinative meet to HEMS OpCen and psychosocial team, etc.
ing of the national as much as possible • Regularly coordinate
clusters: Health, Nutri- have regular press with DOH-HEMS OpCen
tion and WASH. releases or briefings. for reports and other
needs.
122
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT
CODE 1. Conditions for Adopt- 1. Conditions for Adopt- 1. Conditions for adopt-
RED ing Code Red: ing Code Red: ing Code Red:
Any natural, manmade, Any of the following is Any of the following is
technological or soci- present: present:
etal disaster, where all • When more than 50 • Conditions resulting
of the following are (red tag) casualties in mass dead and
present: are suddenly brought missing.
• Declaration of disas- to the hospital. • Disaster declared in
ter in the affected • An emergency 2 or more provinces
area. wherein the services in the region or 30%
• 100 or more casual- of the hospital is of the cities in Metro
ties in one area. paralyzed since 50% Manila.
• Health personnel in of the manpower are • Major facilities or
the region not themselves victims of hospitals, such as
capable of handling the disaster. the provincial/city
entire operation. • Hospital is structur- hospital, in area are
• Mobilization of the ally damaged re- not able to provide
health sector quiring evacuation optimal services due
needed. and/or transfer of to damages or 50%
• Mobilization of key patients. of staff are affected.
offices in DOH. • Conditions requiring • Mobilization of entire
• Uncontrolled human mandatory quaran- regional resources
to human transmis- tine of hospital and not enough thus
sion of SARS/avian its personnel (e.g., requiring external
flu. SARS, avian flu); un- support.
controlled human to • Uncontrolled epidem-
human transmission ic/outbreak.
of SARS/avian flu • Uncontrolled human
within the catch- to human transmis-
ment area. sion of SARS/avian
flu.
CODE 2. Human Resource re- 2. Human Resource re- 2. Human Resource re
RED quirements for re- quirements for re- quirements for re-
sponding to the Code: sponding to the Code: sponding to the Code:
The HEMS Office per- All personnel enumer- Mobilize all regional staff
sonnel and staff aug- ated under Code Blue as needed on rota-
mentation from other All medical interns and tion basis.
offices shall be divi- clinical clerks Establish surveillance
ded into 3 teams to go All nurses system in all evacua-
on a 24-hour duty • All nursing attendants tion centers.
rotation every 3 days. • All institutional work All other teams deployed
The team is composed ers in affected area.
of the following: • All administrative
• Team Leader staff
• 2 Data Collectors/
Encoders
• Logistics
• Communication
• Administrative Of
ficer
• Support Staff/Clerk
• Driver
• At least 1 staff to be
assigned at OCD 123
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT
OpCen on 24-hour
duty

CODE 3. Other requirements: 3. Other requirements: 3. Other requirements:


RED • HEMS to represent All those mentioned in All those mentioned in
the Department Code Blue plus: Code Blue plus:
of Health to NDCC • The Chief of Hospi- • The CHD Director
and other agencies. tal/Medical Center can cancel all types
• Lead in the coordina- Chiefs can cancel of leaves and can
tion with international all types of leaves order all personnel to
partners in the health, and can order all per- report to the CHD.
nutrition and WASH sonnel to report to the • The CHD Director
clusters. hospital. can stop all operations
• Lead in the coordina- • The Chiefs of Hospital/ not related to the
tion with all members Medical Center Chiefs disaster.
of the health sectors. can temporarily stop • The CHD Director
• Lead in the coordina- all elective admissions should anticipate
tion with donor agen- and surgeries and requests for addition-
cies, both international network with other al manpower and
and local. hospitals. specialists not avail-
• Prepare updated • The Chief of Hospi- able in his CHD. He
reports for use of Sec- tal/Medical Center is further authorized to
retary and other Chiefs should antici- accept volunteers and
partners. pate requests for ad- other professionals
• Assist in the prepara- ditional manpower and to augment the CHD’s
tion of the rehabilita- specialists not avail- manpower based on
tion and recovery able in his hospital. some agreements.
plan; represent the He is further author- • Continue networking
DOH in the national ized to accept medical with RDCC and its
DANA team. volunteers and other clusters (Health, Nutri-
• HEMS-OpCen to professionals to aug- tion, WASH).
serve as DOH Com- ment the hospital’s • Public information
mand Post. manpower resources campaign.
• Recommend the rather than transfer- • Handles queries from
activation of the Crisis ring patients based on media.
Committee which some agreements. • For reemerging dis -
serves as the techni- • Networking with other eases, to provide lead-
cal operations arm hospitals for augmen- ership together with
and prepares recom- tation of resources the LGU in decisions
mendations to the and transfer of patients like quarantine of the
Executive Committee in special cases. area and other deci-
of DOH to be chaired • Answer all queries sions in preventing
by the Undersecretary of the media pertain- spread of the
for Policy Develop- ing to patients in the epidemic.
ment Team for Service hospital. • Provide updated report
Delivery and to be • Anticipate evacuation to HEMS Central
assisted by the Direc- and/or use of field OpCen.
tors of HEMS, NEC, hospital; closure and/
NCDPC, NCHFD, or quarantine of the
Finance, Administra- hospital.
tive and MMD. • The Chief of Hospi -
tal/Medical Center
Chief to specifically
be concerned with
124 safety and security, not
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT HEMS CENTRAL CENTER FOR HEALTH
LEVEL OFFICE HOSPITAL DEVELOPMENT
only of the patients but of
the personnel as well.
CODE ✔ Guidelines in imple- ✔ Guidelines in implement- ✔ Guidelines in imple-
RED menting the Code ing the Code Alert menting the Code Alert
Alert • The Hospital Code Alert • The Regional Code
• The HEMS Code shall be declared by the Alert shall be declared by
Alert shall be declared Secretary of Health or by the Secretary of Health or
by the HEMS Director the Director of HEMS for Director of HEMS for
or by the Division external emergencies; emergencies with na-
Chief (Response or by the Medical Center tional implications; Re-
Preparedness). Chiefs; Chiefs of Hospi- gional Director and
• Announced through tal; HHEMS Coordinator; RHEMS Coordinator for
telephone brigade. or Head of the Disaster internal (regional) emer-
• Administrative Officer Committee of the Hospital gencies.
to prepare Office emergencies within their • Regional Directors to
Or der/Department catchment area. automatically declare
Personnel Order. • Chiefs of hospital/medi- Code White during na-
• HEMS Director cal center to automati cally tional events and
or the Division Chief declare Code White during activities especially with
(Response or Pre- national events and the potential of an MCI.
paredness) lifts activities especially with • The alert is raised, low-
the Code Alert and the potential of an MCI. ered or suspended by the
make the necessary • Each hospital shall prepare Secretary of Health,
announcement. its own proce dures in de- HEMS Director for
claring and lifting the Code. emergencies with na-
tional implications, or
✔ The alert level is raised, by the respective Re-
lowered or suspended by gional Director or RHEMS
the Secretary of Health, Coordinator for internal
Director of HEMS for (regional) emergencies.
external emergencies • Each region shall pre-
and national events; the pared its own procedures
respective Medical Center in declaring and lifting the
Chiefs/Chiefs of Hospital or Code.
their designates for emer-
gencies within their catch- ✔ Conditions to raise or
ment area. suspend the alert level
depends on the threat
✔ Conditions to raise or sus- – whether it is increased
pend the alert level de- or is no longer present.
pends on the threat
– whether it is increased or
is no longer present.

✔ Arrival of patients in the


hospitals warrants the
raising of the alert level;
likewise alert can be
suspended when no sig-
nificant incident is moni-
tored and the hazard or
condition (typhoon, elec-
tion, bombing, etc.) is 125
finished and/or contained.
SECTION 6.2
Alert Signals
1. PUBLIC STORMS
WHAT ARE THE DIFFERENT PUBLIC STORM WARNING SIGNALS,
THEIR MEANINGS AND THE THINGS TO BE DONE?
PUBLIC STORM
WARNING MEANING WHAT TO DO
A Tropical Cyclone will affect the • Listen to the radio for more information
locality. about the weather disturbance.
• Check the capacity of the house to
Winds of 30-60 KPH may be expected withstand strong winds and strengthen
in at least 36 hours or intermittent the house if necessary.
rains maybe expected within 36 • The people are advised to listen to
hours*. the latest severe weather bulletin
issued by PAGASA every six
Disaster preparedness plan is acti- hours. In the meantime, business may
vated to alert status. be carried out as usual except when
SIGNAL # 1 flood occurs.
A Moderate Tropical Cyclone will • Special attention should be given to
affect the locality. the latest position, the direction
and speed of movement and the in
Winds of more than 60 up to 100 tensity of the storm as it may inten
KPH may be expected in at least 24 sify and move towards the locality.
hours*. • The general public, especially people
travelling by sea and air, are cautioned
Disaster preparedness agencies/ to avoid unnecessary risks.
organizations are in action to alert • Secure properties before the signal is
their communities. upgraded.
SIGNAL # 2 • Board up windows or put storm shut
ters in place and securely fasten them.
• Stay at home.

A Strong Tropical Cyclone will affect • Keep your radio on and listen to the
the locality. latest news about the typhoon.
• Everybody is advised to stay indoors.
Winds of more than 100 up to 185 • People are advised to stay in strong
KPH may be expected in at least 18 buildings.
hours*. • Evacuate from low-lying areas.
• Stay away from coastal areas and
Disaster preparedness agencies/ river banks.
organizations are in action with • Watch out for the passage of the
appropriate response to actual “Eye wall” and the “Eye of the Ty
emergency. phoon.”
SIGNAL # 3

A Very Intense Typhoon will affect • Stay in a safe house or evacuation


the locality. centers!!!
• The situation is potentially very de
Winds of more than 185 KPH may be structive to the community.
expected in at least 12 hours*. • All travels and outdoor activities
should be cancelled.
The National Disaster Coordinating • In the overall, damage to affected
Council and other disaster re- communities can be very heavy.
sponse organizations are now fully
responding to emergencies and
SIGNAL # 4 in full readiness to immediately
respond to possible calamity.
* Times are valid only the first time the signal number is raised.

126
2. EARTHQUAKES
PHIVOLCS EARTHQUAKE INTENSITY SCALE
INTEN-
SITY DESCRIPTION
SCALE
Scarcely Perceptible - Perceptible to people under favorable circumstances. Delicately bal-
I anced objects are disturbed slightly. Still water in containers oscillates slowly.

Slightly Felt - Felt by few individuals at rest indoors. Hanging objects swing slightly. Still water
II in containers oscillates noticeably.

Weak - Felt by many people indoors especially in upper floors of buildings. Vibration is felt like
III the passing of a light truck. Dizziness and nausea are experienced by some people. Hanging
objects swing moderately. Still water in containers oscillates moderately.

Moderately Strong - Felt generally by people indoors and by some people outdoors. Light
IV sleepers are awakened. Vibration is felt like the passing of a heavy truck. Hanging objects
swing considerably. Dinner plates, glasses, windows and doors rattle. Floors and walls of wood-
framed buildings creak. Standing motor cars may rock slightly. Liquids in containers are slightly
disturbed. Water in containers oscillates strongly. Rumbling sound may sometimes be heard.

Strong - Generally felt by most people indoors and outdoors. Many sleeping people are awak-
V ened. Some are frightened, some run outdoors. Strong shaking and rocking felt throughout
building. Hanging objects swing violently. Dining utensils clatter and clink; some are broken.
Small, light and unstable objects may fall or overturn. Liquids spill from filled open containers.
Standing vehicles rock noticeably. Shaking of leaves and twigs of trees are noticeable.

Very Strong - Many people are frightened; many run outdoors. Some people lose their balance.
VI Motorists feel like driving with flat tires. Heavy objects or furniture move or may be shifted. Small
church bells may ring. Wall plaster may crack. Very old or poorly built houses and man-made
structures are slightly damaged although well-built structures are not affected. Limited rockfalls
and rolling boulders occur in hilly to mountainous areas and escarpments. Trees are noticeably
shaken.

Destructive - Most people are frightened and run outdoors. People find it difficult to stand in
VII upper floors. Heavy objects and furniture overturn or topple. Big church bells may ring. Old or
poorly built structures suffer considerable damage. Some well-built structures are slightly dam-
aged. Some cracks may appear on dikes, fish ponds, road surface, or concrete hollow block
walls. Limited liquefaction, lateral spreading and landslides are observed. Trees are shaken
strongly. (Liquefaction is a process by which loose saturated sand lose strength during an earth-
quake and behave like liquid).

Very Destructive - People panic. People find it difficult to stand even outdoors. Many well-built
VIII buildings are considerably damaged. Concrete dikes and foundation of bridges are destroyed
by ground settling or toppling. Railway tracks are bent or broken. Tombstones may be dis-
placed, twisted or overturned. Utility posts, towers and monuments may tilt or topple. Water and
sewer pipes may be bent, twisted or broken. Liquefaction and lateral spreading cause man-
made structures to sink, tilt or topple. Numerous landslides and rockfalls occur in mountainous
and hilly areas. Boulders are thrown out from their positions particularly near the epicenter.
Fissures and faults rupture may be observed. Trees are violently shaken. Water splash or stop
over dikes or banks of rivers.

Devastating - People are forcibly thrown to ground. Many cry and shake with fear. Most build-
IX ings are totally damaged. Bridges and elevated concrete structures are toppled or destroyed.
Numerous utility posts, towers and monument are tilted, toppled or broken. Water sewer pipes
are bent, twisted or broken. Landslides and liquefaction with lateral spreadings and sandboils
are widespread. The ground is distorted into undulations. Trees are shaken very violently with
some toppled or broken. Boulders are commonly thrown out. River water splashes violently on
slops over dikes and banks.

Completely Devastating - Practically all man-made structures are destroyed. Massive land-
X slides and liquefaction, large-scale subsidence and uplifting of land forms and many ground
fissures are observed. Changes in river courses and destructive seiches in large lakes occur.
Many trees are toppled, broken and uprooted. 127
RICHTER MAGNITUDE SCALE
Magnitude
Scale Description

1 Earthquake with M below 1 are only detectable when an ultra sensitive seismometer is
I operated under favorable conditions.

2 Most earthquakes with M below 3 are the “hardly perceptible shocks” and are not felt.
II They are only recorded by seismographs of nearby stations.

3 III Earthquake with M 3 to 4 are the “very feeble shocks” and only felt near the epicenter.

4 IV Earthquakes with M 4 to 5 are the “feeble shocks” where damages are not usually reported.

5 V Earthquakes with M 5 to 6 are the “earthquakes with moderate strength” and are felt over
the wide areas; some of them cause small local damages near the epicenter.

6 VI Earthquake with M 6 to 7 are the “strong earthquakes” and are accompanied by local dam-
ages near the epicenters. First class seismological stations can observe them wherever they
occur within the earth.
Earthquake with M 7 to 8 are the “major earthquakes” and can cause considerable dam-
VII ages near the epicenters. Shallow-seated or near-surface major earthquakes when they oc-
cur under the sea, may generate tsunamis. First class seismological stations can observe
them wherever they occur within the earth.

Earthquake with M 8 to 9 are the “great earthquakes” occurring once or twice a year. When
VIII they occur in land areas, damages affect wide areas. When they occur under the sea, consid-
erable tsunamis are produced. Many aftershocks occur in areas approximately 100 to 1,000
kilometers in diameter.

Earthquakes with M over 9 have never occurred since the data based on the seismographic
IX observations became available.

3. VOLCANIC ERUPTIONS
3.1 MAYON VOLCANO ALERT LEVELS
ALERT
LEVEL MAIN CRITERIA INTERPRETATION/RECOMMENDATION

0 Quiet. No eruption in foreseeable future.


No Alert All monitored parameters within Entry in the 6-km radius Permanent Danger
background levels. Zone (PDZ) is not advised because phreatic
explosions and ash puffs may occur without
precursors.

1 Low level unrest. No eruption imminent.


Abnormal Slight increase in seismicity. Activity may be hydrothermal, magmatic or
Slight increase in SO2 gas output above tectonic in origin.
the background level. No entry in the 6-km radius PDZ.
Very faint glow of the crater may occur
but no conclusive evidence of mag-
ma ascent.
Phreatic explosion or ash puffs may
occur.

2 Moderate unrest. Unrest probably of magmatic origin; could


Increasing Low to moderate level of seismic eventually lead to eruption.
Unrest activity. 6-km radius Danger Zone may be extended to 7
128 Episodes of harmonic tremor. km in the sector where the crater rim is low.
Increasing SO2 flux.
Continuation of 3.1 MAYON VOLCANO ALERT LEVELS
ALERT
LEVEL MAIN CRITERIA INTERPRETATION/RECOMMENDATION

Faint/intermittent crater glow.


Swelling of edifice may be detected.
Confirmed reports of decrease in
flow of wells and springs during
rainy season.

3 Relatively high unrest. Magma is close to the crater.


Increased Volcanic quakes and tremor may be If trend is one of increasing unrest, eruption is
Tendency come more frequent. possible within weeks.
Towards Further increase in SO2 flux. Extension of Danger Zone in the sector where
Eruption Occurrence of rockfalls in summit area. the crater rim is low will be considered.
Vigorous steaming/sustained crater glow.
Persistent swelling of edifice.

4 Intense unrest. Hazardous eruption is possible within days.


Hazardous Persistent tremor, many “low frequen- Extension of Danger zone to 8 km or more in
Eruption cy”-type earthquakes. the sector where the crater rim is low will be
Imminent SO2 emission level may show sustained recommended.
increase or abrupt decrease.
Intense crater glow. Incandescent lava
fragments in the summit area.

5 Hazardous eruption ongoing. Pyroclastic flows may sweep down along gul-
Hazardous Occurrence of pyroclastic flows, tall lies and channels, especially along those
Eruption eruption columns and extensive fronting the low part(s) of the crater rim.
ashfall. Additional danger areas may be identified as
eruption progresses.
Danger to aircraft, by way of ash cloud encoun-
ter, depending on height of eruption column
and/or wind drift.

3.2 BULUSAN VOLCANO ALERT SIGNALS


ALERT
LEVEL CRITERIA INTERPRETATION

No Alert Background, quiet. No eruption in foreseeable future.

1 Low level seismic, fumarolic, other Magmatic, tectonic, or hydrothermal distur-


unrest. bance; no eruption imminent.

2 Moderate level of seismic, other unrest Probable magma intrusion; could eventually
with positive evidence for involve- lead to an eruption.
ment of magma.
3 Relatively high and increasing unrest, Increasing likelihood of an eruption, possibly
including numerous low frequency explosive, probably within days to weeks.
volcanic earthquakes, accelerating
ground deformation, increasing fu-
marolic activity.
4 Intense unrest, including harmonic Magma close to or at the earth’s surface.
tremor and/or many “long-period” Hazardous explosive eruption likely, possibly
(i.e., low frequency) earthquakes within hours or days.
and/or dome growth and/or small
explosions.
129
Continuation of 3.2 BULUSAN VOLCANO ALERT LEVELS

ALERT
LEVEL MAIN CRITERIA INTERPRETATION

5
Hazardous eruption in progress.
Hazards in valleys and downwind.

3.3 TAAL VOLCANO ALERT SIGNAL


ALERT CRITERIA INTERPRETATION
LEVEL

No alert Background, quiet. No eruption in foreseeable future.


(NORMAL)

1 Low level seismicity, fumarolic, other Magmatic, tectonic or hydrothermal distur-


(ABNOR- activity. bance; no eruption imminent.
MAL)

2 Low to moderate level of seismicity, A) Probable magmatic intrusion; could eventu-


(ALARM- persistence of local but unfelt earth ally lead to an eruption.
ING) quakes. Ground deformation B) If trend shows further decline, volcano may
measurements above baseline levels. soon go to level 1.
Increased water and/or ground probe
hole temperatures, increased bub-
bling at Crater Lake.

3 Relatively high unrest manifested by A) If trend is one of increasing unrest, erup-


(CRITICAL) seismic swarms including increas- tion is possible within days to weeks.
ing occurrence of low frequency B) If trend is one of decreasing unrest, vol-
earthquakes and/or harmonic tremor cano may soon go to level 2.
(some events felt). Sudden or
increasing changes in temperature or
bubbling activity or radon gas emis-
sion or Crater Lake pH. Bulging of
the edifice and fissuring may accom-
pany seismicity.

4 Intense unrest, continuing seismic Hazardous explosive eruption is possible


(ERUPTION swarms, including harmonic tremor within days.
IMMINENT) and/or “low frequency earthquakes”
which are usually felt, profuse steam-
ing along existing and perhaps new
vents and fissures.

5 Base surges accompanied by eruption Hazardous eruption in progress. Extreme


(ERUPTION) columns or lava fountaining or lava hazards to communities west of the vol-
flows. cano and ashfalls on downwind sectors.

130
4. HURRICANES
HURRICANE CATEGORIES

BAROMETRIC STORM
PRESSURE WIND SPEED SURGE DAMAGE POTENTIAL

Category One (1): Weak

> 28.94 in 74-95 mph 4-5 ft Minimal damage to vegetation. No real damage to other
(980 mb) (64-82 kt or structures. Some damage to poorly constructed signs. Low-
119-153 km/hr) lying coastal roads inundated, minor pier damage, some
small craft in exposed anchorage torn from moorings.

Category Two (2): Moderate

28.50-28.94 96-110 mph 6-8 ft Considerable damage to vegetation; some trees blown
in (965-980 (83-95 kt or down. Major damage to exposed mobile homes. Moderate
mb) 154-177 km/hr) damage to houses. Considerable damage to piers; marinas
flooded. Small craft in unprotected anchorages
an torn from
moorings. Evacuation from some shoreline residences and
low-lying areas required.

Category Three (3): Strong

27.91-28.50 111-130 mph 9-12 ft Large trees blown down. Mobile homes destroyed. Ex-
in (945-965 (96-113 kt or tensive damage to small buildings. Poorly constructed
mb) 178-209 km/hr) signs blown down. Serious coastal flooding; larger
structures near coast damaged by battering waves and
floating debris.

Category Four (4): Very Strong

27.17-27.91 131-155 mph 13-18 ft All signs blown down. Complete destruction of mobile
in (920-945 (114-135 kt or homes. Extreme structural damage. Major damage to lower
mb) 210-249 km/hr) floors of structures due to flooding and battering by waves
and floating debris. Major erosion of beaches.

Category Five (5): Catastrophic

< 27.17 in > 155 mph > 18 ft Catastrophic building failures. Devastating damage to roofs
(920 mb) (135 kt or 249 of buildings. Small buildings overturned or blown away.
km/hr)

131
5. LAHAR
LAHAR ALERT

ALERT SIGNAL INTERPRETATION


LEVEL

Alert I “Get ready” People residing near the river channels and low lying areas
- Get ready
- Tune in to their national/local radio station for further announce-
ment

Alert II “Get Set “ Residents in the endangered areas


- Secure their houses and pack basic item and belonging
- Prepare to leave to higher grounds/safer places or to the predesig-
nated evacuation center

Alert III “Go” People in the endangered areas


- Leave their homes
- Proceed to safer places, higher grounds, designated pick-up
points for evacuation to designated evacuation centers.

Source: Department of Health – Health Emergency Management Staff. A compilation on Natural Hazards
Accessedom Philippine Athmospheric, Geophysical and Astronomical Services Administrastion Website
http://www.pagasa.dost.gov.ph/wb

132
SECTION 7
RAPID HEALTH ASSESSMENT/
ASSESSMENT FOR RECOVERY

DEFINITION

Rapid Health Assessment is the “collection of subjective and objective information to


measure damage and identify those basic needs of the affected population that require
immediate response within 24 hours.”

OBJECTIVES

1. To determine the magnitude of the emergency.


2. To define the specific health needs of the affected population.
3. To establish priorities and objectives for action.
4. To identify existing and potential public health problems.
5. To evaluate the capacity of the local response, including resources and logistics.
6. To determine external resource needs for priority actions.
7. To set up the basis for a health information system.

INFORMATION

The assessment involves the collection of two key categories of information:


• Classification of the victims
• Classification of damage to infrastructure and/or interruption of services

Classification of Victims

To prioritize the allocation of scarce resources in the soonest possible time, it is es-
sential to classify the victims. The following are considered essential to survival and
are called lifelines:
o Water
o Food
o Shelter
o Energy

Victims can be classified according to their access to lifelines. The following is used
to describe the severity of the impact on people:
o Affected - all those living within the geographical area involved
o Severely affected - those who have lost one or more of their lifelines
o Critically affected - those who have lost all of their lifelines or who have been
displaced (and therefore are totally dependent on others to supply them)

Therefore, a report describing the impact of a hazard provides the number of:
o Casualties (killed, injured, sick)
o Affected (total, severe, critical)

Classification of Damages in Emergency Situations


133
The following are the physical elements that require assessment by the health
sector after a disaster:
o Integrity of infrastructure
o Capacity of service delivery
o Access to services
o Essential supplies – water, energy
o Capacity for distribution of essential health supplies

For each facility or service in the affected area, the assessment grades function ac-
cording to a predefined scale. The following is an example of a grading scale:
o Destroyed or unavailable
o More than 50% reduction in capacity
o Less than 50% reduction in capacity
o Undamaged

Determining Magnitude of Emergency and Health Needs


of Affected Population

The health impact to the community along the five elements is considered:
a. People – number of injuries, number of deaths, number of missing, and num-
ber of affected population
b. Properties – number of affected/ damaged health facitlites such as hospitals,
rural health centers, laboratories
c. Environment – description of changes in land, soil, air, water
d. Services – type of disruption of specific services
e. Livelihood – damage to sources of livelihood, etc.

The hospital focuses on the four elements (people, properties, environment and ser-
vices) and derives the health needs of the affected population.

Determining Response Priorities

The health sector carries out the following activities according to priorities identified in
the assessment:

1. Priority Relief Needs


• Assistance in search and rescue (not a DOH role, except when requested for
in special circumstances)
• First aid
• Acute medical and surgical care
• Care of the displaced and vulnerable
• Security of water supply
• Assistance in provision of shelter, warmth and clothing

2. Secondary Relief Needs


The health sector acts to improve the capabilities of services where deficien-
cies are indicated. This is accomplished by: (a) increasing stocks of materials
and supplies; (b) developing auxiliary power sources, and providing supplies
of fuel, and acquiring additional repair equipment, and (c) recruiting and brief-
ing personnel, volunteers, retired professionals, and other similar workers.
• Control of communicable disease
134 • Mental Health and Psychosocial services
3. Management of Logistics, Transport, Communications

4. Epidemiological Surveillance
• Morbidity – number of illnesses – priorities include trauma, diarrhœa , ARI,
measles, notifiable diseases
• Mortality – number of dead
• Laboratory support
• Water quality
• Nutrition
• Vectors

5. Public Information and Community Participation

6. Monitoring, Evaluation and Reporting

7. Rehabilitation and Reconstruction (for internal disasters)


• Replacement and repair
• Restocking
• Review of emergency plan, local policy and administrative procedures
• Overall development policy and planning review
• Retraining – technical and administrative

Recommended Tools

The Hospital should accomplish and submit appropriate Rapid Health Assessment
Forms Prototype; for an MCI, for an outbreak and for a natural disaster within 24 hours
upon the occurrence of the event using the appropriate forms of HEMS.

Corresponding Health Situation Updates for Natural Disasters, MCI and Outbreak are
submitted twice a week for the first two weeks and once a week thereafter until termina-
tion of response activities. The forms are in the section on Information Management.

Rapid Assessment Surveys (RAS)


Aim

Decide on the first priority to:


1. Prevent or reduce the adverse health consequences of the health
emergency.
2. Optimize the decision-making process associated with management of
the relief effort.
3. Avoid the so-called “second disaster” which is a result of arrival on the
disaster scene of outdated or inappropriate drugs, medical and
surgical teams without proper support, and relief programs that do
not address local needs.

Time

Conducted during the first 24 hours of the disaster.


135
Continuation of Rapid Assessment Survey

Process

Keep in mind the “Keep It Simple and Short (KISS)” principle. This helps
lessen the burden of the field workers.

Content

1. Presence/nature of disaster (all hazards)


2. Emergency or disaster
3. Impact of disaster: magnitude and lifelines
• Area affected by the disaster - location and size
• Impact on human lives
o Number of population/individuals/families affected
o Number of deaths and injured
o Types of injuries and illnesses
o Characteristic and condition of the affected population
• Damage to Facilities/ Services / Material Resources
o Emergency medical, health, nutritional, water and sanitation
situation.
o Infrastructure and critical facilities; homes and commercial
buildings.
o Economic resources, and social organization
• Level of continuing or emerging threats (natural/human caused);
vulnerability of the population to continuing or expanding impacts
of the disaster over the coming weeks and months.
• Level of response
o By affected area/community/internal capacities to cope with
situation
o Needed from outside the community
- Central Office
- Private voluntary organizations, nongovernment organiza-
tion, International organizations and donor countries

Basic Key Questions Required Within 24 Hours of the Event

1. Is there an emergency or not? (If so, indicate type, date, time and place
of emergency, magnitude and size of affected area and population.)
2. What is the main health problem?
3. What health facilities or services have been or may be affected?
4. What is the existing response capacity (actions taken by the local author-
ities, by DOH HEMS)?
5. What decisions need to be made?
6. What information is needed to make these decisions?

ASSESSMENT FOR RECOVERY


Assessment during the recovery phase is part of the Damage Assessment and Needs
136 Analysis (DANA), a process that is usually undertaken by a multidisciplinary team. While
the Health Sector is not responsible for the overall process, it contributes actively to the
process with its own assessment (HEMS, June 2007).

The concept of DANA is complex for it covers the first initial reports, the succeeding
reports, as well as the macro assessment of the damages in the long-term perspective.

The hospital assesses the impact of the health emergency/ disaster in terms of damages
and losses created by the new situation, identifying the future areas where risks may
evolve.

Primary damage assessment involves rapid appraisal of deaths, injuries and disease
and identification of damage to infrastructure, material resources and services. Sec-
ondary damage assessment, on the other hand, is concerned with the impact of the
primary damage on the economic, social and cultural life of survivors. Since sustainable
livelihood security is the goal of both recovery and sustainable development, the as-
sessment is concerned with three kinds of losses or disruption – loss of livelihood, loss
of social cohesion, and loss of cultural identity. (HEMS, June 2007)

These losses can create new vulnerability to future disasters or make existing vulnera-
bility worse. Failure to recover or partial recovery makes it more likely that people will be
more vulnerable to the next stressful situation. The assessment at this stage is known
as secondary vulnerability assessment.

The secondary damage assessment and secondary vulnerability assessment provide


the information base for the recovery planning.

The sources of information are:


• Response Operations
• Post-Incident Evaluations
• Development Programs
• Special Teams
• Previous Disasters

The assessment and analysis of information for this phase supports the development of
the hospital recovery program which contributes to an overall strategy of the Community
or the Hospital Catchment Area recovery program (Carter, 1991). The latter include:

Government aspects
• National infrastructure (roads, ports, etc.)
• Government administrative facilities
• Education facilities
• Health Care Systems – Hospital etc,
• Resettlement of displaced persons and communities

Private Sector
• Industrial systems
• Commercial buildings, stores

Community
•Re-establishment of Social Services System
•Long-term rehabilitation of communities and individuals

137
SECTION 8
Mass Casualty Management System

The planning of the hospital response in emergencies and disasters inevitably revolves
around its surge capacity and the development or enhancement of its Mass Casualty
Management System (HEMS, June 2007; WHO and ADPC, 2006). For this reason, the
Department of Health issued Administrative Order No. 155 s. 2004 on the Implementing
Guidelines for Managing Mass Casualty Incidents During Emergencies and Disasters
as basis for establishing systems procedures and mechanisms, including the develop-
ment of an integrated comprehensive action plan for field management and hospital
reception.

DEFINITIONS

Mass Casualty Incident is an event resulting in a number of victims large enough to


disrupt the normal course of emergency and health care services. The event affects
several victims which could be as few as three or as many as several hundreds. Manag-
ing the victims, however, entails resources greater than those of the initial responders.

Mass Casualty Management is the handling of victims of a mass casualty incident,


aimed at minimizing loss of lives and disabilities. There is a need to initiate fast, timely,
coordinated and adequate response to reduce morbidity, mortality and disability among
the victims. The management of the incident spans from the disaster or impact site (pre-
hospital care) to the transport of the last victim to the emergency room of the receiving

Figure S8.1. Rescue Chain in a Mass Casualty Management System


Establishing a Mass Casualty Management System

RESCUE CHAIN -- MULTI-SECTORAL


IMPACT ZONE

COMMAND
SEARCH POST
RESCUE TRIAGE
Traffic Control
STABILIZATION
FIRST AID EVACUATION
Regulation or A&ED
of Evacuation
CP/AMP

PRE-HOSPITAL ORGANIZATION HOSPITAL ORGANIZATION

Source: Sixth Inter-regional Course in Public Health and Emergency Management in Asia and the Pacific (PHEMAP), WHO
138 (WPRO, SEARO) and ADPC, 2006.
hospital. It is directed at prompt and efficient bringing back of disrupted emergency and
health care services to routine operation. The first five minutes response will determine
the response for the next five hours.

Mass Casualty Management System refers to groups of units, organizations, sectors


and agencies which work jointly through institutionalized procedures to minimize dis-
abilities and loss of lives in a mass casualty event through the efficient use of all existing
resources.

As shown in Figure S8.1, the rescue chain starts at the disaster site with activities like
initial assessment, command and control, search and rescue, and field care, and contin-
ues up to the transfer of victims to the appropriate health care facility for definitive care.

DIFFERENT APPROACHES TO MASS CASUALTY INCIDENTS

1. “Scoop and Run”


• Most common
• Does not require specific technical ability from rescuers
• Justified for small numbers occurring near a hospital
• May just transfer the problem to the hospital

2. Classical Approach
• First responders are trained in basic triage and field care
• Disregards the receiving hospitals from the field
• Quickly results in chaos

3. Mass Casualty Management System Approach


• Most sophisticated approach; includes:
o Pre-established procedures for:
- Resource mobilization
- Field management
- Hospital reception
o Training of various levels of responders
o Incorporation of links between field and health care facilities
o Command Post
o Multisectoral response
• Dependent on the availability of large amounts of human and material
resources

GENERAL CONSIDERATIONS IN THE ESTABLISHMENT OF THE


MASS CASUALTY MANAGEMENT SYSTEM

1. Preparation for Mass Casualty Management


• Pre-planning and training are critical.
• Guidelines and procedures are established.
• Incident Command should be implemented early.
• First five minutes will determine the next five hours.

139
2. Conditions to anticipate and address in developing a Mass Casualty
Management System (MCMS):
• Limited human resources
• Limited material resources – facility, transport, communication
• Poor communication
o Topography
o Isolation
• Political environment

In the development of a Mass Casualty Management System appropriate for the setting
and consistent with available resources, an understanding of the MCMS components is
essential. For upgrading the system in a step-wise manner, assessments through drills
and/or actual emergency events will provide valuable insights and lessons.

As shown in Figure S8.2, a Mass Casualty Management System entails sequence of


activities at various levels of responses:

1. Pre-hospital
a. Mass casualty incident site
• Search and rescue
• First triage
b. Collection Point for unstable MCI
c. Advance Medical Post (AMP)
• Tag - Second triage (entrance to AMP)
• Treat
• Transport - Third triage

2. Evacuation Site or Temporary Shelter


From the Advance Medical Post, the following victims are placed in evacuation
sites or temporary shelters:
• Uninjured victims who have no relatives/place to go
• Victims who need shelter, not treatment

3. Hospital
a. Field Hospital will be established if there is no hospital around or the hospital
is too far from the impact site
b. Fourth triage at the Emergency Room
c. Definitive treatment

4. Emergency Medical Service (EMS)


These are the medical services rendered from the impact site to the Emergency
Room of the hospital; these are centered on evaluation, care and stabilization of
victims at the impact site, and transporting them to the nearest appropriate health
care facility.

140
Figure S8.2. Role of the Hospital in the Mass Casualty Management System (MCMS)

Mass Casualty Incident Mass Casualty Management

1st Collection 2nd 3rd 4th


TRIAGE Point TRIAGE Treatment TRIAGE TRIAGE
Impact Site Transport Emergency
(for
Room
unstable
Search & MCI)
Rescue
Advance Medical Post Hospital

EMERGENCY MEDICAL SERVICE (EMS)

PRE - HOSPITAL HOSPITAL or


FIELD HOSPITAL
Source: Banatin & Go, 2007

SPECIFIC CONSIDERATIONS IN THE ESTABLISHMENT OF MASS


CASUALTY MANAGEMENT SYSTEM

I. Field Organization (On-site/Pre-hospital)

Field organization encompasses procedures used to organize the disaster area to


facilitate the management of victims. Its components are the following.

A. Alerting Process

The alerting process is the sequence of activities implemented to achieve the


efficient mobilization of adequate resources. It aims to:
• Confirm the initial warning.
• Evaluate the extent of problems.
• Ensure that appropriate resources are informed and mobilized.

Dispatch Center
• Core of the alerting process (Operations Center)
• Functions
o Receives all warning messages (radio/ phone)
o Mobilizes a small assessment team from police, fire or ambulance
services
• Types of alert
o Pre-confirmation alert
o Confirmation report from the field
o Post-confirmation alert 141
B. Initial Assessment

Initial assessment should obtain the following information:


• Precise location of the event
• Time and type of event
• Estimated number of casualties
• Added potential risk
• Exposed population
• Resources needed

This involves the deployment of an On-scene Response Team composed of


individuals skilled in assessment, triage, treatment and surveillance . When
human resources are limited, one individual may perform multiple tasks

C. Pre-identification of Field Areas

The identification of field areas for various purposes prior to dispatch and opera-
tions will allow various incoming resources to reach their intended places rapidly
and efficiently. This is the first part of deployment. This should consider the topo-
graphical area, wind direction and access roads. Maps could be used initially
and will help in the management of restricted areas; potential risks to victims and
the population are graphically determined, including boundaries. The following
should be mapped out and identified:
• Impact Zone
• Command Post
• Collecting Area in unstable location
• Advance Medical Post Area (Tag, Treat, Transfer: 3-T Principle)
• Evacuation Area
• VIP and Press Area (Information Officer)
• Access Roads (Geographical presentations if available)
• Checkpoint for Resources (Staging Area)

D. Safety/Security

This component calls for the best practice technique to protect victims, respond
ers and exposed population, and determine immediate/potential risks.

Measures

1. Direct Actions
• Reduce risk – fire fighting.
• Contain hazardous materials.
• Evacuate exposed population.

2. Preventive Actions: Establish field areas.


Primary : Impact Zone/Ground Zero
- Strictly restricted to professional rescuers who are adequately
equipped, such as HAZMAT teams, WMD teams, etc.
- Known in WMD as “Hot Zone”

142
Secondary
- Known in WMD as the “Warm Zone,” it is intended for decontamination.

Tertiary
- Command Post, Advance Medical Post, Evacuation Center and park-
ing for various emergency and technical vehicles will be set up in this
area which is approximately 100 meters from impact zone and appro-
priately positioned depending on the wind direction.
- Accessed by press officials and serves as “buffer zone” to keep
onlookers out of danger - approximately 50-100 meters from warm zone
and approximately positioned depending on the wind direction.
- Known in WMD as “Cold Zone”

3. Minimum Personal Protective Equipment (PPE) for any medical responder


who is in contact with a patient: gloves, goggles, mask

4. For suspicion of Weapons of Mass Destruction incidents, medical responders


are allowed only at cold zone with proper protective clothing. Only those with
appropriate protective clothing and with proper training will be allowed entry
into the hot and warm zone.

Personnel
• Fire services
• Specialized units
• Hazardous Materials and Explosives (bio-nuclear and radioactive material)
Experts, etc
• Airport manager
• Chemical plant expert

Security Measures
• Non-interference of external elements; Crowd/Traffic Control
• Contribute to safety:
o Protect workers from external influence – additional stress.
o Ensure free flow of victims and resources.
o Protect general public from risk exposure.
- Ensured by police officer/special units/security force of airport/build
ing/hospital/establishment, etc.

E. Command Post (CP) or Incident Command Post (ICP)

This is a multisectoral control unit tasked to:


• Coordinate sectors involved in field/ scene management
• Linked with backup system: provide information and mobilization of resources
• Supervise victim management

A requisite for the unit to be effective is the Radio Communication Network, which
serves as a coordination/communication hub of people who do not work routinely
(pre-hospital setting).

143
Personnel
• High-ranking officer (government police, fire, health, defense)
o Plant manager/airport manager/chief security, etc.
o Fire officer/police officer skilled in Incident Command System/Mass
Casualty Management
o Highest representative of the Department of Health, or Local Health Office
or Center for Health Development in regional disasters
o Two positions for medical concerns based on A.O. 155 s. 2004:
- Medical Controller, a designated senior DOH officer appointed to
assume the overall direction of the medical response to mass casualty
incidents and disasters. Control is established from a designated
Operations Center either in the Central Operations Center or the
Regional Operations Center. Main responsibility is to coordinate all the
services of the Sector.
- Incident Medical Commander, the highest representative of the DOH or
Local Health Office as designated by the local executive depending on
the extent of the disaster. Serves as the liaison officer of the Health
Sector to the Command Post headed by the Incident Commander. For
regional disasters, it should be the highest representative from the
DOH-CHD.

• Identified by name/position, coordinator/commander.


• May depend on the type of incident.
• Must be familiar with each other’s roles during previous meetings/drills/simu-
lation exercises (policy).
• Core group cooperates with volunteer organizations.

Method
• Communication/coordination hub of the pre-hospital organization.
• By constant reassessment, Command Post will identify needs to increase/
decrease resources:
o Organize timely rotation of rescue workers exposed to stressful or
exhausting conditions in close coordination with backup system.
o Ensure adequate supply of equipment/ manpower.
o Ensure welfare/comfort of rescue workers.
o Provide information to backup system, other officials and trimedia
through an Information Officer.
o Release as soon as situation allows emergency (“E”) staff and
reestablish normal operations.
o Determine termination of field operations.

F. Management of Victims

1. Search and Rescue (MCI)/Search and Recover (MDM)


• Locate victims.
• Remove victims from unsafe locations – collecting area.
• Assess victim’s status (On-site Triage).
• Provide first aid, if necessary (No CPR on-site in a Mass Casualty
Incident).
• Transfer injured victims to Advance Medical Post
144
• Transfer of dead victims by MDM group
• May, in special situations, require medical personnel (trained) to stabilize/
resuscitate/amputate (trapped) victim before extrication.

This activity will be handled only by skilled teams, such as those coming
from the Bureau of Fire, Coast Guard, 501 Engineering Brigade, CSSR, 505
Fighter Wing, etc. In situations where there might be a need for on-site
assistance of medical personnel to commence stabilization of the patients
dur ing evacuation or extrication of victims, only DOH personnel with training
in Search and Rescue should involve themselves (especially in high-risk
situations like collapsed buildings or in mountainous areas), except in
exceptional situations and with the company of trained rescuers.

The Department of Health is not into Search and Rescue except in the condi-
tion described earlier.

2. Field Care
• Pre-established capabilities/inventory: Pre-planning
• Integrated community plan: Practiced with policy support
• “Golden Hour” Principle

Trimodal Distribution of Death in Trauma (Advanced Trauma Life Support


or ATLS)
1st Peak: within seconds to minutes
2nd Peak: golden hour versus golden 24 hours
3rd Peak: days to weeks/months

Recent progress in pre-hospital emergency/disaster medicine: Establish Ad-


vance Medical Post with specially skilled/trained “disaster field medical
teams.”
• Good triage/stabilization capacity
• Specifically trained/upskilled medical teams
• Good (radio) communications between the field scene and medical facility
Don’t transfer chaos in the scene to the hospital.”

2a. Triage

Definition: French word meaning “to sort”; is a system used to identify


treatment priorities in a multiple-victim situation.

Basis: Urgency (victim’s status)


Survival (chance or likelihood)
Care resource availability and capability

Objective: Quick identification for immediate stabilization, life-saving


measures and surgery.

START System
• Meaning: Simple Triage and Rapid Treatment
• Most commonly used by first responders.
• Assessment focuses in three areas: respiration, pulse rate and quality,
and mental status. (RPM) 145
Table S8.1 shows the levels of triage in the field and in the hospital, location of conduct,
and categories used.

Table S8.1. Triage Levels by Period, Location and Categories

Triage Period Location Categories

FIELD CARE

First During Search Impact site Acute


and Rescue (Ground Zero) Non-acute

Second Stabilization or Advance Medical Red


Treatment Post Yellow
Green
Blue
Black & White

Third Evacuation Transport Red


Yellow
Green
Blue
Black & White

HOSPITAL CARE

Fourth Definitive Care Emergency Room Red


Yellow
Green
Blue
Black & White

Color Tagging

The basic colors used for triage include: red for first priority cases; yellow for second
priority cases; green for third priority cases; blue for fourth priority cases; and black/
white for last priority cases.

In the Philippines, the prescribed tag is the ribbon for practical reasons.

Categories

Red – Transferred as soon as possible to tertiary facilities in an equipped ambulance


with medical escort
Yellow – After evacuation of Red, without life threatening problem
Green – “Walking wounded’ to Admitting Section/Outpatient Department
Blue – To be returned for Re-triage
146 Black and White – To Morgue, Forensic Services, Public Health and psychosocial
interventions to relatives/kin
Determining Priority for Case Management

Patient classification is based on the severity of the injury and need of Emergency Medi-
cal Service and evacuation.

Table S8.2. Use of Color Tag for Prioritization of Care

ON SCENE HOSPITAL CARE


COLOR
TAG
Priority for Medical needs Priority Conditions
evacuation

RED 1st Immediate care 1st Life- threatening

YELLOW 2nd Need care, 2nd Urgent


injuries not life-
threatening

GREEN 3rd Minor injuries 3rd Delayed

BLUE 3rd or 4th Near dead 4th After the red


and yellow

BLACK Not a priority Dead Last Dead


and WHITE

Priority for In-Hospital Care (Retriaging in the Hospital)

RED – Immediate: Priority One (Life-threatening Conditions)


The condition is life-threatening and the patient requires immediate attention and
transport. The following conditions should be present for a Mass Casualty Incident
(MCI) victim to be classified Priority One:

a. Obstruction or damage to airway.


b. Disturbance of breathing – respiration above 30/min.
c. Disturbance in circulation – capillary refill greater than 2 seconds or carotid pulse
weak , irregular or absent, radial pulse absent.
d. Does not follow commands or altered level of consciousness.
e. Need for life-saving measures (BLS and ATLS) and urgent hospital admission.
f. Victims whose injuries demand definitive treatment in the hospital but which treat
ment may be delayed without prejudice to ultimate recovery.

YELLOW – Urgent: Priority Two


Patient has passed primary survey, but with major system injury, may delay transport
to one hour. Any one of the following conditions could place a victim into a Priority 147
Two category:
a. Needs to be treated within one hour; otherwise they will become unstable.
b. Severe burns; burns involving hands, feet or face (not including the respiratory
tract); burns complicated by major soft tissue trauma.
c. Hospital admission is required.
d. Moderate blood loss; back injuries; head injuries with a normal level of conscious-
ness.

GREEN – Delayed: Priority Three


An injury exists but treatment can be delayed for four to six hours. Generally, any-
one who can walk (walking wounded) to a designated area for treatment will be a
Priority Three. The following injuries are examples:

a. Minor injuries not threatened by airway, breathing and circulatory instability.


b. Minor fractures, minor soft tissue injuries, minor burns.
c. May or may not be admitted.

BLUE – Near Dead: Priority Four


Victims who are clinically dead. Those tagged blue in the field are to be returned
for re-triaging when time and physical conditions of area allow, e.g., collapsed
structure, etc.

BLACK and WHITE – Dead: Last Priority


a. Patient is dead.
b. Those who die while awaiting treatment, and those in cardiac arrest following
trauma.
For Moslem communities, white tag will be used for dead Moslems.

2b. First Aid

Personnel: Volunteers, fire, police, staff, special units, EMT and Medical Personnel

Location
• On-site, before moving victim
• At collecting point/area in an unstable environment
• “Green Area” of “Advance Medical Post”
• Ambulance in transit to facility

Action: Primarily to transfer with consideration of the RPM order of priority.

2c. Advance Medical Post

Purpose: Reduce loss of life and limb: Save as many as possible in the context of
existing and available resources/situation (e.g., Field Hospital).

Location
• 50-100 meters from Impact Zone (walking distance)
• Direct access to Evacuation Road/Command Post
• Clear Radio Communication Zone and SAFE (Upwind)

Role
148 • Provide “entry” medical triage.
• Effectively stabilize victims of an MCI through:
o Intubation, tracheostomy, chest drainage.
o Shock management, analgesia, fracture immobilization.
o Fasciotomy, control of external bleeding, and dressing.
• Convert red to yellow as possible..
• Organize patient transfer to designated care facility/ies.
• Advance Medical Post principle: Tag-Treat-Transfer (3-T)

Personnel
• Emergency Room, Admission and Emergency Department (A and ED):
Physicians/nurses (trained/skilled)
• Support – Anesthesiologists/surgeons/EMT’s/nurses/aiders, etc.

2d. Field Hospital (FH)

• Tent/building/open/mobile
• Established if there is no hospital around or the hospital is too far from the
Impact site.

2e. Evacuation Site or Temporary Shelter

From the Advance Medical Post, these victims are placed in evacuation sites:
o Victims who need shelter, not treatment.
o Uninjured victims who have no relatives or place to go.

3. Evacuation

3a. Transfer Organization

This consists of procedures undertaken to ensure that victims of a mass casualty


situation are safely, quickly and efficiently transferred by appropriate vehicles
to the appropriate and prepared facility.

Preparation for Evacuation


• Single Reception Facility
• Multiple Reception Facilities
o Type of vehicle required
o Type of escort required
o Destination

Preparation for Transport


Transport Officer should be responsible for:
• Assessing patient’s status, vital signs, ventilation/hemostasis.
• Checking security of equipment and accessories.
• Ensuring efficiency of immobilization measures.
• Ensuring triage tags: secure/clearly visible.

Evacuation Procedures:
Principles
• Not to overwhelm care facility.
• Avoid spontaneous evacuation of unstable patients.
149
Rules
• Victim is in most possible stable condition.
• Victim is adequately supported by appropriate equipment during transfer and
transport
• Receiving facility is correctly informed and ready.
• Best possible vehicle and escort are available.

3b. Victim Flow

■ Based on the “Noria Principle” used during World War I, Battle of Chemin
de Dames, Verdun, France. (‘Noria” is the Spanish word for the Arabic water
wheel)

■ Simulates that of a “conveyor belt” flow where the victims are relayed from first
aid to the most sophisticated care level shown in Figure S8.3.

Figure S8.3. Victim Flow: “Conveyor Belt” Management Diagram


Evacua- Triage Treatment
Triage tion
3-T
Tag
Treat
and
Transfer

Impact Collecting TRANS-


Zone Point AMP FER HOSPITAL
Victim Flow
Transport Resource Flow

3c. Ambulance Traffic Control

Radio Links
• Transport Officer at AMP
• Hospital Admission and Emergency Department/Emergency Room
• Command Post
• Ambulance Headquarters
Ambulance Driver takes orders from Transport Officer

3d. Road Control

Police officers are in charge of Crowd and Traffic Control.

3e. Evacuation of Non-acute Victims

• Use available mass transport.


150 • As much as possible, transport to primary care center.
Field Organization Checklist

■ Situation Assessment
■ Report to Central Level
■ Work Areas Pre-identification
■ Safety
■ Primary Area – Impact Zone
■ Secondary Area units: Command Post,/Advance Medical Post/
Evacuation/Transfer
■ Radio Communications
■ Crowd and Traffic Control
■ Search and Rescue
■ Triage and Stabilization
■ Controlled Evacuation

II. Hospital Organization


A. Hospital Disaster Plan

• Hospital Mass Casualty Management (MCM) Plan


• Dissemination and regular drills among the hospital staff and multisectoral
groups

B. Activation of Hospital MCM Plan

Alerting Process

Dispatch/Opcen/Unqualified Observer
• Emergency Room/Admission & Emergency Department (ER/A&ED)
• Operator to activate System Recall

Mobilization

• Hospital Scene Response Team


• Hospital Staff
o Hospital Senior Management Staff
o Reinforcment Staff
- Internal: ER/A&ED staff leaves, replacement
- Centripetal Mobilization: Avoid burnout
o Coordination: other sectors
- Police
- Red Cross/NGO/Paramedics/Volunteers
- Radio Groups

• Hospital Command Post


o Clearance of receiving facility: beds and designated areas
- Care Facility Capacity and Capability Rating 151
C. Management of Victims

1. Reception of Victims

Location: Accessible/suitable/sufficient
Equipped/manned
*Chaotic scene overwhelms care facility.
Personnel: Triage officer (4th triage) – Confirms Evacuation Triage; may
recategorize patients

Links with field, especially Command Post.

2. Hospital Treatment Area

Red Treatment Area: Follow Trauma Flow Chart.


Yellow Treatment Area: Monitored/reassessed/stabilization maintained/re-
categorized – Red area
Green Treatment Area: Holding area “walking wounded”
Hopeless Victim Area: Supportive Care
Bodies Morgue/mortuary
“Activate Mental Health Team”

3. Hospital Definitive Treatment Units

4. Secondary Evacuation
• When hospital facility is overwhelmed
• Highly specialized care – neurosurgery
• Domestic and overseas evacuation
• Hospital Command Post requests: district/regional level

D. Support Requirements

Various departments are mobilized in support of patient care. As highlighted in


the Integrated Code Alert System, this is done by alert status:

Code WHITE
• Emergency Department, Surgery (Operating Room), Pharmacy, Laboratory
and Radiology to:
- Ensure that emergency medicines (especially for trauma needs) are
made available at the emergency room.
- Review and increase medicines and supplies in the operating rooms to
meet sudden requirements.
- Ensure that other needs such as X-ray plates, laboratory requirements,
etc. are made available and not required to be purchased by victims.
- Ensure and monitor use of personal protective equipment (PPE) for all
health personnel.
• Personnel Department - Prepare for mobilization of additional staff.
• Finance Department - Ensure availability of funds in cases of emergency
purchases and the like.
• Logistics Department - Coordinate with possible suppliers for additional
152 requirements.
• Dietary Department - Open for and meet the needs of the victims as well
as the health personnel on duty.
• Security Force - Institute measures and stricter rules in the hospital.

Code BLUE
• Activation of Hospital Emergency Incident Command System (HEICS)
• Chief of Hospital or his designate - Make proper coordination with other
hospitals for networking and/or transfer of patients.
• Incident Command - Assign a Safety Officer, Liaison Officer, (to coordinate
with other agencies), and Public Information Officer (spokesperson of the
hospital).
• Social Service Section - Prepare assistance to victims in coordination with
mental professionals of the hospital if available, and with the Department of
Social Welfare; lead in providing information to relatives of victims.
• Mortuary Section - Anticipate dead victims brought to the hospital for
proper care and identification.
• Security Team - In anticipation of possible influx or patients, relatives,
responders, police, press, etc., should ensure smooth flow of traffic inside
the compound especially for the ambulances.

Code RED
All those mentioned in Code Blue and highlighting the key role of the Chief of
Hospital as follows:
• The Chief of Hospital/Medical Center Chiefs:
- Can cancel all types of leaves and can order all personnel to report to
the hospital.
- Can temporarily stop all elective admissions and surgeries and network
with other hospitals.
- Should anticipate request of additional manpower and specialists not
available in his hospital; authorized to accept medical volunteers and
other professionals to augment the hospital’s manpower resources
rather than transferring patients based on agreements.
- Networks with other hospitals for augmentation of resources and trans -
fer of patients in special cases.
- Be concerned with security and safety of patients, hospital personnel
and the infrastructure.
- Answers all queries of the media pertaining to patients in the hospital.
- Provides leadership especially in decision-making on matters like
evacuation and/or use of field hospital, closure and/or quarantine of the
hospital.

Special conditions such as emergencies related to Weapons of Mass Destruc


tion entail modification of responses appropriate to the hazard identified, e.g.
chemical, radiological, etc.

153
Requirements from DOH Hospitals in MCM

1. Upgrading of hospital capability that shall include the ability to handle


trauma victims, burn patients, poisoning cases, etc.

2. Ensuring the readiness of the Emergency Rooms in terms of equipment,


manpower and systems to answer to Mass Casualty Incident especially for
general hospitals.

3. Availability of sufficient emergency medical kits containing equipment and


supplies for treating a minimum of 10 serious casualties. The number
should increase depending on the capability of the hospitals. A responding
team should have the capability for treating a minimum of 3-5 serious
patients.

4. Ready availability at all times of at least one ambulance for emergencies/


disasters equipped with all the necessary emergency supplies and equip
ment including communication equipment to establish coordination.

5. Activating Hospital Emergency Plan, observation of the Code Alert Sys


tems and Hospital Emergency Incident Command System (HEICS) in such
situations.

-- AO 155. Section VII B Responsibility of all DOH Hospitals

154
SECTION 9
Management of the Dead and Missing Persons
During Disaster

This section draws largely from Administrative Order No. 2007-0018. National
Policy on the Management of the Dead and the Missing Persons During Emergen-
cies and Disasters. The Department of Health (DOH) was mandated to lead the
multisectoral process of formulating the policy in response to the mass fatality
events in recent years 2004 to 2006.

Mass Fatality Incident refers to any event resulting in number of deaths large enough to
disrupt the normal course of health care services, usually a result of natural and/or hu-
man-generated disasters, including terrorism or the use of Weapons of Mass Destruc-
tion. As a consequence, there would be numerous deaths and missing persons.

In emergency or disaster management, most efforts are being concentrated on the man-
agement of the living victims while the least considerations are being given to the dead
and the missing, to the extent that there are a lot of problems cropping up from the side
of the bereaved families, to the community at large, to the leaders, and most especially
to the media when not properly managed. Management of the Dead and Missing Per-
sons during Emergencies or Disasters (MDM) in disasters must be a major component
of the overall management of the consequences of disasters. MDM has five domains,
namely: Search and Recovery; Identification of the Dead; Final Arrangement of the
Dead; Handling the Missing Persons; and Assistance to the Bereaved Families. MDM is
not the sole responsibility of a single agency but rather requires concerted efforts of the
various sectors of the society.

In the Philippines, the lead agency in managing the dead and missing persons during
disasters is the Department of Health. It serves as the coordinating body responsible for
all the MDM operational activities of the various key players in the five domains men-
tioned.
Figure S9.1. MDM Functional Structure

Management of the Dead, the Missing, and the Bereaved (DOH)

Search and Identification Final Handling Assistance to


Recovery of the Dead Arrangement the Missing Bereaved
Families

DND – AFP/PNP NBI/PNP-CL DILG DSWD DSWD


BFP-SRU Forensic LGU Leagues DILG DOH, PNRC
PCG Experts Mortuary PNRC DILG
DILG Academe Cemetery NBI Insurance
PNRC LGU Leagues Religious PNP Companies/
LGU Leagues Organizations LGU Leagues Commission
Social Security
Groups
LGU Leagues 155
The activities related to the management of the dead and the missing persons are the
responsibility of the DOH, the Armed Forces of the Philippines (AFP)/Philippine National
Police (PNP), National Bureau of Investigation (NBI), Department of the Interior and Lo-
cal Government (DILG) and Department of Social Welfare and Development (DSWD).
The functions of search and recovery, identification of the dead, final arrangement,
handling the missing, and assistance to bereaved families have to be coordinated and
harmonized at various sites at all levels, from the national, regional and local levels.

GUIDING PRINCIPLES

1. All efforts shall be exerted for proper retrieval, identification and disposition of the
remains in a sanitary manner and cautions to prevent negative psychological and
social impact on the bereaved and the community, including the responders.
2. Every person has the right to be found, to be identified, and to be buried accord-
ing to a culturally acceptable norm.
3. Rights to privacy of the dead shall be observed at all times.
4. The dead shall be treated with utmost respect.
5. When death is the result of disaster, the body does not pose a risk for infection.
6. Victims shall never be buried in common graves.
7. Mass cremation of bodies shall never take place when this goes against the cul-
tural and religious norms of the population.
8. Every effort must be taken to identify the bodies. As a last resort, unidentified
bodies shall be placed in individual niches or trenches, which is a basic human
right of the surviving family members.

NB: Section IV. Definition of Terms. Distinction is made regarding the following:

Collective Grave shall refer to the burial of two (2) or more dead bodies/body parts in an
orderly process, preserving the individuality of every body, and maintaining individual
characteristics of each body.

Mass Grave or common grave shall refer to the indiscriminate burial of more than two (2)
unidentified bodies/body parts in the same excavated site.

Temporary Burial shall refer to shallow burial of two (2) or more dead bodies/body parts
in an orderly process, preserving the individuality of every body and maintaining indi-
vidual characteristics of each body pending proper identification and disposition.

OPERATIONAL FRAMEWORK

1. A coordinated body shall be established under the National Disaster Coordinat-


ing Council (NDCC) primarily for the management of the dead, the missing, and
the bereaved families during an emergency or disaster, to be led by the Depart-
ment of Health.
2. Recovery/Retrieval Operation will commence simultaneously with the Search and
Rescue Operation and will end upon the declaration of the NDCC as per recom-
mendation of the Local Disaster Coordinating Council.
3. In any event of disaster, the Local Health Officer of the concerned local govern-
ment unit (LGU) shall lead/coordinate the activities in the management of the
dead, the missing and the bereaved families.
4. If two (2) or more municipalities/provinces are involved, the concerned Provincial
156 Health Officer shall lead in the MDM.
5. If two (2) or more provinces are involved, the concerned Regional Health Director
shall lead in the MDM.
6. In providing assistance to the bereaved, the Social Welfare Office of the con-
cerned LGU shall be primarily in charge, to be supported by other concerned
agencies.
7. In every agency at all levels, the MDM shall be incorporated as a component of
the agency’s Disaster Management Program.

MDM OPERATIONAL GUIDELINES AND PROCEDURES

A. Search and Recovery Operation

Dead Body Recovery shall be done spontaneously and simultaneously, led by the
Armed Forces of the Philippines of the Department of National Defense (AFP-DND)
and supported by the following agencies and groups: the Philippine National Police
(PNP), Search and Rescue Unit of the Bureau of Fire Protection (BFP-SRU),
Philippine Coast Guard (PCG), Philippine National Red Cross (PNRC), Private
Rescue Personnel, Local Rescue Unit and Civilian Group Volunteers. For the
National Capital Region (NCR), the Search and Recovery Operation shall be led
by the PNP supported by other agencies.

In the event of disaster, the initial site commander shall be the Chief of Police (COP)
who shall turn over the responsibility to AFP upon the arrival of the AFP task group
except for that in NCR.

1. The Search and Rescue Operations Commander shall establish and dissemi-
nate a unified and standardized tagging system of the bodies and body parts
recovered.
2. All body parts and dead bodies retrieved on-site shall be placed in cadaver
bags or any appropriate means during transport to identified collection point or
storage area which are preferably refrigerated, for examination or proper
identification.
3. The Local Health Office shall look after the health conditions and needs of the
responders and volunteers. In the event that the Local Health Office cannot
cope, it can request support from the DOH.
4. Protection and safety of responders and volunteers must be observed in the
retrieval, handling, transport and disposition of body parts and dead bodies
and shall be the primary considerations of sending agencies. There should be
proper coordination among the agencies on this matter.
5. The local chief executive through the local health office shall coordinate all
processes related to the management of corpses, including the retrieval, han-
dling, transport and disposition of body parts and dead bodies.

B. Identification of the Dead Operation

1. The LGU shall request the NBI and/or PNP Crime Laboratory for disaster
vic tim identification.
2. The NBI and/or PNP shall proceed to the disaster site upon the request of the
LGU to assess the situation and shall establish mortuary operations in coordi-
nation with the LGU. 157
3. In case of a mass fatality incident caused by natural disasters, the NBI shall
primarily be in charge of identification of the dead. The NBI shall coordinate
with the PNP-CL and other related experts.
4. In case of a mass fatality incident caused by human-generated activities, the
PNP shall primarily be in charge of identification of the dead. The PNP shall
coordinate with the NBI and other related experts.
5. The Medico-Legal Officers of the NBI and/or PNP shall issue a Certificate of
Identification for all examined/processed and identified bodies.
6. The NBI and/or PNP shall provide the Local Health Officer an official list of
identified and unidentified disaster victims.
7. The Local Health Officer shall issue a Death Certificate based on the Certifi-
cate of Identification issued by the NBI/PNP.
8. The LGU shall provide the NBI and/or PNP with a list of missing persons.
9. The LGU through the NDCC shall provide the Department of Foreign Affairs
(DFA) a list of identified and unidentified foreigners.
10.The LGU shall identify and put up areas for temporary collection or storage of
retrieved body parts and corpses as per local health office recommendations.
11. The Local Health Office shall monitor the proper sanitation of the temporary
collection and storage area at all times and shall take the responsibility to
maintain the sanitary retrieval and disposal of body parts and dead bodies.
12.All retrieved body parts and corpses waiting for examination and identification
in the collection points or storage areas shall be properly preserved by any
appropriate and available means.
13.Refrigeration of bodies and body parts is preferable. In its absence, temporary
burial will be resorted to. Chemical preservatives (such as quicklime, formol
and zeolite, as well as commonly used disinfectants such as hypochlorite)
may be applied only after the examination and identification of the bodies and
body parts.
14.The NBI and/or the PNP may request the fingerprints, dental and medical
records of the missing/dead in the custody of other government agencies
(GSIS, SSS, or other offices) for the purpose of identifying dead bodies only.
15.The Interpol Identification System for the Antemortem (Dead/Missing Persons
Form) and Postmortem (Dead Bodies Identification Form) forms may be used
in generating the data relative to MDM. These forms may be made available
(posted in the NDCC Website) and accomplished by all agencies concerned.
16.The NBI and/or PNP shall ensure scientific identification of the all recovered
bodies using all possible available technologies in conformity with national and
international standards.
17.The LGU shall, in coordination with the NBI, PNP, DOH, DILG, and other
agencies involved in managing the dead/missing shall conduct trainings and
seminars regarding the proper handling of the missing/dead.
18.All concerned agencies shall undertake Forensic Research regarding Disaster
Victim Identification (DVI).

C. Final Arrangement for the Dead

1. Legitimate claimants shall be responsible for the ultimate disposal of identified


cadavers.
2. The respective embassies of identified dead foreigners shall be informed and
the repatriation of their bodies shall be their responsibility.
158 3. The LGU shall be responsible for the final disposition of the unidentified bodies.
4. The unidentified bodies shall be buried in the collective or individual graves,
marked with their unique case numbers.
5. Cremation of unidentified bodies will not be allowed.
6. The LGU shall consult the community and religious leaders of the disaster site
regarding the final disposition of the unidentified bodies.
7. Religious and ethnic considerations shall be considered in the final disposition
of bodies.
8. Exhumation of unidentified remains shall be done in the presence of local
health officials.
9. Necessary decontamination or disinfection of the dis-interment areas must be
done.
10.All body parts and corpses that remain unidentified after examinations shall be
buried immediately according to the prescribed procedures.
11. No embalming procedures for identified dead bodies shall be done without
permission from the nearest of kin of the dead (bereaved).
12.The Local Health Office should take the responsibility of maintaining the sani-
tary retrieval and disposal of body parts and dead bodies.
13.All identified body parts and corpses shall be turned over to the rightful/legiti-
mate claimant accordingly.
14.Burial of bodies in mass graves or the use of mass cremation/burning shall be
avoided in all circumstances.
15.All unidentified bodies and body parts shall be turned over to the LGU for final
disposition after thorough postmortem examinations have been finished.
16.MDM related to infectious diseases and Biological, Chemical, Radiological,
Nuclear, and Explosives Emergencies (BCRNE) shall be done in accordance
with the existing DOH guidelines/procedures.

D. Management of the Missing Persons Operation

1. Provincial/City/Municipal Social Welfare Office (P/C/MSWDO) shall:


a. Establish the Social Welfare Inquiry Desks for data generation/information
management of missing persons and the surviving families;
b. Manage information regarding the Identification of Retrieved Bodies/Body
Parts using the Interpol identification System;
c. Validate and process documents of the missing persons for the issuance of
the Certificate of Presumptive Death; and
d. Submit to the Local Chief Executive (LCE) processed and validated docu-
ments.
2. The LGU shall submit to the NBI and/or PNP an updated list of missing and
dead persons.
3. The DOH, PNRC and DSWD shall provide technical and resource augmenta-
tion/assistance for the medical, psychological and physiological needs of the
families of the missing persons.
4. The NDCC through the Office of Civil Defense (OCD) as per the recommenda-
tion of the LGU shall issue Certificates of Missing Persons Believed to Be
Dead During Disaster.

E. Management of the Bereaved Families

1. P/C/MSWDO is the lead agency in the overall management of the bereaved


families. 159
2. The DSWD shall provide technical and resource augmentation/assistance to
the P/C/MSWDO on the overall management of the bereaved families.
3. The DSWD, PNRC and NGOs shall provide technical and resource augmeta-
tion/assistance to P/C/MSWDO for the physiological needs of the bereaved
in terms of : Food Assistance; Financial Assistance; Livelihood Assistance;
Clothing Assistance; Shelter Assistance; Management of the Orphans; and
Food/Cash for Work.
4. The DSWD, PNRC and NGOs shall provide technical and resource augmen-
tation/assistance to P/C/MSWDO for the social needs of the bereaved in
terms of: Family/Peer Support System; Social Welfare Inquiry Desk/Informa-
tion Center; Educational Assistance; and Legal Needs.
5. The DSWD, PNRC and NGOs shall provide technical and resource augmen-
tation/assistance to P/C/MSWDO for the psychological needs of the bereaved
in terms of: Mental Health and Psychosocial Support approaches such as
Psychosocial First Aid.
6. The DOH and PNRC shall provide the technical and resource augmentation/
assistance for the medical and psychological needs of the families of the
missing persons, and provide a support system from among volunteers for the
families of the missing persons, respectively.
7. The DOH shall provide services for Mental Health Management.

F. Reporting Protocol

1. The LGUs concerned shall submit to the NDCC-OCD, through the DOH, an
initial report on the MDM containing the background of the disaster, initial find
ings, and initial actions taken.
2. LGUs shall, from time to time, submit an update or situation report to the
NDCC-OCD, through the DOH.
3. Final report and documentation shall be submitted by the LGUs concerned to
the NDCC-OCD, through the DOH.
4. LGUs and NDCC-OCD shall be guided by proper protocol on confidentiality of
reports.
5. NDCC-OCD shall be the repository of all information/reports, which could be
shared and/or accessed by concerned agencies.

G. Communication

1. In time of disasters, the established communication networks within the NDCC


member agencies shall be used in the dissemination of information and other
updates at all levels.
2. The NDCC shall be designated as the clearinghouse for information dissemi-
nation.
3. The NDCC-OCD, DOH, National Telecommunication Commission (NTC), and
the Movie Television Review and Classification Board (MTRCB) shall coordi-
nate/collaborate in drawing the guidelines for the proper coverage of MDM
activities.
4. The Local Health Office shall conduct Information, Education and Communica-
tion (IEC) services to the public on proper sanitation and hygiene practices,
emphasizing that, in general, the presence of exposed corpses poses no
threat of epidemics.
160
H. Information Management

1. All information obtained about the dead/missing person and from relatives
shall be held confidential.
2. The right of the public to information shall be respected subject to the existing
rules and regulations.
3. NDCC-OCD shall be the repository of all information/reports, which could be
shared and/or accessed by concerned agencies.
4. There shall be a list/database of all accredited search and rescue volunteer
groups available at the NDCC.
5. LGUs and NDCC-OCD shall be guided by proper protocol on confidentiality of
reports.
6. The issuance of the Certificate of Missing Person Believed to Be Dead During
Disaster shall be supported by required proofs, and in certain cases (such as
those with respect to informal undocumented wage earners, transients and
passersby), shall be issued after the lapse of one year in accordance with the
resolution on the issuance of Certificate of Missing Person Believed to Be Dead.

I. Logistics Management

1. All foreign donations (food and non-food) intended for disaster relief shall be
free from any customs taxes and duties.
2. There shall be established norms and guidelines in receiving/accepting and
managing donations for disasters from DSWD – relief goods and cash; DOH
– medicines and cash; and NDCC – checks and cash (fully receipted)
3. All concerned agencies shall formulate a logistics management system to
include the preparation of a list of logistics needed on MDM for submission to
NDCC/DOH.
4. All agencies shall have a stockpile good for 200 victims and that would last for
at least three (3) days of operations (for replenishment by the NDCC).
5. NDCC shall invest in cold storage for the dead bodies.
7. The LGUs shall include in their Disaster Management Plan all possible logisti-
cal arrangements such as burial sites, etc.

J. Monitoring and Evaluation

1. The Local Health Office shall monitor the entire MDM operation.
2. The Local Health Officer shall monitor the proper sanitation of the temporary
collection and storage area at all times.
3. The DOH shall initiate the conduct of Post-Incident Evaluation (PIE).

ROLES OF THE DEPARTMENT OF HEALTH IN MDM

The roles and responsibilities of DOH in general include:

1. Serves as lead agency in the Management of the Dead and the Missing Persons
During Disaster.
2. Leads the Health Sector in the formulation of policies, protocols, guidelines, and
standards related to MDM.
3. Gathers, clears, and releases information regarding mortalities together with 161
causes of mortalities in coordination with all the stakeholders in the Health Sector.
4. Provides technical advice to and coordinates with the NDCC as well as interna-
tional agencies regarding MDM.
5. Conducts public information, health education/promotion, and other social mobili-
zation or advocacy activities related to MDM.
6. Monitors and evaluates existing policies and initiates revision or update, or even
formulation of new policies and guidelines pertaining to MDM.
7. Provides and publishes the general information in handling and transferring of
remains. The information should include the characteristics and environment of a
right place that will serve as temporary work camp for holding area.

ROLE OF THE HOSPITAL IN MDM

The hospital may need to adapt and/or formulate policies and procedures not covered
by existing policies and standard operating procedures (SOPs) related to the following
concerns:
1. Provision of Mental Health and Psychosocial support to direct and indirect victims
including the responders.
2. Procedure in confirmation of the dead brought to the hospital (4th triage)
3. Identification of the dead (dress and personal materials, etc.)
4. Provision of technical assistance in terms of expertise and laboratory services in
the identification of the dead (pathologists, DNA testing, etc.)
5. Mortuary: Refrigeration/care of the body (cadaver bags, etc.)
6. Public information
7. Ambulance use – discourage its use as transport for the dead.

162
SECTION 10
Public Health Roles of the Hospital
in Emergency Management

The hospital plays crucial roles in emergency management. It is the receiving end of
victims and it can be a responding agency to any type of emergency or disaster at in the
disaster site. It is well-known for its life-saving roles during emergencies.

The role of the hospital as a receiving health care facility has public health implications
(ADPC, WHO/WPRO, 2006) and it is expected to function as follows:
1. Provides not only curative but preventive services as well.
2. Contributes to the diagnosis, prevention and control of diseases.
3. Signals early warning of communicable diseases.
4. Hosts public health reference laboratories.
5. Serves as a resource center for public heath education.
6. Provides Psychosocial and Mental Health Services.
7. Undertakes Management of Mass Dead brought to hospitals.
8. Acts as center for research.

A. PROVIDES CURATIVE SERVICES DURING EMERGENCIES

1. Treats trauma injuries with infections.


2. Treats communicable diseases resulting from outbreaks.
3. Provides treatment to victims belonging to vulnerable segments of the population
(children, pregnant women, elderly, disabled, etc.)
4. Provides therapeutic nutrition to victims with malnutrition.
5. Provides intervention to direct and indirect victims with organic psychological
afflictions due to trauma.
6. Provides drugs and medicines for treatment.

B. PROVIDES DISEASE-PREVENTIVE SERVICES


1. Provides immunizations for vaccine-preventable diseases.
2. Maintains cold chain management.
3. Provides chemo-prophylaxis to the exposed/contacts of highly communicable
diseases.
4. Provides safe water to prevent water-borne diseases.
5. Provides isolation rooms in the hospital for communicable diseases.
6. Provides necessary PPEs to care providers.
7. Provides treatment protocols.
8. Conducts health education.

C. SIGNALS WARNING FOR COMMUNICABLE DISEASES

1. Conducts disease surveillance among the victims and the health workers/re
sponders.
2. Conducts advocacy and early warning activities regarding impending outbreak of 163
communicable diseases based on surveillance results.
3. Develops and disseminates IEC materials in the form of health advisories, key
health messages, etc.

D. HOST TO PUBLIC HEALTH LABORATORIES

1. Provides laboratory services such as water analysis, culture and sensitivity of


disease pathogens, etc.
2. Provides diagnostic laboratory examinations.
3. Provides blood banking laboratory services.
4. Provides facility to store blood and blood products.

E. RESOURCE CENTER FOR HEALTH EDUCATION

1. Available resource persons for health education initiatives.


2. Source of materials for health education and promotion activities.

F. MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT SYSTEMS

Develops and/or adapts the hospital minimum responses to mental health and psy-
chosocial support services arbitrarily categorized into:
1. Designation of mental facilities
2. Establishment and activation of referral systems
3. Identification, training and mobilization of health workers including local indig-
enous traditional health care providers
4. Provision of treatment protocols
5. Provision of reporting and assessment forms
6. Provision of selected psychotropic drugs
7. Provision of information on availability of mental health services

G. MANAGEMENT OF DEAD BODIES


1. Health Sector Action
2. Health Considerations in Cases of Mass Fatalities
3. Practical Approach to a Multiple Fatality Accident (12 points)
• Initial concerns
• Personnel
• Handling of the bodies at the scene
• Evidence and property
• Removal and transport of remains
• Temporary mortuary facility
• Examination of remains
• Preservation of body
• Dealing with claimants
• Death certification and release of bodies
• Disposal of the dead
• Other concerns

H. CENTER FOR RESEARCH


1. Rich materials for research purposes in terms of cases and patients
2. Abundant data/information for research studies

164
SECTION 11
Mental Health and Psychosocial Support

POLICY BASE

Administrative Order No. 168 s. 2004 Section V-E: Policy Statements on Program Com-
ponents states that
“1. Mental Health in Disaster should be a major component and should be institutional-
ized in all phases of disaster. Likewise, mental health services should be provided to the
victims, relatives of victims, as well as the responders.”

DEFINITION

Mental Health and Psychosocial Support (MHPSS) is a composite term used to de-
scribe any type of local or outside support that aims to protect or promote psychosocial
well-being and/or prevent or treat mental disorder.

“These close-related terms reflect different, yet complementary approaches. Agencies


outside the health sector tend to speak of supporting psychosocial well-being. People…
in the health sector tend to speak of mental health but have also used the terms psy-
chosocial rehabilitation and psychosocial treatment to describe non-biological interven-
tions for people with mental disorders.” (IASC, 2007)

CURRENT STATE

The Health Emergency Management Staff is in the process of reformulating guidelines


on Mental Health in collaboration with the Department of Social Welfare and Develop-
ment, the agency earlier responsible for providing psychosocial support through Criti-
cal Incident Stress Debriefing (CISD). The guidelines will now follow the Inter-Agency
Guidelines on Mental Health and Psychosocial Support in Emergency Settings 2007 of
the Inter-Agency Standing Committee (IASC).

The IASC guidelines center on six core principles, namely:


1. Human rights and equity
2. Participation
3. Do no harm
4. Building on available resources and capacities
5. Integrated support systems
6. Multi-layered supports:
a. Basic services and security
b. Community and family supports
c. Focused, non-specialized supports
d. Specialized services

Health service is one of the four areas in the Core Mental Health and Psychosocial
Supports. The other three are Community Mobilization and Support, Education, and Dis-
165
semination of Information. For health, the minimum response covers five points, namely:
1. Include specific psychological and social considerations in the provision of gen-
eral health care.
2. Provide access to care for people with severe mental disorders.
3. Protect and care for people with severe mental disorders and other mental and
neurological disabilities living in institutions.
4. Learn about and, where appropriate, collaborate with local, indigenous and tradi-
tional health systems.
5. Minimize harm related to alcohol and substance use.

Given this context, the DOH-HEMS/DSWD Technical Working Group agreed to a set of
health service minimum responses, i.e., essential high-priority responses that should be
implemented as soon as possible in an emergency.

AREAS FOR HOSPITAL ACTION

With the above IASC framework, the HEMS coordinator, in consultation with the psy-
chiatrist, psychologist and social worker, needs to draw the hospital minimum responses
in mental health and psychosocial support services to cover internal and external emer-
gencies.

As shown in Table S11.1, the country’s minimum responses may serve as a checklist
to guide the development and/or adaptation of appropriate hospital responses given its
geographical and socio-cultural setting:

Table S11.1. Checklist of Minimum Mental Health and Psychosocial Services

Philippines Minimum MHPSS Responses Hospital Minimum


MHPSS Responses
Adapt Develop Remarks
1. Designate mental facilities at strategic loca-
tions in the area.
2. Establish access to mental hospital networks
(government and private).
3. Establish referral system.
4. Identify/tap personnel trained on Psychiatric
Emergencies.
5. Mobilize health workers trained in identifica-
tion and management of alcohol and other
substance use (AOSU).
6. Provide treatment protocols.
7. Provide screening procedure/guidelines incor-
porated in Treatment Protocols.
8. Provide reporting forms and assessment
tools.
9. Utilize existing monitoring/assessment tools
for alcohol and other substance use (AOSU)
166 in emergency settings.
Continuation of Checklist of Minimum Mental Health and Psychosocial Services

Philippines Minimum MHPSS Responses Hospital Minimum


MHPSS Responses

Adapt Develop Remarks

10. Include selected/limited psychotropic drugs


in a separate “E” kit based on previous
reports and identified need with necessary
precautions/guidelines on its use.
11. Identify and designate MHPSS workers in-
cluding psychiatrists to be included in the
DOH emergency response team.
12. Submit list of response teams to HEMS-
OpCen for proper staffing, scheduling of de-
ployment.
13. Ensure proper orientation and supervision of
traditional health care providers,
14. Mobilize local indigenous traditional health
care providers.
15. Provide area in health facilities and on-site for
mental health consultations and management.
16. Provide information on the availability of men-
tal health services/facilities, e.g., distribution
of IEC materials and basic mental health edu-
cational activities.
17. Ensure adequate stock pile of resources for
basic biological needs.
18. Mobilize hospital network to take over psychi-
atric facility/local MH facility operations or for
referral/distribution of patients to their respec-
tive hospitals.
19. Activate collaborative services.
20. Activate referral system.

SOCIAL CONSIDERATIONS

The social considerations in the first minimum response relate to an equitable, appropri-
ate and accessible health care, such as:
• Maximizing participation of both genders in the design, implementation, monitor
ing and evaluation of any emergency health services.
• Maximizing access to health care, geographically and culturally. Aim to balance
gender and include representatives of key minority and language groups among
health staff to maximize survivors’ access to health services. Use translators if
necessary.
• Protection and promotion of patients’ rights to:
o Informed consent for both sexes before medical and surgical procedures
(clear explanations of procedures are especially necessary when emer- 167
gency health care is provided by international staff, who may approach
medicine differently)
o Privacy (as much as possible, e.g., put a curtain around the consultation
areas)
o Confidentiality of information related to health status of patients. Caution is
especially needed for data related to human rights violation (e.g., rape).
• Use of essential drugs consistent with the WHO Model List of Essential Medi-
cines.
• Recording and analysis of sex- and age-disaggregated data in the health infor -
mation system.

PSYCHOLOGICAL CONSIDERATIONS

A. A half-day to one-day orientation for health staff on the psychological components of


emergency health care may include the following contents:

• Psycho-education and general information


o Importance of treating survivors with respect to protect their dignity.
o Basic information on what is known about mental health and psychosocial
impact of emergencies, including understanding of local psychosocial re-
sponses to an emergency.
o Avoiding inappropriate pathologizing/medicalization (i.e., distinguishing
non-pathological distress from mental disorders requiring clinical treatment
and/or referral).
o Knowledge of available mental health care in the area to enable appropri-
ate referral for people with severe mental disorders.
o Knowledge of locally available social supports and protection mechanisms
in the community to enable appropriate referrals.
• Communicating to patients, giving clear and accurate information on their health
status and on relevant services, such as family tracing. Communicating in a
supportive manner include:
o Active listening
o How to deliver bad news in a supportive manner
o How to deal with very angry, very anxious, suicidal, psychotic or withdrawn
patients
o How to respond to sharing of extremely private and emotional events such
as sexual violence
• How to support problem management and empowerment by helping people
clarify their problems, brainstorming together on ways of coping, identifying
choices, and evaluating the value and consequences of choices.
• Basic stress management techniques, including local (traditional) relaxation tech-
niques.
• Non-pharmacological management and referral of medically unexplained somatic
complaints, after exclusion of physical causes.

B. Make available psychological support for survivors of extreme stressors (also


known as traumatic stressors).

Most individuals experiencing acute mental distress following exposure to extremely


stressful events are best supported without medication. All aid workers, and espe-
168 cially health workers, should be able to provide very basic psychological first aid
(PFA). PFA is often mistakenly seen as a clinical or emergency psychiatric interven-
tion. Rather, it is a description of a humane, supportive response to a fellow human
being who is suffering and who may need support. PFA is very different from
psychological debriefing in that it does not necessarily involve a discussion of the
event that caused the distress. PFA covers:
• Protecting from further harm. (In rare situations, very distressed persons may
take decisions that put them at further risk of harm.) Where appropriate, inform
distressed survivors of their right to refuse to discuss the events with other aid
workers or with journalists.
• Providing the opportunity for survivors to talk about events but without pressure.
Respect the wish not to talk and avoid pushing for more information than the
person may be ready to give.
• Listening patiently in an accepting and non-judgmental manner.
• Conveying genuine compassions.
• Identifying basic practical needs and ensuring that these are met.
• Asking for people’s concerns and trying to address these.
• Discouraging negative ways of coping, (specifically, use of alcohol and other sub-
stances), explaining that people in severe distress are at much higher risk of
developing substance use problems.
• Encouraging participation in normal daily routines (if possible) and use of positive
means of coping (e.g., culturally appropriate relaxation methods.
• Accessing helpful cultural and spiritual supports.
• Encouraging, but not forcing, the company of one or more family members or
friends.
• As appropriate, offering the possibility to return for further support.
• As appropriate, referring to locally available support mechanisms (e.g., rituals,
festivals, discussion groups) or to trained clinicians.

- In a minority of cases, when severe acute distress limits basic functioning,


clinical treatment will probably be needed. If possible, refer the patient to a
clinician trained and supervised in helping people with mental disorders.
- In most cases, acute distress will decrease naturally over time, without out
side intervention. However, in a minority of cases, a chronic mood or anxi-
ety disorder (including severe post-traumatic stress disorder) will develop. If
the disorder is severe, it should be treated by a trained clinician as part of
the minimum emergency response. If the disorder is not severe (e.g.,
person is able to function and tolerate suffering), the person should
receive appropriate care, i.e., from trained and clinically supervised health
workers such as social workers and counselors attached to health services.

Moreover, there is increasing inter-agency consensus that psychosocial concerns in-


volve all sectors of humanitarian work, because the manner in which aid is implemented
(e.g., with/without concern for people’s dignity) affects psychological well-being. Mor-
tality rates are affected not only by vaccination campaigns and health care but also by
actions in the water and sanitation, nutrition, food security and shelter sectors. Similarly,
psychosocial well-being is affected when shelters are overcrowded and sanitation facili-
ties put women at risk of sexual violence.

In most emergency situations, significant numbers of people exhibit sufficient resilience


to participate in relief and reconstruction efforts. Many key mental health and psychoso-
cial supports come from affected communities themselves than from outside agencies. 169
From the earliest phase of an emergency, local people should be involved to the greatest
extent possible in the assessment, design, implementation, monitoring and evaluation of
assistance.

HOSPITAL STAFF
The Hospital HEMS Coordinator considers the following concerns in support of hospital
staff including volunteers (HEMS, June 2007):

1. Recognition of the sources of stress for Health Emergency Workers


a. Health Emergency/Disaster Event Stressors
• Personal injury
• Personal loss
• Traumatic stimuli – gruesome sights/activities
b. Occupational Pressures
• Time pressure
• Work overload
• Physical demands
• Emotional demands
c. Organizational Pressures
• Role conflict
• Role ambiguity
• Confusing chain of command
• Organizational conflict

2. Identification of Health Emergency Workers at Greatest Risk for Severe Stress Symptoms

Those who directly experience or witness any of the following during or after the
disaster:
• Life threatening danger or physical harm (especially to children)
• Exposure to gruesome death, bodily injury, or dead or maimed bodies
• Extreme environmental or human violence or destruction
• Loss of home, valued possessions, neighborhood or community
• Loss of communication with or support from close relations
• Intense emotional demands (such as searching for possibly dying survivors or
interacting with bereaved family members)
• Extreme fatigue, weather exposure, hunger, or sleep deprivation
• Extended exposure to danger, loss, emotional/physical strain
• Exposure to toxic contamination (such as gas or fumes, chemicals,
radioactivity)

Those with history of:


• Exposure to other traumas (such as severe accidents, abuse, assault, com-
bat, rescue work)
• Chronic medical illness or psychological disorders
• Chronic poverty, homelessness, unemployment or discrimination
• Recent or subsequent major life stressors or emotional strain (such as single
parenting)

3. Development of mechanisms (e.g., training, fast track administrative procedures,


staff rotation) to ensure that health workers have the following before, during and
170 after disaster work:
■ Health emergency preparedness before disaster work/assignment

• Have a good training on disaster work.


• Have a factual information on the disaster situation.
• Have ample emergency and regular supply packed.
• Have communication lines with family, superiors and authorities.
• Have a personal/family emergency and contingency plan.
• Have mutual aid system with neighbors.
• Secure well-being of family.

■ Health emergency response at disaster work/assignment

Health worker
• Make working conditions as comfortable as possible.
• Try to get enough food, fluids, rests, breaks, relaxation, exercise,
sleep.
• Develop a buddy system with co-worker.
• Encourage and support each other.
• Be aware of stress reactions and signs of burnout.
• Have communication lines with family, co-workers, superiors, authori-
ties.
• Have defusing/debriefing sessions.

Hospital Staff (HEMS/WHO/WPRO, 2nd edition)


• Rotation of work assignments to allow time away from the daily routine
of disaster work for those in the field.
• Rest and recreation program for those in active duty.
• Conduct of debriefing sessions regularly.
• Provision by superiors and hospital for situations to give credit, ex-
press appreciation and recognition of their disaster workers at regular
intervals.
• Provision of appropriate assistance to those who might require coun-
seling and/or specialist psychiatric attention.

■ Health emergency recovery after disaster work/assignment

• Attend defusing/debriefing sessions.


• Anticipate problems at home/at work.
• Be aware of the effects of disaster to self.
• If with children, help them understand work without frightening them.
• Catch up on sleep, rest, relaxation, exercise.
• Take time to introspect, learn, grow from experience.

171
These pointers are aimed at minimizing the occurrence of the burnout syndrome to
which health workers, particularly in health emergency/disaster work are prone to. Burn-
out syndrome is a state of exhaustion, irritability, and fatigue which markedly decreases
worker’s effectiveness and capability. Its symptoms consist of:

Mental Emotional Physical Behavioral


Mental confusion Depression Exhaustion Feeling of excessive
Slowness of thought Hyper-excitability Loss of energy fatigue
Inability to make judg- Irritability Gastrointestinal Hyperactivity
ments & decisions Excessive rage disturbances Inability to express
Loss of objectivity in reactions Sleep disorders self
evaluating own Anxiety
function

NEED FOR RESEARCH


At present, there is scarcity of scientific evidence regarding the kind of Mental Health
and Psychosocial Support that proves to be most effective in emergencies. Most re-
searches have been conducted months or years after the end of the acute emergency
phase. The survivors, communities and health workers will benefit from appropriate
documentation and analysis of the experiences of practitioners in a hospital setting.

172
SECTION 12
Networking and Coordination

POLICY BASE

Administrative Order No. 168 s. 2004 contains the following provisions.

In Section V-C: Policy Statements on Support Systems:


“2. Resource pooling/sharing of resources (including manpower and materials) among
the various stockholders in the health sector shall be institutionalized.”

In Section V-F: Networking and Collaboration:


“1. Response to emergencies and disasters is not a monopoly of any institution. Hence
there should be an active desire to coordinate with all agencies, other government
agencies, nongovernment organizations, private organizations and also international
organizations.
2. Collaboration with the Health Sector responding to emergencies and disasters will
ensure a more comprehensive, integrated and coordinated response to maximization of
resources. Hence, a system for coordination/collaboration should be developed.”

DEFINITIONS

1. Networking is an exchange of information or services among individuals, groups


or institutions. It is a purposive engagement of individuals and groups in a proc-
ess of collaboration to achieve common goal. (HEMS, June 2007)

2. Coordination is an ongoing process. The nature of the relationship depends on


what is acceptable to the participating agencies. No single model can be
provided. It is important to forge linkages not only during emergencies, but
also more importantly before the disaster.

Coordination ensures: (HEMS, June 2007)

• Information sharing
• Working together with a common goal
• Avoidance of overlapping of services
• Regular communication of relevant data

IMPORTANCE OF NETWORKING AND COORDINATION

Networking enables the health facility to:


1. Coordinate and guide the activities of the members of the response teams.
2. Maximize resource utilization and minimize waste of resources.
3. Facilitate referrals of cases from one facility to another.
4. Facilitate transmission and receipt of information and instructions.
173
Coordination enables the health facility to:
1. Understand each other’s operations, roles and responsibilities.
2. Integrate views, capabilities and options.
3. Ensure cooperation.
4. Determine the strategic direction.
5. Maximize resources.
6. Achieve synergy.

Coordination of the action taken in response operations is very important. Good co-
ordination ensures that resource organizations are utilized to the best effect, therefore
avoiding gaps or duplication in operational tasks.

OBJECTIVES OF NETWORKING AND COORDINATION

In a broader context, networking aims to exchange information and services to broaden


resources and thus achieve goals while supporting others to achieve theirs (HEMS,
June 2007). Similarly, coordination also involves information sharing and working to-
gether with a common goal to avoid overlapping/duplication of tasks and facilitate the
maximization of resource utilization.

Specifically, networking and coordination enable the health facility to:


1. Improve efficiency, effectiveness and speed of response.
2. Provide a framework for strategic decisions.
3. Unify the strategic approach.
4. Reduce gaps and duplication in services.
5. Ensure appropriate division of responsibilities.

PRECONDITIONS TO COORDINATION

To establish good working relationship with other groups or entities, consider the
following:
1. Have all agencies commit to a common goal.
2. Develop clear, detailed group goals and a mission statement from the start of the
project or engagement.
3. Define the parameters of coordination.
4. Enlist and maintain the support of top-level management with decision-making
authority.
5. Identify role/s of own organization and in relation to other participating organiza-
tions.
6. Identify priorities of the whole group. Recognize that each agency has a differ-
ent set of priorities to take into consideration, but maintain a set of equal
importance for each agency on the team.
7. Identify points of complementation, integration and collaboration.

REQUIREMENTS AND TECHNIQUES FOR COORDINATION

Requirements:
• Perceived need for coordination
• Mutual understanding and respect
• Agreed parameters and responsibilities
174 • Common vocabulary and concepts
Figure S12.1. The Spectrum of Coordination Activities

Information Points of Comple- Points of Points of Collaborative


Sharing mentation Integration Collabora- Planning
(What is at (Avoid (Strategies, tion and
hand) duplication) etc.) Programming

Least difficult Most difficult


“The degree of coordination possible will depend on the circumstances”

Coordination techniques:
• Use a neutral facilitator.
• Build consensus before meetings/proposals.
• Document agreements and arrangements with memoranda of understanding.
• Identify strengths and capabilities before dividing work and responsibilities.
• Respect organizational mandates.
• Establish and maintain effective communications.
• Take final decisions in plenary.
• Include partners and beneficiaries.
• Provide mechanisms for timely action, especially during crises.
• Ensure responsibilities for follow-up and follow-through on decisions.
• Provide personal and organizational incentives to coordinate.
• Make use of the news media to strengthen coordination.

Possible Information-sharing activities:


• Provide rosters, points of contacts, and alternative means of communication.
• Initiate, maintain, and share early warning systems and information.
• Clarify general roles and responsibilities.
• Identify the specific resources each organization brings to the emergency.

Potential shared resources and divisible work:


• Identify the affected population and jointly assess local capacity and needs.
• Identify gaps and overlaps in assistance.
• Agree on standards of assistance and services.
• Collaborate in preparation of appeals.
• Negotiate as a group for access and resources.
• Conduct common training.

STAGES IN NETWORKING

Networking is a continuum of three stages namely :

1. Stakeholders analysis
• Clear statement of the mission or objectives of the agenda or activities being
planned.
• List of individuals and groups who may share the agenda and its vision.
• Identification of possible stakeholders from the list who will provide the
needed support. 175
2. Social mobilization
• Is about people taking action for the common good.
• Key steps involved in planning social mobilization activities:
i. Situation analysis of the need to conduct such activities.
ii. Formation of team or committees/technical working groups that will be
involved in a participatory planning and will sustain the strategic part
nership. It is important that the team will be able to overcome any
obstacles along their implementation of the activities.

3. Sustained interaction

WHEN TO APPLY NETWORKING AND COORDINATION

Networking and coordination cut across all the activities in each of the three phases of
health emergency management, particularly for these areas of concern:
• Organization
• Systems implimentation
• Resource mobilization
• Tasking and responsibility sharing of partners and sectoral workers
1. Health Emergency/Disaster Preparedness
• Do collaborative planning (e.g., preparation of preparedness and contingency
plan, plans for shared use of facilities, investments in infrastructure, evacu-
ation and transportation)
• Organize emergency response teams in hospitals, clinics and other health
institutions.
• Prepare and stockpile medicines and supplies.
• Pre-identify, pre-designate and prepare potential evacuation centers.
• Conduct sanitary and environmental inspections to designated evacuation
centers.
• Conduct inventory of all available resources: clinics, hospitals and medical
institutions in the area; services, logistics.
• Establish Regional Epidemiology Surveillance Unit/Local Epidemiology
Surveillance Unit.
• Organize the health sector in the region and establish a regional network.
• Act as the cluster focal points at the regional level.
• Develop a functional referral system.

2. During Health Emergency/Disaster Response


• Activate emergency response teams.
• Provide medical care/assistance to victims during evacuation operations.
• Initiate and coordinate evacuation operations.
• Monitor occurrence of epidemics in evacuation centers and undertake the
necessary measures to control and prevent spread of diseases.
• Provide warning to the public on occurrence of epidemics.
• Conduct daily inspection on the state of sanitation in the evacuation center.
• Submit periodic reports to the council.

3. Post Health Emergency/Disaster Recovery


• Provide psychological debriefing to victims and bereaved families.
176 • Continue to provide direct service and/or technical assistance on sanitation.
• Submit after operation reports to the council.
NETWORKS/ORGANIZATIONS AND RESPONSIBILITIES:
NETWORKING WITH THE HEALTH SECTOR

Networking in the Catchment Area (DOH-SDP, 2000a)

Networking for the hospital is imperative. Every hospital integrates its hospital health
emergency preparedness, response and rehabilitation plan with those of community dis-
aster management agencies for better inter-operability during emergencies or disasters.
This is critically important in disaster notification and communication, transport of casu-
alties, and provisions for dispatch of hospital response teams to a disaster site. Strong
relationships with community agencies (e.g., fire department, the local EMS/emergency
management, the civil defense agency, volunteer agencies) ensures a more compre-
hensive, integrated and coordinated disaster and emergency response in addition to
maximization of resources.

The hospital HEPRR plan has to incorporate measures to respond to identified hazards
commonly occurring in the community (e.g., typhoons, landslide, volcanic eruptions,
etc.). These include the pre-identification of expert personnel (e.g., poison control) and
special supplies (e.g., antidotes) which may not readily be available in a particular dis-
aster situation, and the formulation of appropriate procedures to ensure rapid access to
these resources. For consideration in the plans are acquisition of additional shelter, food
and water.

Below is a list of partners and agencies who are members of the network in the different
catchment areas of hospitals.

DOH Hospitals and Offices


Philippine Hospital Association (Local Counterpart)
Philippine Medical Association (Local Counterpart)
Specialty Groups (Local Counterpart)
Philippine National Red Cross (Local Counterpart)
Respective Local Chief Executives
Respective Disaster Coordinating Councils and member agencies
- Local Health Counterparts (PHO, MHO, CHO) and LGU Hospitals
Department of the Interior and Local Government
-Bureau of Fire Protection (Local Counterpart)
-Philippine National Police (Local Counterpart)
Department of National Defense
-Armed Forces of the Philippines
-Philippine Navy
-Philippine Army
-Philippine Air Force
Department of Transportation and Communication
- Philippine Coast Guard
Local Emergency Medical Services groups
Academe/Universities
Local Private Hospitals
Pharmaceutical Companies
Local Laboratories
Local Ambulance Service Providers 177
Local Funeral Parlor and Morgue
Local Transportation Group/Trucking Services
Local Business Sector Group
Local Nongovernment Agencies
International Organizations with local counterparts
Local Private Organizations and Civic Organizations
Community (Community/Barangay Leaders, Church, Youth)
Local Volunteers
Local Blood Bank
Local TV/Radio stations/Press

Cluster Approach

A recent development in networking and coordination is the institutionalization of the


Cluster Approach in the Philippine Disaster Management System. The Cluster Approach
aims to ensure a more coherent and effective response by mobilizing groups of agen-
cies, organizations and NGOs to respond in a strategic manner in support of the exist-
ing government coordination structure and emergency response mechanism.

The cluster lead at National Level is DOH-HEMS with the Center for Health Develop-
ment at the regional level for four clusters: Nutrition; Water, Sanitation and Hygiene
(WASH); Health, and Psychosocial Services.

Roles and Responsibilities


• Inclusion of humanitarian partners in the cluster taking stock of their mandates
and program priorities
• Establishment and maintenance of appropriate humanitarian coordination
mechanisms
• Attention to priority cross-cutting issues
• Needs assessment and analysis
• Emergency Preparedness
• Planning and strategy development
• Application of standards
• Monitoring and reporting
• Advocacy and resource mobilization
• Training and capacity building

The regional counterpart of the members of the three (3) clusters at the national level
can be tapped by the hospital. These include among others:

Nutrition Cluster
• CHD-HEMS as Government Lead Agency in the region
• United Nations Children’s Fund as the Inter-Agency Standing Committee
(IASC) Country Team Counterpart/Co-Lead
• DOH-National Nutrition Council
• DOH-National Center for Disease Prevention and Control
• Department of Social Welfare and Development
• Department of Science and Technology-Food and Nutrition and Research
Institute
• World Health Organization
• Philippine National Red Cross
178
• Save the Children
• Accion Contra El Hambre

Water, Sanitation and Hygiene (WASH) Cluster


• CHD-HEMS as Government Lead Agency in the region
• United Nations Children’s Fund as the IASC Country Team Counterpart/Co-Lead
• DOH-National Center for Disease Prevention and Control
• Department of Public Works and Highways
• Department of the Interior and Local Government
• OXFAM Great Britain-Philippines
• World Health Organization
• Philippine Center for Water and Sanitation/International Training Network
Foundation
• Plan International
• Manila Water Company, Inc.

Health Cluster
• CHD-HEMS as Government Lead Agency in the region
• World Health Organization as the IASC Country Team Counterpart/Co-Lead
• DOH-National Center for Disease Prevention and Control
• DOH-National Epidemiology Center
• DOH-National Center for Health Promotion
• Department of Social Welfare and Development
• United Nations Children’s Fund
• United Nations Population Fund
• International Federation Red Crescent
• Philippine National Red Cross
• Plan International
• Save the Children
• Handicap International
• International Organization for Migration

For providing mental health and psychosocial support to direct and in direct victims,
as well as responders, during emergencies and disasters, the CHD is responsible in
coordinating with DSWD and other GOs and NGOs.

Hospital Networking and Referral System (DOH-SDP, 2000a)

The hospital network is a sharing arrangement among several hospitals of different


levels and specialties in a given area to work together. It is aimed at managing medi-
cal emergencies more efficiently. The hospital network can readily be mobilized during
disaster operations. This implies that the hospital develops its external disaster plan in
conjunction with other emergency facilities in the community. For example, there may be
a pre-arranged memorandum of agreement with hospitals outside the immediate area
should hospital capacity be exceeded. Hospitals, both private and government, need to
work as a network irrespective of specialty and capability. With a clear system of refer-
rals, pre-planned and pre-arranged to tertiary medical centers and special units of gov-
ernment and private institutions (e.g., burn, spinal, pediatric trauma centers), continuous
appropriate patient care is assured.
179
One example is the Hospital Zoning System in Metro Manila, where DOH Metro Ma-
nila-retained hospitals were divided into eight zones. Each zone has a lead hospital and
support hospitals. This hospital zoning system identifies easily the specific hospital to
request support from and mobilize its resources for the appropriate emergency condi-
tion.

At the policy level, Section VIII of Administrative Order FAE 007 s. 1998: Policies and
Guidelines on the Transfer and Referral of Patients Between DOH Metro Manila Hospi-
tals addresses the situation that during MCI, the prescribed usual rules and procedures
on Emergency Referrals were unsuitable.

At the implementation level, the development of the Metro Manila Hospital Network can
provide lessons to hospitals.

With a clear system of referrals, pre-planned and pre-arranged to tertiary medical cent-
ers and special units of government and private institutions (e.g., burn, spinal, pediatric
trauma centers), continuous appropriate patient care is assured.

Metro Manila Hospital Network


One example of a hospital network arrangement is that of the hospitals in
Metro Manila. The arrangement is based on the rated capability of a hos-
pital using the following criteria: (1) presence of specialty experts, existing
training program and of available personnel in the emergency room capable
at all times of handling specific sub-specialty problems; and (2) available
equipment, therapeutics and communication facilities, infrastructure and
service performance. .

The hospital capability ratings serve as a guide for networking activities in


the different phases of health emergency management.

RATED 1 means that the hospital is capable of accepting all cases of this
specialty. A hospital Rated 1 is an end-hospital that will not refuse patients
unless the situation makes admission extremely difficult or impossible.

RATED 2 means that the hospital is capable of handling sub-specialty


cases but has some limitations such as bed capacity, equipment, etc. and
cannot be expected to offer definitive care. It may also mean there are not
enough full-time consultants or residents available on a 24-hour basis or
that there is no training program and therefore no front-line personnel in
this specialty.

RATED 3 means the hospital is incapable of handling cases of this sub-


specialty beyond giving primary care and resuscitation.

Per catchment area, a lead hospital (Rated 1) for the identified sub-special-
ty and its support hospitals were identified. A two-way referral system be-
tween the lead hospital and other hospitals in the network was established.
180
SECTION 13
Human Resource Development

Human Resource Development (HRD) consists of organized learning activities arranged


within an organization to improve performance and/or personal growth for the purpose
of improving the job, the individual and/or the organization. A comprehensive process, it
covers training and development, career development, and organizational development
as well.

The goal of HRD is to improve the performance of organizations by maximizing the ef-
ficiency and performance of its people. It centers on the development of knowledge and
skills, actions and standards, motivation, incentives, attitudes and the work environment.

POLICY BASE

This holistic view is reflected in the provisions of the National Policy – Administrative
Order No. 168 s. 2004, Section V-B: Human Resource Development, which states that:

1. All health workers should receive basic training on health emergency manage-
ment as part of their educational preparation as it is expected that everyone
should participate in preparedness, response, rehabilitation, and mitigation activi-
ties at various levels.
2. The safety/security of the health worker is of prime importance in any health
emergency operation. Before deployment, they should be provided with proper
identification, proper uniform, and the necessary personal protective equipment.
Furthermore, they should be properly oriented and given proper guidance on the
risks and hazards involved in such an operation.
3. A system for rewards, incentives, and recognition for outstanding performance
should be put in place to develop a culture of excellence in health emergency
management.
4. The physical and psychological integrity of health workers is an important factor
in the success of health emergency management. Physical and psychological
fitness of personnel shall be maintained through drills/simulation exercises,
stress management, debriefing sessions and respite care in long-term operation.
A mental health program for disasters should be developed and integrated in the
training for health personnel.
5. A mechanism for certifying, updating, and conducting refresher courses shall be
organized to ensure that all personnel involved in health emergency manage-
ment are knowledgeable in current trends and state-of-the-art techniques and
technology related to their area of expertise.
6. Core and functional competencies required of health emergency personnel at
various levels shall be identified to develop an integrated national human re-
source development program addressing various types of health emergencies.
Selection of health personnel for training shall be based on their roles and
responsibilities. Personnel trained and developed shall be retained in areas
where their expertise can be maximally utilized, e.g., emergency rooms. In the
event that they are rotated there should be a system wherein they could
readily be recalled for emergency operations.
181
7. An inventory of the available human resources based on their expertise should
be developed at each level.

Administrative Order No. 155 s. 2004: “Management of Mass Casualty Incidents”


Section V: General Guidelines provides that:

D. Training sessions and drills relative to MCI shall be institutionalized and organ-
ized annually in all DOH Hospitals and Centers for Health Development to con-
tinually upgrade levels of knowledge and maintain a state of readiness. All
physicians, nurses and other emergency responders shall be required to under-
go MCM training.

Section VI: Implementing Guidelines of the same Administrative Order further


provides:

2. Capability Building
a. Basic Life Support (BLS) training shall be mandatory for all health personnel.
b. Advance Cardiac Life Support (ACLS) and Pediatric Cardiac Life Support
(PCLS) shall be a requirement for all medical personnel assigned in the
Emergency Rooms.
c. All Response Teams shall have additional training in Emergency Medical
Technician’s Course – Basic and Mass Casualty Management.
d. Regular simulation exercises shall be done at least once a year.

TRAINING

The HEMS Coordinator is responsible for the training of its members, as well as their
communities, relative to health emergency skills and management while the Assistant
Coordinator acts as the Training Officer.

Training Process

The development of appropriate, effective and efficient training programs is a five-step


training process that includes: Training Needs Assessment, Preparation of a Training
Design, Development of Instruction Methodology, Conduct of Training, and Validation of
Training. The activities and outputs of each step are in Table S13.1.

182
Table S13.1. Training

STEPS ACTIVITIES OUTPUTS

1. Training Needs Analyze the job. List of task performances,


Assessment (TNA) • List the task perform- conditions, and standards
ances, task conditions
and standards.
• List the training needs Schedule of training &
and their priorities. priorities

2. Design training • Design training to suit • Sequenced set of train-


the results of job analy- ing objectives and tests
sis.
• Define and arrange
the training objectives
and assessment in
logical sequence within
the framework of train-
ing design.

3. Develop instruc- • Choose the instructional • A program of instruction


tion/methodology methods and media. which has been
• Compile the course pro- successfully trailed
gram and content .
• Trail and amend the in-
struction content and
methods.

4. Conduct instruc- • Conduct the course. • Trainees who have


tion/methodology • Administer the test. achieved course objec-
• Monitor the progress of tives
the course. • Course modified as
• Apply remedial meas- necessary
ures to problems met.

5. Validate training • Identify the problem • Validated and success-


areas from Steps 4 and ful conduct of training
5 by analyzing:
- effectiveness
- appropriateness
- efficiency
• Modify or update the
training as necessary.

183
Functional Core Competencies

The HEMS coordinator can be guided by the results of the Training Needs Assessment
(TNA) conducted for the identified six groups of trainees namely: Health Emergency
Managers, Leaders, Responders, OpCen Staff, Trainers, and General Public. The func-
tional competency requirements and required training courses for each group are shown
in Table S13.2.

Table S13.2. Competency Requirements and Required Training Course/Package by Roles


Position Competency Requirement Required Training
Roles/Functions (Functional) Course/ Package
1. Health Emergency • Technical writing for policy devel- • Hospital Emergency Aware-
Managers opment ness and Response Train-
- Leader • Policy development planning ing (HEART)
- Policymaking, • Knowledge & skills in standard • Leadership Training espe-
budget, etc formulation cially in decision-making
- Standard formulation • Training needs analysis • Management Training
- Capability building • Analytical thinking – Policymaking, Planning,
- Advocacy • Evidence-based analysis Budgeting, Standard
- Coordination/collabo - • Negotiation Formulation, TNA,
ration • Public information Evaluation
- Management of • Social marketing • Power and Risk communi-
event • Public speaking cation
- Monitoring & evalua- • Power communication • Coordination Skills
tion (M/E) • Coordination/collaboration skills • Crises and Consequence
• Decision-making Management
• Conflict management • MCI and ICS
• Leadership training • Personnel Management
• Training in M/E • Logistics Management
• Organizational management
• Basic HEM
• Information technology (IT)
2. Leaders (Chief of • Basic HEM • Orientation on Basic HEM
Hospital) • Crisis & Consequence Manage- • HEART
- Decision-makers ment
- Resource mobilizers • Mass Casualty Incident & Inci -
- Communicators dent Command System (MCI &
- Advocators ICS)
- Program director/supervisor

3. Responders • Rapid assessment skills • Basic Life Support (BLS),


a. Pre-hospital • Basic knowledge on hospital Standard First Aid;
- Responds to emer- system; Basic Life Support • Medical First Responder
gencies (Patient (BLS), Standard First Aid; Medi- (MFR)
management) cal First Responder (MFR) • Emergency Medical Techni-
- Decontamination • Emergency Medical Technician cian (EMT)
- Triage (EMT) • Advanced Cardiac Life
- Ambulance care • Advanced Cardiac Life Support Support (ACLS)
(patient management) (ACLS) • Advanced Trauma Life
• Mass Casualty Incident (MCI) Support (ATLS)
• Health Emergency Management • Mass Casualty Incident ,
• Decontamination skills Incident Command System
• Incident Command System (ICS) & Weapons of Mass De-
skills struction (MCI-ICS-WMD)
• Ambulance traffic control • Basic Health Emergency
• Radio communication Management
• Sound knowledge of access (HEM)
routes to health care facilities
• Networking/coordination
184 • Safe driving skills
Continuation of Competency Requirements and Required Training Course/Package by Roles
Position Competency Requirement Required Training
Roles/Functions (Functional) Course/ Package

Hospital Knowledge and skills in: • Basic Life Support (BLS),


- Decontamination/isolation • Basic Life Support & Standard Standard First Aid;
- Patient management/triage First Aid • Medical First Responder
- Specific case management • Advanced Cardiac Life Support (MFR)
o Burns (ACLS) • Emergency Medical
o Weapons of Mass • Advanced Trauma Life Support Technician (EMT)
Desruction (WMD) (ATLS) • Advanced Cardiac Life
o Radiological, Biological • Triage Support (ACLS)
& Chemical (RBC) • Mass Casualty Incident , Inci- • Advanced Trauma Life
o Poisoning dent Command System & Support (ATLS)
Weapons of Mass Destruction • Mass Casualty Incident ,
(MCI – ICS- WMD) Incident Command System
• Specific case management & Weapons of Mass De-
struction (MCI-ICS-WMD)
• Radiological, Biological &
Chemical (RBC) Courses
• Basic Health Emergency
Management (HEM)
4.Trainers • Presentation skills • Basic Training of Trainers
• Communication skills (TOT)
- Training needs assess- • TNA skills
ment (TNA) • Training design skills
- Training design
- Actual conduct of training
- Development of evaluation
tool
- Evaluation of training
- Development of module

5. OpCen Staff
- Monitoring of events • Knowledge of DOH System/ • Organization of the DOH
Health Sector and the Health Sector
• Knowledge of HEMS Policies, • Health Emergency Manage-
guidelines, procedures in moni- ment (HEM) Basic
toring • Public Health and Emer-
• Skills in tri-media monitoring gency Management in Asia
• Skills in map reading, hazard and the Pacific (PHEMAP)
mapping, etc.
- Coordination In addition to the above: • Basic courses in computer
• Knowledge of the network and including use of Internet
contact persons • Networking and Coordina-
• Communication skills tion
• Negotiation skills
• Skills in decision making
- Data Management • Knowledge in all HEMS reporting • Basic Epidemiology
forms and templates • Data Management
• Knowledge in data collection,
data evaluation, data analysis
and data dissemination
• Knowledge in epidemiology, sta-
tistics and surveillance
• Skills in presparation of reports
and presentation
• Skills in computer and other tech-
nology
185
Continuation of Competency Requirements and Required Training Course/Package by Roles
Position Competency Requirement Required Training
Roles/Functions (Functional) Course/ Package

- Logistics Mobilization • Knowledge of available re- • Logistics Mobilization


sources in DOH • Mass Casualty Incident and Inci-
• Knowledge on the steps in dent Command System
mobilizing human (e.g., medi-
cal teams, etc.) and material
resources to the affected com-
munity
• Knowledge and skills in MCI/
ICS

- Risk Communication • Knowledge of available IECs • Risk Communication


especially for emergencies • Basic Communication Technology
• Skills in media handling (Radio, Map Reading, GIS, etc.)

- Others • Administrative Functions such


as:
- Maintaining database of con-
tact persons, experts, facilities,
logistics, etc.
- Filing, recording of important
documents
- Updasting files
• Performing other functions
assigned
• Skills in BLS/ First Aid/ EMT

6. Other Hospital Personnel Knowledge and skills on the fol- Basic HEM Training – 2-day course
- Initial responder lowing: (training module to be developed)
- First aider - Basic HEM (Awareness)
- Health education & - BLS
promotion - First Aid
- Reporting - 4W’s & 1H (Who, Where,
When, Why and How)

Hospitals

The HEMS Coordinator needs to classify the different hospital staff by their function in
health emergency to determine the appropriate training courses for them. The recom-
mended courses include the requirements from A.O. 155 for Mass Casualty Manage-
ment, stated below.

1. BLS training shall be mandatory for all health personnel.


2. Advance Cardiac Life Support (ACLS) and Pediatric Cardiac Life Support
(PCLS) shall be a requirement for all medical personnel assigned in the
Emergency Rooms.
3. All Response Teams shall have additional training in Emergency Medical Techni-
cian’s Course – Basic and Mass Casualty Management.

Specially designated hospitals should have training on their areas of expertise. Below is
a list of such hospitals and their corresponding training requirement:
1. Hospital Poison Control Centers - Toxicology Training, Chemical Terrorism
2. Trauma Centers
186 3. Infectious Disease Hospitals – Biological terrorism, emerging and re-emerging
diseases (SARS, Avian Flu, etc.)
4. Burn Centers
5. Hospitals with Radio-nuclear Management Capability – Radiological Terrorism
6. Hospitals with Chemical Management Capability – Chemical Terrorism

Similarly, designated referral hospital laboratory should have training on their areas of
laboratory capability.

Apart from the training which hospital staff should have, they can serve as technical
resource persons and/or trainers. As part of the Hospital Emergency Preparedness, Re-
sponse and Recovery (HEPRR) Plan, the hospital can provide technical assistance on
Basic Life Support, Basic First Aid, and Basic Health Emergency Management (HEM) to
the community within their catchment area.

CAREER DEVELOPMENT

A holistic approach in initiating and nurturing staff in health emergencies is crucial to


human resource development. Upgrading of competencies through training should be
mapped out in the context of a long-term perspective – that of a career path of the hos-
pital staff, an area that needs to be defined and enhanced.

Health Human Resource Management

Beyond knowledge and skills, psychosocial support for the staff deserves closer at-
tention, given the pressures inherent in the work including the 24-hour shifts, the quick
decision-making process, and need to balance with equally important demands of their
respective families.

Considering the nature of the work where speed and timeliness are of the essence, spe-
cific concerns such as safety, incentives, compensation, and other workers’ benefits as
covered in the second, third and fourth provisions of the A.O. 168 need to be addressed
by the hospital. It should be cognizant that these areas are part of health human
resource management which is a function of the Central DOH, and part of a multisecto-
ral process covering the entire government workforce.

The DOH had earlier highlighted this aspect through A.O. 155 Section V-F which states
that:

All DOH personnel mobilized in response to emergencies and disasters like MCI shall
be entitled to overtime pay and other allowable benefits based on actual time ren-
dered due them even during Saturdays, Sundays and holidays. This shall be support-
ed through the issuance of a pertiment hospital/office order which shall state funding
of such overtime from savings of the hospital, HEMS-Stop Death funds or any other
funds subject to the usual accounting and auditing rules and regulations.

It is crucial for the hospital to distinguish those concerns which can be responded to
promptly by implementation of guidelines and procedures from those which will take
some time since these require refinement of existing systems and/or development of
new policies and procedures. A timetable of having the new systems in place provides
moral boost to the staff performance.
187
SECTION 14
Logistics Management

POLICY BASE

A.O. 168 s. 2004 Section V-C: Policy Statements on Support Systems provides:

1. Logistics Management shall be developed for health emergency with the aim of pro-
viding the right requirement, with the right amount at the right time and the right
place. A system for procurement and delivery shall be developed wherein the
logistical needs are identified at the different levels of health facilities.

PURPOSE

The purpose of this section is to provide an overview of logistics management system


and to provide guidelines for the hospitals to be able to perform their logistic man-
agement functions during emergencies and disasters.

DEFINITION

1. Logistics management has been described as the procurement and delivery of


the right supplies, in the right quantities, in the right order, in good condition
(proper packing and not expired), at the right place, at the right time (HEMS, June
2007).

Getting the appropriate emergency resources to the right place at the right time in
the most efficient means possible is a primary concern. These resources include
drugs, medicines, supplies, equipment and materials needed in response to
emergencies and disasters.

2. Logistics management is the process of planning, preparing, implementing and


evaluating all logistics functions in the provision of assistance, as well as its place
in carrying out emergency management operations.

LOGISTICS MANAGEMENT PROCESS

A. Planning

• Annual Procurement Plan (APP)

The APP containing a list of all drugs/medicines, supplies, equipment and


materials to be procured for the coming year shall be prepared and submitted
by the HEMS Coordinator and signed by the Chief of Hospital at least one
quarter prior to the start of the succeeding calendar year. Any procurement
188
not included in the APP will not be approved and processed.

The HEMS Coordinator of the hospital should be involved during logistics


planning for emergency requirement.

In the preparation of the APP, the HEMS Coordinator of the hospital will have
to consider the following:
- Inventory of available stocks including the expiry date of drugs, medicines,
supplies and materials including equipment.
- Utilization of the past years.
- Postmortem analysis of disasters specifically for logistics.
- All drugs and medicines should be found in the Philippine National Drug
Formulary (PNDF) latest edition. If not included look for an alternative
or request for exemption from the drug committee.
- Projected needs.
- Projected emergencies and kinds of hazards in the hospital or catchment
area.
- Leading causes of morbidity and mortalities during the past emergencies
or disasters and other relevant health indices.
- Appropriate storage facilities and alternate backups.

It is important that drugs and medicines for emergency use conform to standard
specifications and appropriateness to emergency conditions, indicating the
following:
- Dosage
- Size
- Volume
- Preparation
- Ingredients
- Required packaging
- Appropriate storage and transport (e.g., cold chain management)
- Necessary supplies for administration (e.g., vaccines need syringes, needles,
and special puncture-proof container for containment prior to waste treatment
and disposal).
- It is very important that only drugs and medicines in the latest PNDF will be
considered.

• Supplemental Annual Procurement Plan

In the event of additional needs or during emergency procurement, a supplemen-


tal APP will have to be prepared and submitted.

B. Procurement

The hospital can procure emergency drugs/medicines and supplies. However, if the
hospital can make arrangements with pharmaceutical companies and other suppli-
ers during emergencies there might be no need to procure large amount of drugs
and medicines.

Procurement shall follow the pertinent government rules and regulations and other
DOH policies relative to procurement. 189
Purchase request for the whole year must be submitted to the procuring entity every
first quarter of the year (or the hospital may have a different schedule) with the
following supporting documents:
• Annual Procurement Plan/Supplemental Annual Procurement Plan
• Certificate of Clearance (medicines, drugs, medical supplies and equipment)
• Certificate of Availability of Fund

In the event that supplies and materials are not available locally or the hospital’s
supply was depleted because of the emergency and ongoing operation, they can
request for augmentation from HEMS. A letter of request or just a call, especially
during emergencies, will suffice. The request shall be supported by a report on the
emergency.

C. Storage/Warehousing

There are various options for storage during preparedness, response and rehabilita-
tion phase.

Preparedness

Look at various storage/warehouse areas in and outside the hospital. Ideal storage
areas may include warehouses and other suitable buildings where storage manage-
ment procedures already exist during pre-disaster phase.

Emergency/Response Phase

When ideal storage is not available, especially during emergency or response


phase, available space in the field can be utilized. There are ways to innovate/
modify the minimum requirement for storage. These may include among others:
• Lockable transport container that can be left near the site or stricken areas
• Temporary storage for stocks in transit

The following are some guidelines to be observed to ensure proper storage and to
minimize wastage of drugs/medicines, compact food, medical supplies and reagents:
• Store foods in a dry, well-ventilated area free from insects and rodents.
• Boxes, bags and containers must not be placed directly on floor. Use pallets
or boards underneath piles.
• Keep items at least 40 cm away from the wall and do not stock them too high.
• Replace damaged boxes, bags and containers.
• Pile boxes, bags and containers two by two crosswise to permit ventilation.
• Observe ”First in-First Out” principle and dispose of food supplies at least one
(1) year, and medicines at least six (6) months, before the expiry date.
• Vaccines should be stored at the cold storage with a temperature of 2-8
degrees centigrade.
• Do not store food and vaccine together in one cold storage.
• Keep the medicines away from sunlight.

It is necessary to categorize and record what might be termed as logistic tools to


address needs for disaster situations. Commodities which are likely to be needed
may include among others:
190 • Operational support items (e.g., fuel, oil lamps/lanterns, flashlight, means of
communication)
• Relief commodities (e.g., food, shelter materials, clothing)
• Medical necessities (e.g., drugs, water purification accessories)
• Items likely to be required for recovery programs (e.g., building materials)

D. Distribution and Delivery

The HEMS Coordinator can request their own supply for use in the emergency room
or for the use of the response teams in responding to the site. They have to make
their own listings for these, considering that they should be able to handle at least
5 red victims during response. Majority of the needs of the hospitals are for trauma
management, so this should be considered.

The resources are distributed to the concerned department/unit.

In the event of augmentation from CHD, emergency drugs, medicines, supplies


(including BP Compact Food) shall be provided to the Response Teams so they can
respond immediately during emergencies in their areas.

E. Monitoring and Reporting

To ensure that essential items are always available, incoming supplies, supplies dis-
tributed, and stock levels should be closely monitored. It is important to:
• Record the end destination for items in the stock records.
• Monitor that they are being used appropriately.
• Provide reliable reports.

The Hospital Supply Officer together with the HEMS Coordinator shall prepare the
following:
• Monthly Inventory Report of available stocks in the warehouse, the expiry date,
and the location of delivery of the items every first week of every month.
• Annual Utilization Report of the distributed drugs and medical supplies. This
should be received by DOH-HEMS on or before January 15 of the succeeding
year. This is to be submitted if the funds came from HEMS.
• In Postmortem Analysis of every emergency and disaster, logistical problems
and issues should be discussed and evaluated. Recommendations can be used
as inputs in the crafting and amendment of logistics for Hospital SOP/Protocol for
Emergencies.
• Monitoring of the units should be done regularly.

ACCEPTANCE AND DISTRIBUTION OF DONATIONS

Guidelines on acceptance and distribution of foreign and local donations during a disas-
ter, including the roles and functions of hospitals, shall be in accordance with A.O. 2007-
0017, which provides for the following:

A. General Guidelines

There shall be no donation for purposes of emergencies and disaster situations,


whether from international or local sources, unless a formal acceptance for the
purpose is issued by the Secretary of Health or his designated representative. 191
B. Acceptance

Infant formula, breastmilk substitutes, feeding bottles, artificial nipples and teats
shall not be items for donation. No acceptance for donation shall be issued for
any of these items.
Acceptance of donation in foodstuffs for purposes of emergency and disaster
situations should be made for foodstuffs that have a shelf life of at least three (3)
months from the time of arrival to the Philippines.

Acceptance of donation in drugs/medicines for purposes of emergency and dis-


aster situations should comply with the following minimum criteria:
■ Shelf life of at least twelve (12) months from the time of arrival to the Philip-
pines.
■ Labeling with English translation or in a language that is understood by Philip-
pine health professionals.
■ Packaging that complies to international shipping regulations accompanied by
a detailed packing list
■ Weight per carton does not exceed 50 kilograms.
■ Exclusive packaging with regards to other supplies.
■ Documentary proof of compliance to applicable quality standards.
■ Documentary proof that the items were obtained from reliable sources.

C. Distribution

The DOH shall distribute the donated items to emergency and disaster affected
areas. The distribution of such items for election purposes shall not be allowed
nor the repackaging thereof in consideration of elective or appointive government
officials.

ROLES AND FUNCTIONS OF THE HOSPITAL DURING EACH PHASE

A. Health Emergency Preparedness Phase

During this phase, the Logistic Management System shall be developed.


• Proper coordination and arrangement must be established between the HEMS
Coordinators, Logistics and Supply Officer, Budget Officer and the warehouse
management.
• Proper protocols and procedures likewise should be established to ensure faster
accessibility to the drugs and medical supplies as needed.
• Logistics and Supply Officers should have data of available suppliers in the event
of an emergency procurement; they can also establish special arrangements or
go into an MOA (MOA) with established and credible suppliers.
• Sufficient logistical capacity must be in place for the ambulance needs as well as
for emergency room requirements.
• Ensure plans are in place.

B. Health Emergency Response Phase

• Rapid Assessment, specifically on logistics needs, must be conducted. Vulner-


192 ability of logistics components (i.e., commodities, transport vehicles of various
kinds, supply systems and routes) must be considered and addressed.
• The Logistics Officer should take charge in supplying all the needed logistical
requirements needed by the responders.
• The Finance Officer should ensure available finances and shall be responsible for
sourcing out from other budgets.
• The Hospital Liaison Officer should be able to network with other hospitals to
identify sources.

C. Health Emergency Recovery and Reconstruction Phase

• Conduct evaluation.
• Update inventory of resources.
• Review and update systems and plans.
• Replenish utilized resources.

Hospitals should have a supply stock for two weeks to one to three months based
on hazards in their region. DOH Central Office will be called only for augmentation
purposes.

HOSPITAL LOGISTICS

The hospital should be in constant state of readiness to respond to any health emer-
gency/disaster in terms of logistics for patient care and for safety of workers, both at the
disaster site and in the hospital.

Necessary supplies and equipment must be ready for immediate distribution to appro-
priate locations in the hospital: (a) Emergency Room (e.g., stretchers and wheelchairs
to the receiving area); (b) X-ray; (c) Laboratory ; (d) Blood Bank; (e) Operating Rooms;
(f) Intensive Care Units; (g) Special Units – Burn, Toxicology, etc.

The essential medical facilities and support for disaster operations to on-scene and
in-hospital response teams should be in place, regularly monitored and regularly main-
tained. This includes: (a) ambulance facilities that enable the Scene Response Teams to
conduct rescue operations at the site of the disaster (see Section 4.1); (b) transport and
communication facilities; and (c) standby power generators. Apart from the supplies and
equipment for patient care, the personal protective equipment (PPE) for workers is an
utmost necessity.

The hospital, particularly in disaster-prone areas, has to develop logistic management


procedures to support the organizational shift in times of emergencies and disaster.
Prior arrangements have to be made, such as opening of credit lines with suppliers of
critical supplies to ensure continuous supply of medicines and other consumables, and
with maintenance service providers to ensure prompt repair and/or temporary replace-
ment of critical medical equipment that break down during disasters.

One major area to consider is the procurement, transport and storage of biological sup-
plies such as blood, plasma or vaccines.

Stockpiling of Equipment and Supplies at Hospital Level

Normally all hospitals have a system of procurement and stockpiling drugs, medicines
193
and supplies usually for 2-3 months. In health emergency management, there is no
need for the hospital to maintain stocks of drugs, medicines, supplies, equipment and
materials, as long as these can be procured locally. However, arrangement and agree-
ments with local suppliers must be in place.

In case these logistics are not available locally, stockpiling is suggested but has to be
monitored regularly to prevent the expiration of drugs and supplies to pass unnoticed.
The needs to be met may vary depending on the demand and previous experience.

The categories of logistics may include:


a. Emergency Kit for the responders
b. Emergency stocks of reagents
c. Emergency drugs, and medical supplies for the emergency room
d. Power generators
e. HEMS Trauma Kit (first responder medical supplies)
f. Others (e.g., things which are most frequently requested and needed)

Inventories should be regularly reviewed and updated. Periodic tests must be carried
out to ensure that the equipment are always in good working condition.
It is important to record the end distribution destination for items in the stock records,
to monitor that they are being used appropriately and to provide reliable reports.

Supplies that are not usually readily available locally can be requested from the DOH
Central Office. These include, among others:
a. Cadaver bags
b. Water disinfectants
c. B5 compact food (donation)
d. Vitamin A
e. Lime

Logistic management is one critical system that breaks or makes responses to emer-
gencies and disasters. Some investments may be expensive but are most likely well
worth it.

194
SECTION 15
Information Management

POLICY BASE

A.O. 168 s. 2004 Section V-C: Policy Statements on Support Systems provides:

4. A system for managing information during emergencies shall be developed and


institutionalized for the health sector to ensure that appropriate, timely and rel-
evant information are disseminated to the target stakeholders. Furthermore, flow
of information and proper way of documentation should be established.

5. A communication system should be developed at all levels to improve monitor-


ing and response to emergencies and disasters.

DEFINITION

Information Management, an iterative process of data collection, information sharing


and utilization, is carried out to support decisions and activities during pre-disaster,
emergency/disaster and post-disaster phases of health emergency management. (De la
Peña, 2007)
.
The tasks for a Management of Information System are the following:
1. Set policy, goals and objectives (to address identified information needs), prepare
guidelines.
2. Develop methodologies, procedures, indicators, etc.
3. Issue guidelines and identify training needs.
4. Collect data and information.
5. Filter the data.
6. Analyze the data.
7. Disseminate information about managing risks to:
• Guide decision-makers.
• Inform the public.
• Inform research.
• Obtain feedback.

DATA COLLECTION

The Information Management Manual for Coordinating and Monitoring Health Emergen-
cy and Disaster Response, Volume I, 2007 identifies the roles and information needs of
eight key players in health emergency management at the national level; the hospital is
the fifth key player. It presents seven data collection tools of DOH-HEMS which are the
reporting forms of the HEMS Coordinator. Three forms have been added to the Informa-
tion Manual set – the Inventory Checklist, Patient List from Field Medical Commander,
and the Mass Casualty Medical Record. Table S15.1 presents the data collection forms/
195
reporting forms and their timing/frequency for DOH-HEMS. (The forms are presented
towards the last part of this manual.)

Table S15.1. Data Collection Tools

Reporting form Timing/Frequency

Form 1. Hears Field Report Within 24 hours of occurrence of event


Annex

Form 2. Materials Utilization Report One month after the event or as needed

Form 2-1. Inventory Checklist Daily for first two weeks, as necessary
Annex thereafter

Form 3-A. Rapid Health Assessment Within 24 hours of occurrence/aware-


Annex ness of event

Form 3-B. Rapid Health Assessment Within 24 hours of occurrence/awareness


(MCI) Annex of event

Form 3-C. Rapid Health Assessment Within 24 hours of occurrence/awareness


(Outbreak) Annex of event

Form 5. List of Casualties Annex Daily for first two weeks, as necessary
thereafter

Form 5 -1. Patient List from Field Medi- Daily for first two weeks, as necessary
cal Commander Annex thereafter

Form 5-2. Mass Casualty Medical Case Prompt accomplishment


Record Annex

Form 6-1. Post Mission Report Annex Within 24 hours of completion of mission

Form 6. HEMS Coordinator’s Final Re- Within one week after termination of re-
port Annex sponse

Data and information have three dimensions of quality in information, namely:


1. Time dimension – refers to timeliness (ready when needed), currency (up-to-
date), and frequency (available as often as needed) of the data or information
being managed.
2. Form dimension – refers to clarity (easy to understand), level of detail (de-
tailed vs. summary report), and order (sequence of data presentation) in
which the data or information is presented in the reports.
3. Content dimension – refers to the accuracy (free from error), relevance
(an swer the needs of the user), and completeness (free of omissions) of the
196
data or information.
The Hospital HEMS Coordinator shall ensure the quality of data and information follow-
ing these guidelines:
1. All data and information providers shall exercise due diligence in verifying ac-
curacy of their reports. Doubtful data or information shall be verified with reliable
sources within the network of agencies involved in emergency and disaster man-
agement.
2. Data collection forms and reporting templates shall be prepared and submitted
within the prescribed deadline and frequency.
3. The persons responsible for filling out the data collection forms and preparing
the reports shall ensure that the latest data and information are provided.
4. Prescribed forms shall be filled out as completely as possible. Templates may be
modified but the general format shall be followed and the minimum data/informa-
tion asked for shall be provided. For data fields requiring descriptive information
(e.g., Brief Description of Event), the person preparing the report shall provide as
much relevant details as possible.
5. As much as possible, all forms and reports shall be typewritten or computer-gen-
erated. Otherwise, they shall be written legibly and in black ink.

DATA COLLATION, INTERPRETATION AND ANALYSIS

Data collated with the above tools shall be assessed and interpreted to help make deci-
sions related to resource mobilization and other aspects of emergency response. After
verifying the reliability of data, the Hospital HEMS Coordinator shall assess the rel-
evance of the data to other information, its urgent implications and significance – what
needs to be done in response to the information.

INFORMATION DISSEMINATION AND UTILIZATION

The reporting forms are submitted to DOH-HEMS, specifically OpCen, as prescribed.


The utilization of information is incumbent upon the offices and personnel to whom it is
disseminated. The following actions may be considered in planning and implementing
appropriate health emergency response by the Hospital HEMS coordinator.
1. Resource Matching – allocation of personnel and resources to identified tasks
2. Preliminary Deployment – responding using available resources
3. Activation of Support Services and Request for Outside Assistance – when the
required response cannot be addressed by immediately available resources, but
which may be available from other organizations through existing planning ar-
rangements
4. Logistics Support – considering:
• Length of self-sufficiency of affected area
• Need to bring a small stock of high-usage items
• Replenishment of consumables
• Provision of operational equipment
• Repair of operational equipment
5. Prognosis – forecasting the potential for additional assistance or resources re-
quired for the following hours or days as appropriate

197
DATA STORAGE

Hard copies of the accomplished forms shall be organized and stored into related files
for each type of report. Where feasible, an electronic storage of data is maintained. In-
formation may be retrieved from these manual and electronic databases upon clearance
of highest authority as needed for use by policymakers and researchers.

198
SECTION 16A
Health Promotion and Advocacy

INTRODUCTION

Behaviors conducive to health among the population is the ultimate goal of every health
worker. However, behavior is greatly influenced by the knowledge and attitude of the
people. This area is where Health Education and Promotion plays a crucial role.

Health Promotion and Advocacy is one of the 10 P’s or elements of Successful Health
Emergency Management. This element advocates for behavior change towards prepar-
edness and response to health emergency and disaster.

POLICY BASE

A.O. 168 s. 2004 Section V-C: Policy Statement on Support Systems states:

3. Media management and public information shall be made readily accessible in


such situations. As such, there shall be a designated spokesperson in all health
facilities and institutions to respond to inquiries related to health emergencies.
Such person should be trained and be readily available, accessible to the media”

DEFINITIONS

Health Promotion as defined by the World Health Organization is the process of ena-
bling people to increase control over, and to improve, their health. Health promotion is
much more narrowly conceived as “the science and art of helping people change their
lifestyle to move toward a state of optimal health.” To reach a state of complete physical,
mental and social well-being, an individual or group must be able to identify and realize
aspirations, satisfy needs, and change or cope with the environment. At the heart of the
process is the empowerment of the community, their ownership and control of their en-
deavors and destinies. This affirms the earlier definition of the Ottawa Charter of Health
Promotion in 1986, where it is implied that Health Promotion works through concrete
and effective community action in setting priorities, making decisions, planning strate-
gies and implementing them to achieve better health.

Advocacy is the organization of information for the purpose of persuading, convincing


and motivating the target audience towards a specific idea or behavior. It changes the
social climate within which “changes in the behavior of people about their own lives”
takes place.

Health Promotion in Health Emergency and Management is educating and promot-


ing for a change in lifestyle among the common people that will lead to the prevention of
health emergencies and disasters.

199
Advocacy in Health Emergency and Management covers all the phases of the
emergency/disaster cycle (Hodgkinson and Stewart, 1991). Preparedness advocacy
includes planning activities like public education and training potential service providers.
Mitigation advocacy is linked to activities designed to reduce the likelihood of disaster
occurring. Responsive advocacy activities include the actual provision of emergency
response like evacuation and rescue services. Recovery advocacy activities are longer-
term efforts to assist or rebuild the affected community. This is the rehabilitation period
after the disaster which will also bring its post-disaster hazards like psychological trau-
ma and diseases.

PROCESS

1. How to Conduct Health Promotion

1.1. Develop a Health Promotion Plan.

The development of a Health Promotion Plan on Health Emergency and Man-


agement is one of the tasks in the Health Emergency Management Coordinator’s
roles and responsibilities – “Takes the lead in public information and awareness
concerning disasters and emergencies.” There are three major steps in the
development of a Health Promotion Plan. These are: (1) Conduct of Diagnosis
– deals with the assessment of the different situations affecting the behavior and
lifestyle of the people; (2) Development of Intervention Strategies – determining
the strategies that will be done in order to achieve the desired behavior change;
and (3) Development of Evaluation Tools and Parameters – assessment of the
effect of the health promotion intervention.

1.1.1. Conduct of Diagnosis

a. Social Diagnosis – process of determining people’s perception of their


own needs, quality of life, and aspirations for the common good, through
broad participation and the application of multiple information-gathering
activities designed to expand understanding of the community. Methods
that can be used for Social Diagnosis are: community fora, focus groups,
surveys, interviews, etc.

b. Epidemiological Diagnosis – data gathering of important statistical data


related to health emergency and disaster. This step determines the health
issues associated with quality of life, in particular, specific health problems
and non-health factors related to poor quality of life. Epidemiological data
include vital statistics, years of potential loss, disability, disease preva-
lence and incidence, morbidity and mortality.

c. Behavioral and Environmental Diagnosis – assessment of the present


behavior of the target audience and the environmental factors that affect
their risk. It also includes non-behavioral causes (personal and environ-
mental factors) that contribute to health problems, but controlled by behav-
ior. Behaviors identified should be scaled to their importance and change-
ability.
200 Environmental Diagnosis is a parallel analysis of factors in the social and
physical environment other than specific actions that could be linked to
behaviors.

d. Educational and Organizational Diagnosis – assessment of the causes


of health behaviors which were identified in (c) Behavioral Diagnosis.
Three kinds of causes are identified:

1. Predisposing factors – any characteristics of a person or population


that motivate the individual/s prior to the occurrence of that behavior.
These include values, cultures, beliefs and attitudes of the person or
population.

2. Enabling factors – characteristics of the environment that facilitate


action and any skill or resource required to attain a specific behavior,
including the knowledge, skills and resources of the population and
environment.

3. Reinforcing factors – rewards or punishments following or anticipated


as a consequence of a behavior, which serve to strengthen the motiva-
tion of behavior.

e. Administrative and Policy Diagnosis – the assessment of resources,


budget development and allocation, development of an implementation
time table, organization or personnel within the programs, coordination
of the program with all other departments, and institutional organization
within the community.

Administrative diagnosis – analysis of the policies, resources and circum-


stances prevailing, and of organizational situations that could hinder or
facilitate the development of the health programs.

Policy Diagnosis – assessment of the capability of the program goals and


objectives in relation to those of the organization and its administration.

1.1.2. Development of Intervention Strategies

Following the recommendations of the Ottawa Charter, the strategies


should focus on the five areas of health promotion in order to:

1. Develop personal skills – personal and social development of the tar-


get audience by providing information, education and enhancing skills
related to health emergency and disaster management.

2. Build health public policy – putting health emergency and disaster


management on the agenda of policymakers in all sectors and at all
levels.

3. Create supportive environment - establishing network and alliance


building among partner agencies. 201
4. Reorient health service – greater attention to health research as well
as changes in professional education and training. This must lead to a
change in attitude and organization of health services, refocusing on
the total needs of the individual as a whole person.

5. Strengthen community action – empowerment of communities, their


ownership of the projects, and activities geared towards prevention of
health emergency and disaster.

1.1.3. Development of Evaluation Tools and Parameters

This can be done through records review, survey, focus group discus-
sion and other evaluation methods. The health promotion program can be
evaluated at one or more of three levels:

Process Evaluation – evaluates the process by which the program is being


implemented; assesses the planned strategies/activities versus the strate-
gies/activities actually implemented.

Impact Evaluation – measures the program effectiveness in terms of inter-


mediate objectives and changes in predisposing, enabling and reinforcing
factors. It measures the attainment of the Behavioral and Environmental
Diagnosis and Educational Diagnosis.

Outcome Evaluation – measures change in terms of overall objectives


and changes in health and social benefits or the quality of life. This form of
evaluation takes a very long time to get results. It may take years before
an accrual change in the quality of life is seen.

1.2. Implement the Health Promotion Plan – refers to the execution of the
strategies and activities of the plan

1.3. Evaluate the effects of the Health Promotion Plan – refers to the Process,
Impact and Outcome Evaluation

2. How to Conduct Advocacy

2.1. Build oneself as an advocate. Learn to imbibe the qualities of an advocate,


which include the following:

• Objectivity – degree of confidence or suspicion you have in the system, and


your belief in the potential of positive change
• Independence – uninfluenced and informed judgment
• Sensitivity and understanding – interest and empathy
• Persistence and patience – determined and secure enough in your position to
weather storms, deal with setbacks, and maintain energy over time.
• Knowledge and judgment – understanding what to ask for and whom to ask,
and be able to exercise judgment about what is reasonable, and what is not
• Assertiveness – firmness with politeness; having a good working relationship
with others without letting them not control you
202 • Ethics and respect for others – having respect for the privacy and confi-
dentiality of others, and respect for the basic rules of ethical conduct, to be
effective and to maintain credibility

2.2. Develop the Advocacy Plan.

2.2.1. Assess the problem – What is the issue, idea or behavior that needs persua-
sion, convincing and motivation of the target audience? Form an advocacy
team.
2.2.2. Gather information and form solutions – Conduct literature review or other
similar situations from other organizations, communities or institutions.
2.2.3. Choose your strategies – There are different strategies or tools that can be
used. Advocacy strategies include:
1. Policy reform
2. Organized community response
3. Dispute resolution

Advocacy tools that can be used are:

1. Big bang – presentation of information during national events.


Examples:
Basic Life Support Demonstration at the different malls during the obser-
vation of the National Disaster Consciousness Month
Conduct of National Convention on Disaster Management by the Health
Sector in the Philippines during the celebration of the Health Emergency
Week

2. Little bang – small events can become excellent venues for presenting
your advocacy arguments.
Example: Announcements during flag ceremony or community assemblies

3. Big visit – visits by leaders and decision-makers in your areas. Example:


Personal appearance of the Secretary of Health or other executives at any
community event

4. Inside man – key people in an organization can do advocacy with leaders


and decision-makers with whom they have routine access and you do not.
Example: Making use of the gate keepers

5. Letter – a letter to a leader and decision-makers can provide a good


means to present your arguments and allow the other side time to think
out their response.
Example: Issuance of Department Memorandum on the Observance of
the National Disaster Consciousness Month

6. Quiet meeting – sometimes it is more effective to talk with the person


alone.

7. Technical journal – concerns the need to make certain ideas respectable


in professional circles before pushing them with government officials.

2.3. Implement the plan – actual implementation of the strategies and tools 203
conceptualized.
2.4. Evaluate the plan – carry out the identified assessment tools and proce-
dures.

OUTPUT
Following is an example of a health promotion and advocacy plan.

HEALTH EDUCATION AND PROMOTION PLAN

I. DIAGNOSIS

A. Social Diagnosis

• The World Bank study entitled “Natural Disaster Risk Management in the Philip-
pines: Enhancing Poverty Alleviation Through Disaster Reduction,” published in
2004, reported that the country’s vulnerability to natural hazards cost the Govern-
ment an average of PhP 15 billion annually in direct damages, or more than 0.5%
of the country’s GNP.

• A study on the “Impact of disaster-related mortality on gross domestic product in


the WHO African Region by Kirigia, Sambo, Aldis and Mwabu” found that:
o Disaster-related deaths have a statistically significant negative effect on GDP
per capita.
o A unit increase in disaster mortality was found to decrease GDP per capita by
US$0.01828, which is the economic burden of a single disaster-related death.
o The annual GDP lost by the Region has been estimated at US$9,713.
o The undiscounted lifetime GDP lost through the death of 539,597 people was
estimated at US$242,819.

• Indirect and secondary disaster impacts lead to a greater economic burden of


disease and thus lead to a poor quality of life among the Filipinos, especially
those mostly affected.

B. Epidemiological Diagnosis

• Of the 124,566 total population in Real, Infanta and Nakar,Quezon affected by


typhoon Yoyong and Winnie:
o !9,211 families and 94, 060 persons were affected.
o 530 were injured, 623 dead and 338 missing.
o Leading causes of morbidity – ARI, wounds of all kinds, diarrhea, UTI.
o Leading cause of mortality – drowning.

C. Behavioral and Environmental Diagnosis

Behavioral Diagnosis
• Act only when disaster strikes.
• Does not practice health emergency and disaster-preventive measures.
• Note: No existing study has been done on the behavior of the people and
health emergency-concerned staff regarding health emergency and disaster
204 preparedness.
Environmental Diagnosis
• The Philippines forms part of the prominent volcanic chain known as the ring
of fire.
• The country experiences, on average, 887 earthquakes every year.
• Out of 220 dormant volcanoes, 22 are potentially alive.
• The Philippines also lies within the ‘Pacific typhoon belt,’ an area renowned
for hydrometeorological hazards.
• According to the Philippine Atmospheric and Geophysical Services Adminis-
tration, the average tropical cyclone occurrence in the Philippines is 19 to 21
per year, of which two are super typhoons.

D. Educational and Organizational Diagnosis

Educational Diagnosis
(Note: No study on the knowledge and attitude of the people and the health
emergency staff at all levels)

1. Predisposing Factors
• Inadequate knowledge on the facts and concepts of health emergency
among the community
• Inadequate knowledge on what to do when health emergency and disaster
occurs among the community
• Passive attitude towards prevention of disasters
• Attachments of people to personal property

2. Enabling Factors
• Inadequate IEC campaign materials
• Available health emergency trained personnel at the regional level

3. Reinforcing Factors
• Presence of gate keepers in the community

Organizational Diagnosis
• Existing health emergency management staff
• Presence of health emergency and disaster preparedness network

E. Administrative and Policy Diagnosis

• Presence of legal mandate – P.D. 1566: Strengthening the Philippine Disaster


Control Capability and Establishing the Program on Community Disaster Prepar-
edness
• Existing policies on health emergency management at the DOH:
o A.O. 168 – National Policy on Health Emergencies and Disasters
o A.O. 155 – Implementing Guidelines for Managing Mass Casualty Inci-
dents During Emergencies and Disasters

205
II. INTERVENTION

Areas of Health Strategies Activities Evaluation Indicators


Promotion

Build health Advocacy 1. Review existing policies on % existing policies re-


public policy health emergency management. viewed and recommended
for amendment

2. Draft local ordinance on health % local ordinances passed


emergency management at the local board

3. Advocacy forum on health % realized among pledges


emergency management of commitment made

4. Awarding of Best Practices Regional Office/LGUs with


best practices recognized

5. Development of HEMS video Level of reach


presentation

Develop Capability 1. Conduct mandated trainings on % of regional staff trained


personal skills Building health emergency management on health emergency man-
among regional staff. dated training

2. Send health emergency % health emergency


management staff to appropriate management staff sent to
trainings on health emergency. training

3. KAP survey among the com- KAP on health emergency


munity, health workers and evaluated
managers on health emergency
management.

4. Health Promotion Needs as- Health promotion needs


sessment on health emergency identified and analyzed

Reorient IEC Campaign 1. Conceptualization, develop- % distribution reached


health services ment, pretesting, production and Level of reach
distribution of IEC materials and
collaterals

2. Celebration of HEMs event Level of reach

3. Establishment of HEMS re- Functional HEMS resource


source center center

Strengthen Community 1. Development of guidelines on % functional local emer-


community development the organization of local emer- gency brigade
action gency brigade

Create supportive Networking and 1. Conceptualization of HEMS HEMS webpage online


environment alliance building webpage and updated

2. Establishment of health emer- Health emergency SMS


gency SMS network network functional

III. EVALUATION

Year-end survey on Health Emergency among the community, health workers and
206 health managers.
SECTION 16B
Risk Communication and Media Management

INTRODUCTION

The public’s yearning to learn about health, the increasing trend toward health behavior
change, and the advances in information technology all contribute to the likely attain-
ment of a health-informed public. Communication strategies are often done through
mass distribution of information, education and communication (IEC) materials and
media releases. But health providers should not only focus on health behavior in normal
situations but also on communicating health risk messages. Risk communication is an
area of communication strategies that is rarely practiced. It is imperative that health
workers develop the habit of communicating health risks before the event, during the
response and after the disaster. (Covello &Allen, 1988)

WHAT IS RISK COMMUNICATION?

Risk Communication is the purposeful exchange of information about the existence,


nature, and form severity or acceptability of health risks between policymakers, health
care providers and the public/media aimed at changing behavior and inducing action to
minimize/reduce risks.

It is an ongoing process involving potentially affected “audiences” and various stake-


holders to come to a common understanding about the hazards, the risks, their accept-
ability, and actions needed to reduce the risks considering risk management strategies.

It is the process of bringing together various stakeholders to come to a common under-


standing about the risks, their acceptability and actions needed to reduce risks.

Four Kinds of Risk Communication (Sandman, P.and Lanard, J.)

1. High hazard, low outrage


Situation: When the lack of outrage increases the hazard. In this situation, the
hazard is high; however, the outrage or the response/reaction of the people is
very low so there is a behavior of complacency.
Health Emergency Manager’s communicator role: Make the population con-
scious of the hazard to level off the hazard and outrage.

2. Medium hazard, medium outrage


Situation: When outrage and hazard need to be linked. The level of hazard and
the reaction of the public are of the same intensity.
Health Emergency Manager’s communicator role: Take advantage of the situ-
ation to develop communication and behavioral strategies.

3. Low hazard, high outrage


Situation: When outrage is the problem. The outrage is largely of the audience,
but the actual hazard is low. In this situation, the public has overreacted to the
hazard which is at its manageable level or of minimal consideration. The reaction
of the public is manifested in their attitude and their behavior.
207
Health Emergency Manager’s communicator role: Calm the public and inform
them of the real hazard scenario.

4. High hazard, high outrage


Situation: Crisis occurs when hazard is high but outrage is even higher.
Health Emergency Manager’s communicator role: Help the public bear its fear
and misery while avoiding reassurance.

What Is the Purpose of Risk Communication?

• It is the fundamental right of the population to access information about the risks
they face.
• Organizations are seen to be more legitimate and effective when they are trans-
parent and open with information.
• The risk is shared by the organization and the population.
• Risk Communication serves as an avenue for information and education to the
communities, health personnel and decision-makers. It gives a better chance to
explain risks to the population more effectively.
• Populations can make better choices when they are better informed.
• The emergency information can stimulate behavior change.
• It prevents misallocation and wasting of resources.
• It can decrease illness, injuries and deaths.

How Do We Explain Risks?

• Find out what information people want and in what form.


• Anticipate and respond to people’s concerns about their personal risk.
• Take care to give adequate background when explaining risk numbers.
• Acknowledge uncertainty.

What NOT to Do
HOW DO WE CONDUCT RISK COMMUNICATION? During a Crisis
The steps are: DON’T speculate on
the causes of the
1. Identify risks to be addressed. emergency.
• Identify risks of the hazard using the risk management pro- DON’T speculate on
the resumption of
cess. Refer to the Health Emergency Preparedness Plans. normal operations.
• Determine the knowledge and the behavior(s) to be learned DON’T speculate on
and adopted to prevent the risk(s). These will be the basis the outside effects of
for the development of the communication plan. the emergency.
DON’T interfere with
Example: the legitimate duties of
news people.
Hazard: Disease Outbreak, Measles DON’T permit unau-
Risk: Death thorized spokesper-
Knowledge: sons to comment to
• Prevention of measles the media.
• Signs and symptoms of measles DON’T attempt to
• Measures to prevent complications from measles cover up or mislead
the press.
• Home management of measles DON’T place blame for
208 Behavior: the emergency.
• Bring eligible children for measles immunization.
• Bring children with early signs and symptoms of measles to health
workers.
• Proper care and management of measles.

2. Develop a communication strategy.


• Identify communication strategy based on the identified risk(s). Strategies should
focus on the prevention and/or management of the identified risk(s).

Examples:
1. Development of IEC materials
2. Media mix campaign

3. Design a Risk Communication Plan.

The communication plan should contain the following:

• Target group – To whom the Risk Communication will be addressed or the


recipient of the message. One important target group could be the people
responsible for creating risk situations through human activities. Target
audience can be grouped according to the following classifications:
• Social – refers to the age, gender, educational status, religion and eth-
nicity of the target group.
Example: Productive age group or 15-44 years old, mothers, Muslims,
Aetas
• Economic – refers to the economic status of the target group. Exam-
ple: Below poverty line, underpriveleged
• Political – refers to the political affiliation of the target group. Example:
Mayors, businessmen, farmers

• Message – Informs the target group


- what is happening (eg., to know the dangers they are exposed to)
- what it means to them (potential impacts to understand the risk)
- what the target group can do (to know how to respond when the haz-
ard strikes and protect lives and minimize damage)

Risk Communication messages may contain information on the following:


• The nature of the risk
- Characteristics and importance of the hazard concern
- Magnitude and severity of risk
- Urgency of the situation
- Probability of exposure to the hazard and its distribution
- Nature and size of the population at risk
• The nature of the benefits
- Actual or expected benefits associated with each risk
- Who benefits and in what ways
- Where the balance point is between risks and benefits
- Total benefit to all affected populations combined
• Risk management options
- Actions taken to control or manage the risk
- Action individuals may take to reduce personal risk
209
- Justification for choosing a specific risk management option
- Effectiveness and benefits of a specific option
- Cost of managing the risk, and who pays for it
- Risks that remain after a risk management option is implemented

• Source – Who will be the sender of the message.

• Communication channel – Medium through which the message will be conveyed.


The use of media mix is highly recommended to achieve the maximum intended
result. The types of media commonly used are:
• Print – Newspapers, magazines
• Broadcast – Radio, TV
• Electronic – Internet, SMS, MMS
• Folk – Street play
Other channels of communication are:
• Interpersonal communication
• Group communication
• Telecommunication (including cable TV)
• Printed IEC materials (posters, brochures, flyers, billboards, etc.)
• Special events
• Showcases and exhibits

• Intended results – Expected impact of the Risk Communication; change in the


knowledge and behavior of the target group as influenced by the Risk Communi-
cation.
The intended result leads to the expected outcome which is either the prevention
or reduction of the risk(s), although this may take a longer period of time to be
measured.

4. Pre-testing

Check or verify the content, design and mode of communication for appropriateness
as perceived by the target group. Conduct the pretest with a group that matches the
characteristics of the intended audience. The most common methods used in pre-
testing are Focus Group Discussion and Survey.

5. Program implementation

Execution of the communication strategies identified.

6. Program evaluation and impact assessment

Program evaluation refers to the process evaluation or assessment of what strate-


gies/activities had been implemented as against the plan.
Impact assessment refers to the change in the knowledge and behavior of the target
group/audience.

Figure S16B.1 presents a flow chart summing up the entire process of communicating
health risks (Dr. Sulaiman Che Rus).

210
Figure S16B.1. Flow Chart: Steps in Communicating Health Risk (Dr. Sulaiman
Che Rus)

START

Identify and prioritize issues

Analyze communication situation

Set communicataion objectives

Analyze and select audience

Design, develop and pretest

Redesign Accept

No Yes

Communicate Message

Evaluate

OK

End

211
REMEMBER!!!

Seven Cardinal Rules of Risk Communication

1. Accept and involve the public as a partner.


Your goal is to produce an informed public, not to defuse public concerns or
replace actions.

2. Plan carefully and evaluate your efforts.


Different goals, audiences, and media require different actions.

3. Listen to the public’s specific concerns.


People often care more about trust, credibility, competence, fairness, and
empathy than about statistics and details.

4. Be honest, frank, and open.


Trust and credibility are difficult to obtain; once lost, they are almost impossi-
ble to regain.

5. Work with other credible sources.


Conflicts and disagreements among organizations make communication with
the public much more difficult.

6. Meet the needs of the media.


The media are usually more interested in politics than risk, simplicity than
complexity, danger than safety.

7. Speak clearly and with compassion.


Never let your efforts prevent your acknowledging the tragedy of an illness,
injury, or death. People can understand risk information, but they may still not
agree with you; some people will not be satisfied.

MEDIA MANAGEMENT

Role of Media During Risk Communication

Media plays a very important role in Risk Communication and handling media is very
crucial in health emergency management. Understanding them is one of the significant
tasks of a health emergency manager.

Handling Media

1. Familiarize yourself with what media wants.

■ Know what kind of information media wants.


■ Consider that media runs after information to sell their story and in return
merit needed ratings for their newspaper and radio or TV station.
212 2. Be prepared for what media will ask.
• Make available for media consumption information on the nature, effect and
other vital facts about the risk.
• Consider that information should be brief and concise so that it will not create
misinformation. Below are some of the important data/information that media
wants:

a. Casualties
• Number killed or injured
• Number who escaped
• Nature of the injuries received
• Care given to the injured
• Disposition of the dead
• Prominence of anyone who was killed, injured or escaped
• How escape was handicapped or cut off

b. Property Damage
• Estimated value of loss
• Description – kind of building, etc.
• Importance of the property, e.g., business operations, historic value, etc.
• Other property threatened
• Insurance protection
• Previous emergencies in the area What does
c. Causes media like?
• Testimony of participants
• Testimony of witnesses • Good stories.
• Testimony of key responders • Scoops.
• How emergency was discovered • Exclusives.
• Who sounded the alarm
• Who summoned aid • “Gut” material.
• Previous indications of danger • Good sources
who are ap-
d. Rescue and Relief
• The number engaged in rescue and relief operations
proachable,
• Any prominent persons in the relief crew available, cred-
• Equipment used ible and reliable
• Handicaps to rescue ALL THE TIME.
• How the emergency was prevented from spreading
• How property was saved • Being “fed”
• Acts of heroism continuously.

e. Descriptions of the Crisis or Disaster


• Spread of the emergency
• Blasts and explosions
• Crimes or violence
• Attempts at escape or rescue
• Duration
• Collapse of structures
• Extent of spill

f. Accompanying Incidents 213


• Number of spectators – spectator attitudes and crowd control
• Unusual happenings
• Anxiety, stress of families, survivors, etc.

g. Legal Actions
• Inquests, coroner’s reports
• Police follow-up
• Insurance company actions
• Professional negligence, or inaction
• Suits stemming from the incident

3. Decide when to release information.

When to release information:

• If people are at risk, do not wait.


• Inform people concerned of any risk you are investigating and why.
• If it seems likely that media (or others) may release information, release it
yourself.
• Fill in information gaps for the media.
• If preliminary results show a problem, release them and explain the tentative-
ness of the data.
• If the information will not make sense without other relevant information, wait
to release it all at once.
• Advise community on interim actions while waiting to confirm data.
• If you don’t trust your data, don’t release it.
• Consider:-
- Although the agency is vulnerable to criticism, one may be more vulner-
able if information is held on to.
- The alarm caused by early release will be less than the alarm that can be
compounded by resentment and hostility if information is held on to.

4. Choose how to release information.

Information can be released through:

1. Press release – follow the following basic press release structure:


• Summarize the content: “In a press statement today, the Mayor called
on….”
• Quote the source: “A public health emergency can only be avoided by…,”
the Secretary said.
• Link the quote to an important event that is public knowledge: “The state-
ment was made referring to the recent outbreak of measles where 10
children died…”
• Acknowledge controversy but show that this is the best course of action:
“Despite overwhelming resistance to…,the action is needed because …”
• Tell the public what to do: “In support of this, the public is asked to … For
more information call…”

2. Press Statement – it should contain the following:


214 • Opening remarks.
• State the action.
• Link it to an event.
• State other supporters of the action.
• Inform people of their role.

3. Press conference

HOW TO PREPARE FOR A PRESS CONFERENCE:

A. Before a Press Conference


1. Prepare (update) media directory.
2. Select a location which is accessible to media.
3. Make sure there are no other (newsworthy) events happening at
the time of your event/press conference.
4. Issue a press conference advisory.
■ Date
■ Topic or agenda
■ Time
■ Location
■ Contact information
5. Follow up calls after issuing advisory.
6. In the event of other “breaking” news, try to reschedule your event
or reach out to journalists on a one-on-one basis to generate a few
stories.
7. Prepare logistics needed. The ideal set-up includes a podium (or
table) and microphone(s) for the speakers.
8. For indoor press conferences, leave space for TV cameras at the
back of the room.
9. Provide for sign-in table where media can register their name and
contact information.
10. Prepare simple signage, e.g., banner behind the speakers. Name
plates for speakers may also be necessary.
11. Prepare press kit to hand out to media during the press conference.
■ Press release containing key information presented at the press
conference
■ Fact sheets or background information (including graphs, charts,
photos, etc.)
■ Copies of prepared statements
■ Brief background information and photo of speakers
12. Prepare speakers or spokespersons for the event.
13. Decide the order of speakers. Ideally, no more than three speakers
per forum.
14. Develop a brief statement (under 10 minutes is a good rule-of-
thumb) or provide spokespersons “talking points” and Questions
and Answers (Q&As).
15. Include “quotable phrases” or “soundbites” in the prepared
statement(s).
16. Prepare visual aids (e.g., easily seen from any point in the press areas).
17. Anticipate questions and prepare clear, brief answers.
18. Schedule a rehearsal.
19. Prepare visual aids (e.g., easily seen from any point in the press areas). 215
20. Anticipate questions and prepare clear, brief answers.

B. During the Press Conference


1. Arrive at least an hour before the event to give time to attend to any
last-minute matters.
2. Assign staff to greet media guests as they arrive and direct them to
the sign-in table.
3. Start on time even if few people are in attendance.
4. Review with the moderator the tasks. Moderator shall have been
prepared before the event.
o Moderator welcomes the media and briefly explains why the
press conference has been called. Also, acknowledge VIPs
(speakers).
o Moderator may summarize key messages and opens the ses-
sion to questions. The Q & A portion should last no more than 30
minutes.
o Moderator may ask the reporter to identify himself/herself and
the name of their organization before asking a question.
o Moderator designates the appropriate speaker to answer the
question (in case there is more than one speaker).
o Moderator should not let the press conference drag on or fizzle
out. He/she should step in and formally conclude the proceed-
ings.

5. Consider that:
o In science journalism, off-the-record, not-for-attribution, no-publi-
cation news conferences are neither unknown nor totally without
merit.
o An ideal press conference should last no more than one hour.
o TV reporters may still want to get speaker aside for some on-
cam comments after the conclusion of the press conference.

C. After the Press Conference


1. Consider sending thank you notes to the VIPs who attended.
2. Distribute press kits to key media who were unable to attend.
3. Monitor the press for coverage.

216
SECTION 16C
Risk Communication in the Hospital

POLICY BASE

A.O. 168 s. 2004 Section V-C: Policy Statement on Support Systems provides:

3. Media management and public information shall be made readily accessible in such
situations. As such, there shall be a designated spokesperson in all health facilities
and institutions to respond to inquiries related to health emergencies. Such person
should be trained and be readily available, accessible to the media.

RISK COMMUNICATION IN A HOSPITAL SITUATION

During an emergency/disaster, the hospital may be overwhelmed by more members of


the media than by actual disaster victims. The presence of these individuals can impair
the performance of an already stressed hospital staff if not handled properly.

The right of the public to know must strike a balance with the right of the patient to
privacy and quality medical care which media should understand and consider. Doctors
must have a conducive working atmosphere and enough working space in treating his/
her critically ill patient without having to worry about someone seemingly looking over
his/her shoulders.

The activities in the Emergency Room are so critical and urgent that any form of distrac-
tion or interruption may impact on the delivery of efficient and timely patient care.
On the other hand, the hospital recognizes that news releases from media can assist
in providing information to the families of victims who are looking for their loved ones.
Authorities can be contacted to activate the Emergency Broadcast System which dis-
seminates information on very short notice to a large number of people. Media provides
a mechanism for coordination with other stakeholders.

This familiar scenario during an emergency/disaster highlights the issues confronting


the hospitals during a disaster. The hospital takes a broader perspective in its health
promotion and advocacy role focused on the risk communication element prior to, dur-
ing and after an emergency. The sections on Health Promotion and Advocacy and Risk
Communication will serve as a guide to the HEMS Coordinator and other hospital emer-
gency managers in the formulation of plans and protocols.

A media management protocol may include the following actions as examples.


• Identification/designation of a Public Information Officer.
• Description of roles and functions.
• Training for a Public Information Officer.
• Preparation of guidelines on what information to look for and what information to
share with the Press.
• Pre-designation of Press Room/Area.
• Preparation of a schedule for press releases guided by the urgency of the informa- 217
tion that needs to be shared.
• Clearance from the Incident Commander to release critical information.

While a protocol specifies the conduct of the duties of the designated Public Informa-
tion Officer, such as directing members of the press and other media representatives
to a designated area of the hospital away from the patient care activities, it should also
specify the corresponding role of the hospital staff (e.g., All hospital staff must leave
all communications with the press to the designated public information officer and they
should direct any member of the media to the designated public relations/press area in
order to have consistency in the information given out by the hospital.)

An equally important aspect of the Risk Communication Plan is on health promotion


and advocacy for behavior that will reduce risks for the patients, health workers and the
general public. The hospital is a highly vulnerable area given the supplies and equip-
ment used in the provision of services. Risks from internal emergencies and those from
external emergencies have to be addressed with messages for staff, for neighboring
hospitals and operation partners (such as ambulances, police), for victims/patients and
respective families and friends, and for communities in the catchment area. The hos-
pital may refer to the HEMS. November 2007, Key Health Messages for Emergencies:
Philippines.

218
SECTION 17
Health System in Emergency or Disaster

The common health risks encountered during disasters are directed at the vulnerable
elements of the community, such as the people, properties, environment, livelihood and
services. Natural hazards are the most common culprit of disasters nowadays, damag-
ing health care facilities and life lines, bringing about detrimental ecological changes,
crippling the national economy, disrupting basic health care services, and victimizing the
population, not sparing even the health care providers. Accessible, adequate, timely,
equitable and orchestrated multisectoral response is deemed necessary to intervene
rapidly and effectively to save life and limb.

When a mass casualty incident strikes, Mass Casualty Management is instituted from
the disaster or impact site (pre-hospital care) up to the transport of the last victim to the
Emergency Room of the receiving hospital for a fast, timely, coordinated and adequate
response to minimize morbidity, mortality and disability. Aimed at promptly and efficient-
ly bringing the disrupted emergency and health care services back to routine operation,
the MCM is based on: pre-established procedures to be adapted to meet the demands
of a major incident; maximization of the use of existing resources; multisectoral prepara-
tion and response; and strong pre-planned and tested coordination.

The first five minutes response determines the response for the next five hours.

Immediate response starts with on-site or field management where activities include:
scene assessment; setting up of a command post; alerting process; field organization;
triaging of victims; establishment of command, control, coordination and communica-
tion; search and rescue; and field care. There will be evacuation or transport of victims
from the impact site to the appropriate receiving health care facilities for definitive care.
The green-tagged or the walking wounded victims, together with all other survivors, will
be transported or evacuated to safe shelters other than the hospitals.

The safe shelter, evacuation center, or temporary shelter for the displaced population
serves as another milieu for adaptation that may prove to be a safe haven or a death-
bed for the disaster victims depending on its proper management. Preventive, curative
and rehabilitative health services need to be established in this confine in support of the
compromised condition of the victims and the subnormal condition of the environment.
This could be in the context of organizing a suitable health system with only limited or
inadequate health resources – whether logistical, financial or human resources – amidst
a jeopardized circumstance. This health system needs to address the variety of health
needs of this confined population during disasters.

COMPONENTS OF A HEALTH SYSTEM DURING DISASTER

A. Organizational Component

1. Incident Command System - command, control, and coordination spearheaded


by the CHD Director
2. Organized operational and management support teams
a. Health Operation Team
219
b. Planning Team
c. Logistics/Supply Team
d. Administrative Team

Functions:
• Operationalize health care delivery in the evacuation site, including man-
ning the clinic/hospital at the evacuation center if necessary.
• Perform medical management/treatment at the center based on the devel -
oped treatment protocols and health program protocols.
• Deliver direct health services (immunization, services, therapeutic nutrition,
etc.)
• Provide water and environmental sanitation services.
• Take charge of setting up a surveillance system for outbreak prevention.
- Early detection
- Monitoring of cases
- Case definition
- Community surveillance
- Effective treatment
- Rapid response
• Conduct health education and promotion at the center.
• Provide psychosocial support services to both direct and indirect victims as
well as responders.
• Manage the logistics, supplies, equipment and other logistical needs at the
center.

B. Organized Health Operation

Health Operation Team Composition:


a. Medical Team
b. Water, Sanitation and Hygiene (WASH) Team
c. Food and Nutrition Team
d. Surveillance Team
e. Psychosocial Team
f. Health Education Team

C. Health Service Delivery

1. Disease Prevention Services


a. Prevention of communicable diseases such as:
• Food and water-borne diseases
• Vaccine-preventable diseases
• Communicable diseases with epidemic potential
• Respiratory diseases
b. Disease prevention services
• Disease surveillance
• Water and sanitation services
• Food and nutrition services
• Environmental sanitation
• Immunization services
• Case segregation at the evacuation center
220
2. Disease Control Services
a. Early case detection – based on disease surveillance report, and laboratory
results
b. Proper and appropriate treatment of cases – based on the developed treat-
ment protocols and health program treatment protocols
c. Provision of appropriate drugs, medicines and food

Figure S17.1. Strategy for Controlling Communicable Diseases

Primary Environmental sanitation


Prevention Food system
Preventive services provided
by health systems
Secondar
Secondary
Prevention Food system
Control of Health services
Communicable
Diseases Secondary
Prevention Health system: medical care

Tertiary Health system:


Prevention Social services

3. Referral System

Levels of Health Care Services:


a. Community-based
• Health education
• Community surveillance
• Environmental sanitation
• Feeding programs
b. Primary Health Care Services
• Out-patient clinic with daytime operation or 24-hour operation
• Mobile hospital if necessary
• Laboratory
• Medical first aid
• Treatment/management/stabilization of selected diseases (e.g.,
rehydration, etc.)
c. Hospital Care Services
• Referral system
• Established network of hospitals
• Coordinated ambulance services

D. Health Care Structures

1. Health care facilities in the evacuation site in the form of:


• Out-patient clinic with daytime operation 221
• Clinic or hospital with 24-hour operation
• Rehydration center
• Feeding center for the malnourished children
2. Established Operation Center
3. Warehouse for storage of resources

E. Provision of financial and logistical needs

1. Needed medical equipment and supplies


2. Drugs and medicines
3. Transport vehicles
4. Communication equipment
5. Reporting forms
6. Financial support

F. Systems developed

1. Early Warning and Alert System


2. Damage Assessment and Needs Analysis/Rapid Health Assessment
3. Emergency Operations Center
4. Mass Casualty Management
5. Management of Mass Dead and Missing
6. Public Health Services
7. Mental Health and Psychosocial Support
8. Coordination and Networking
9. Human Resource Development
10. Logistic Management
11. Health Promotion and Advocacy/ Risk Communication in Public Information
and Media Management
12. Information Management
13. Evaluation
!4. Research

222
SECTION 18
Evaluation
Once finalized and approved, the hospital’s Health Emergency Preparedness, Re-
sponse and Recovery (HEPRR) Plan needs continuous evaluation and updating to
maintain its viability. The plan should be revised frequently to reflect changes in staff,
technicians, material resources, etc., which have taken place since the plan was pre-
pared.

An overall evaluation of the entire process of health emergency management in the


hospital is closely interlinked with the competencies of the users of the plan, meaning
the Crisis and Consequence Management Committee, HEMS coordinators, and the
hospital staff. Continuous improvement of the hospital and its health emergency man-
agement process through an evidence-based approach is fundamental to its function.
This can be derived from an analysis of the post-incident evaluations (actual experi-
ences) and evaluation exercises (hypothetical situations).

POST-INCIDENT EVALUATIONS (PIE)

Post-incident evaluations (PIE) are conducted during the debriefing of the deployed
teams and at the end of the response phase. The debriefing may be done immediately
at the conclusion of the event. The evaluation at the end of the response phase is often
done in a structured meeting of all participants, which includes a review of events fol-
lowing a timeline, analysis of strengths and weaknesses, and drawing up proposed ac-
tion to improve/enhance the response work. Other documented sources of insights from
actual experiences are the Post-Mission and Final Reports of deployed teams.

The learning process usually centers on the following questions:


• What worked well? Why did these work well?
• What did not work well? Why not?
• What are the insights from these experiences in the context of the event, as well
as past events?
• What are the recommendations for future response work?

The results shall be included in the Hospital HEMS Coordinator’s Final Report (Form 6)
as lessons learned – either as new lessons or validated ones based on previous expe-
riences. A critical review of such lessons should be undertaken for “the lessons cannot
be said to be fully learned until the recommendations have been implemented and new
behaviors demonstrated through subsequent practice or experience.” (WHO/WPRO,
2006)

Post-Incident Evaluation needs to have a comprehensive review of the health emer-


gency/disaster which will include the following aspects as modified from Carter (Carter,
1991):
• Status of HEPRR plans and preparedness prior to the emergency/disaster
• Communications
• Early Warning and Alert system including origin(s), transmission and receipt,
processing dissemination, action taken (by sender, recipient), functioning of
warning systems 223
• Emergency Operation Center, acquisition, receipt and handling of information,
display and assessment of disaster situation, decision-making, dissemination of
decisions and information
• Activation of the Hospital Emergency Incident Command System and Emergency
Response Plan
• Mobilization of Response Facilities/Units
• Assignment of tasks to units/departments involved in the Response Operation
• Operations for internal and external emergencies that carried out search and
rescue/search and recovery, casualty handling, initial relief measures, clearance
of vital routes/areas, evacuation, restoration of services, handling the mass dead
• Mental Health and Psychosocial Support Services
• Arrangements for emergency feeding, health, shelter, welfare
• Assessment of Risk Communication in Promotion and Advocacy (e.g., Public
Information, Media Relations)
• Provision of information for recovery programs
• Human Resource Development concerns of staff (e.g., Training, Welfare, etc.)
• External Assistance arrangements – Central, Regional and International Donors,
Community
• Any special factors raised by the nature and effects of the particular disaster
• Research requirements revealed by the disaster

Where appropriate, the Post-Incident Evaluations can include briefing from technical
experts on future trends and developments to help achieve optimum utilization of post-
incident experiences.

COMPREHENSIVE EXERCISE PROGRAM (DRILLS AND EXERCISES)


A continuing evaluation of the viability of a hospital’s HEPRR plans and of the training of
personnel, however, requires exercises of increasing complexity through the implemen-
tation of a comprehensive exercise program. Through exercises ranging from orienta-
tion exercises, drills, tabletop exercises to functional and full-scale exercises, hospital
personnel should be oriented on and familiarized with the plan.

The emphasis is on a comprehensive exercise program made up of progressively com-


plex exercises, each one building on the previous one, until the exercises are as close
to reality as possible (i.e., making use of scenarios commonly occurring in the hospitals
and communities) and, more importantly, until mastery is achieved.

A progressive program has several important characteristics:


■ Involves the efforts and participation of various entities – departments, organiza-
tions or agencies. Through the involvement of multiple entities, the program
allows the involved organizations to test, not only their implementation of emer-
gency management procedures, but their coordination with each other in the
process as well.
■ Is carefully planned to achieve identified goals.
■ Is made up of a series of increasingly complex exercises.

In the progressive internal and external exercises, the role/function of each department/
unit in the hospital during the response and recovery phases is closely examined along
with their increasing commitment to work in order for the hospital to build/enhance a
coordinated, effective response.

The stepwise manner of organizing the exercises ensures that weaknesses are identi-
224 fied through simpler and less expensive exercises.
The nature of the exercise determines the participants. An orientation for key decision-
makers may include a tabletop exercise while a full-scale exercise may involve one
department, unit, an entire hospital or community. A functional exercise has the players
and also simulators, controllers and evaluators.

The five main types of activities in a comprehensive exercise program are (WHO/
WPRO, 2006):

■ Orientation seminars
■ Drills
■ Tabletop exercises
■ Functional exercises
■ Full-scale exercise

These activities build from simple to complex, from narrow to broad, from least expen-
sive to most costly to implement, from theoretical to realistic.

Focused on questions of coordination and assignment of responsibilities, orientation


exercises are informal discussions aimed at familiarizing participants with plans, roles
and procedures. These are considered the minimum requirement for validating a plan or
its sections or a facility under development.

Drills are exercises used to develop, evaluate and maintain skills in specific proce-
dures, such as alerting and notification. A critique of the procedure being tested and the
existing capacity of the facility for an appropriate support are parts of every drill.

A tabletop exercise is an informal process in which all the assigned personnel examine
and discuss simulated emergency situations, hypothetically respond and resolve prob-
lems based on the operational plan and without a tight time constraint. Group participa-
tion in identification of problem areas determines the success of its conduct.

An interactive process conducted under time constraints in the health facility (i.e., hospi-
tal) is the functional exercise. Designed to validate policies, roles and responsibilities,
and procedures of single or multiple emergency management functions or agencies, the
functional exercise requires more resources.

A full-scale exercise examines the operational capability of emergency response and


management systems. Used to evaluate a component of a total response system, this
type requires deployment of more human and material resources for its detailed plan-
ning and conduct.

It is suggested that exercises are conducted at least twice a year, such as during the
Disaster Consciousness Month of July. Some practical considerations are as follows:

1. Precautionary measures should be taken so as not to alarm the patients during


disaster preparedness drills.
2. Simulations are conducted preferably without announcements.
3. Prior to these exercises, training session may be conducted in a stepwise manner:
- Session for individual participants to learn their functions/tasks
- Separate rehearsals for each section or group of participants, particularly
those on evening shift
- Comprehensive rehearsal for entire hospital
225
4. Post-exercise assessments are conducted to improve the practical exercises and
the components of the HEPRR plans.

Tables S18.1 and S18.2 provide a quick guide for the hospital in the planning and con-
duct of a comprehensive exercise program. Table S18.1 shows the comparison of the
key characteristics of the five types of exercises and Table S18.2 shows the reasons for
the conduct of the five types of exercises.

(NOTE: While the material in these tables was intended for an Operations Center, the information may
also be useful for the hospital. A detailed description of the characteristics and some guidelines on the
use of the five types of exercises is given in Annex S18.1.)

Table S18.1. Comparison of Key Activity Characteristics

Charac- Orientation Drill Tabletop Functional Full-Scale


teristics Exercise Exercise Exercise
Format Informal discus- Actual field or Narrative pre- Interactive, Realistic event
sion in group facility response sentation complex announcement
setting Actual equip- Problem state- Players respond Personnel
Various presen- ment ments or simu- to messages gather at as-
tation methods lated messages (events/prob- signed site
Group discus- lems) provided Visual narrative
sion by simulators. (enactment)
No time pres- Realistic but no Actions at scene
sures actual equip- serve as input to
ment EOC simulation.
Conducted
in real time;
stressful
Leaders Facilitator Manager, su- Facilitator Controller Controller(s)
pervisor, depart-
ment head, or
designer
Partici- Single agency/ Personnel for Anyone with a Players (policy, All levels of per-
pants department, or the function be- policy, planning, coordination, sonnel (policy,
cross-functional ing tested or response role and operations coordination,
May include for the type of personnel) operations, field)
coordination, situation used Simulators Evaluators
operations, re- Evaluators
sponse person-
nel
Facilities Conference Facility, field, or Large confer- EOC or other Realistic setting
room EOC ence room operating EOC or other
center (multiple operating center
rooms)
Time 1-2 hours ½-2 hours 1-4 hours or 3-8 hours or 2 hours to 1 or
longer longer more days

Prepara- Simple prepara- Easy to design, 1 month prepa- Complex, 6-18 Extensive time,
tion tion, 1 month ration months prepa- effort, resources
2 weeks Participants Preceded by ration 1-1½ years de-
need orientation orientation and Preceded by velopment
1 or more drills simpler exer- Including pre-
cises paratory drills,
Significant tabletops, func-
allocation of tional exercises
226 resources
Table S18.2. Reasons to Conduct Exercise Program Activities

Orientation Drill Tabletop Functional Full-Scale


Exercise Exercise Exercise

No previous Assess equip- Practice group Evaluate a func- Assess and im-
exercise ment capabili- problem solving tion prove information
ties analysis

No recent Test response Promote execu- Observe physical Assess and im-
operations time tive familiarity with facilities use prove interagency
emergency man- cooperation
agement plan

New plan Personnel Assess plan cov- Reinforce estab- Support policy
training erage for a spe- lished policies formulation
cific case study and procedures

New proce- Assess inter- Assess plan Assess hospital Assess negotia-
dures agency coop- coverage for a preparedness tion procedures
eration specific risk area

New staff, Verify resource Examine staffing Test seldom-used Test resource
leadership and staffing contingencies resources and personnel
capabilities allocation

New biological Assess interagen- Assess and Assess and


risk cy or interdepart- strengthen inter- strengthen inter-
mental coordina- jurisdictional or jurisdictional or
tion inter-organiza- inter-organiza-
tional relations tional relations

Observe informa- Assess personnel


tion sharing and equip-
ment locations

Train personnel Test equipment


in negotiation capabilities

227
SECTION 19
Research and Development

POLICY BASE

A.O. 168 Section V-C:.Policy Statement on Support Systems states:

10. There should be a system for documentation of lessons learned from all
health emergency incidents.

IMPORTANCE OF HEALTH EMERGENCY/DISASTER RESEARCH

Research is one of the Health Emergency Management strategies. Its importance can-
not be overemphasized as this provides inputs to and serves as a feedback mechanism
for policy and program development.

The rich amount of data and information generated by health emergency and disasters
can be maximized, through research studies, in promoting evidence-based manage-
ment. Health Emergency/Disaster Management is a dynamic process that varies in
every event. Even the policies, systems developed, and the guidelines that go with
these events have been evolving to keep pace with the changing times, technology, and
degree of disaster impacts on the community.

Closely linked with operations management is the search for the “Best Practices” in all
phases. Learning from the response and recovery phases has been the basis for the
significance accorded the preparedness phase.

The critical analysis that is central to research is not the sole prerogative of the aca-
deme. The hospital can seek guidance regarding appropriate research methods and
tools but it remains the key decision-maker, the principal investigator, and the benefi-
ciary and immediate user of the results, either in modifying existing policies and pro-
cedures or developing new ones. Moreover, the results can help in the identification of
new areas of concern where there is limited information and where studies have not
been conducted.

Research is useful to Health Emergency/Disaster Management in the following ways:


• For input to decision-making, e.g., development or revision of policies, proce-
dures and tools
• For monitoring and evaluation purposes, e.g., to test the functionality and effec-
tiveness of health emergency policies, operations and systems
• As source of data for developing teaching materials
• For sharing experiences locally and internationally, e.g., success stories, lessons
learned and best practices

Some sources of data or information for research activities are:

• Success stories, lessons learned, and best practices brought about during the
health emergency/disaster management
228 • Statistical data and reports gathered related to the disaster
• Surveillance reports
• Hazards, varying impacts and risks of the disaster to the community
• Peculiarities, innovations, and practices of emergency operations and systems
• Post-incident Evaluation Report
• Rapid Health Assessment Report

TYPES OF RESEARCH ACTIVITIES THAT MAY BE CONDUCTED

Depending on the level of information available for an area of concern, the hospital may
conduct research on any of the following:
• Need for a program/procedure
• Structure , processes and effects
• Effectiveness and efficiency concerns
• Client satisfaction
• Differential value of the program across populations

The choice between descriptive and analytical studies is largely dependent on the state-
of-the art information for the particular intended study. Of interest to health emergency
managers are the different types of researches, such as policy research, operational
and methodological researches, and epidemiological researches on health conditions
related to disasters.

Fundamental to the institutionalization of the documentation process is the systematic


identification and validation of “Best Practices.” Hospitals in hazard-prone areas are liv-
ing “Experience Resource Centers” whose documentation and reflection of experiences
need to be distilled and shared to improve health care in an emergency/disaster situ-
ation. The HEMS Coordinator needs to works closely with the Regional Research and
Development Coordinator for the organization of such centers and the systematization
of knowledge processing. An initial step is the system for documentation mandated in
the National Policy. Networking with academe in the catchment area will be a valuable
relationship to nurture toward this end.

Among the initiatives in the documentation process to date are the following publica-
tions:
1. Health Emergency Management Staff, Department of Health (2005). Responding
to Health Emergencies and Disasters: The Philippine Experience
2. Bi-annual Proceedings of the Health Emergency Management Convention (2001,
2003, 2005, 2007)

229
230
231
Standard Operating Procedures
232
Standard Operating Procedures
in Mass Casualty Incident
SOP I: INFORMATION AND DISPATCH
(OPCEN CENTRAL, CHD OPCEN, HOSPITAL OPCEN)

STEPS PROCEDURES

1. Verification of For the use of the local system.


report (coming Proper message handling and verification (Use Form I):.
from radio, tele- 1. Get details of the caller and the incident if received by tele-
phone, televi- phone (type, place, magnitude).
sion, Internet, 2. Verify through DOH agencies (HEMS Central, CHDs, Hospi-
etc.) tals, etc.)
a. If reliable, dispatch assessment teams immediately.
b. If not reliable, verify by dialing the return call number,
or call other reliable agencies (BFP, Police, NDCC/
RDCC/PDCC, LGU’s, etc.)
3. Set a limit as to how long to verify and decide the needed ac-
tion to be taken.

2. Whom to 1. Your superiors


inform (within 2. DOH Central Operations Center – for health emergencies
the organiza- especially MCI
tion, outside 3. EARNET – for ordinary emergencies/incidents (police, fire
the organiza- and health)
tion) 4. Respective local government units – if within their catchment
area
5. Region/office concerned (regional catchment area)
6. Respective RDCC, PDCC, etc.
7. Others depending on individual local arrangements

1. Call your Medical Controller to manage the event.


3. What to do 2. Dispatch a Rapid Assessment Team initially to the site and
initially report to the Incident Commander.
3. Depending on the report of assessment, send a medical team.
4. Identify and designate a Field Medical Commander when
sending more than one team.
5. Always inform HEMS Central OpCen and other appropriate
agencies.
6. Monitor the incident and have continuous coordination with
the on-site team and your OpCen.
7. Send additional teams as needed and as recommended by
the Field Medical Commander.
8. For anticipation of longer missions, schedule duties and shift
ing of several teams considering their capability.
9. Document everything; preferably have a board to put up
data for easier analysis.
10. Anticipate possible inquiries by press or higher officials;
designate a spokesperson to answer all inquiries. 233
Continuation of SOP I, Information and Dispatch

STEPS PROCEDURES

4. Alerting other 1. Alert other hospitals within the vicinity/catchment area for
hospitals/res- possible back-up.
cue teams 2. Perform continuous regular reassessment of the situation.
3. Alert all other hospitals when the magnitude of the incident
necessitates their participation.

5. Preparations Responding Teams


done while 1. Advanced Cardiac Life Support medicines and supplies
waiting (to 2. Appropriate ambulance and transport vehicle with communi-
include sup- cation equipment
plies to be pre- 3. Inventory of emergency drugs and supplies
pared by the 4. Standardized recording sheets (patients, response groups,
Operation Cen- problems actions taken, locator chart, maps, etc.
ter and res- 5. Briefing of the team members
ponding teams) 6. Provisions like food, etc.
Operations Center
1. Inventory of resources, manpower, etc.
2. Review of stock level of drugs and supplies
3. Locator maps, white board, marker, eraser, etc.
4. Communication equipment
5. Status of traffic and access routes in the area

6. Coordination Information needed:


with the Field 1. Precise location of the event
Medical Com- 2. Time of the event
mander (initial- 3. Type of the incident
ly during the 4. Estimated number of casualties, nature of injuries, disposition
first 24 hours) 5. Added potential risk
6. Exposed population
7. Resources needed (need for public health teams, sanitation
teams or psychological teams, etc.)
8. List of response groups and their capabilities
9. Problems encountered and actions taken
10. Coordination needed especially with transporting of victims
to hospitals
11. Suggestions/recommendations

7. Endorsement 1. Status of incident and resources


of staff (data 2. Activities that transpired during the tour of duty
needed) 3. Problems encountered and actions taken
4. Pending problems and current actions being done
5. And other special concerns

234
SOP II: SITE SELECTION, SIGNAGES AND LOGISTICS

STEPS PROCEDURES

1. Selection of the Identified by the Field Medical Commander with concurrence


Advance Medi- of the Incident/Scene Commander upon considering the fol-
cal Post lowing criteria:
1. Safety from the disaster impact and from natural factors
2. Security not a problem
3. Proximity, easy route access and upstream location
4. Available/accessible water source (preferably potable)
and provision for waste disposal
5. Communication access
6. Route to ingress/egress
7. Spacious terrain – flat surface preferably with protective
covering
8. Should not disrupt activities of other response groups

2. Signages All Health Sector’s response teams/hospitals must have


the corresponding signages in the following areas and must
provide their own when responding. All letters must be be
reflectorized and readable at 20 feet.
1. Advance Medical Post, Field Medical Commander
2. Triage Area, Triage Officer
3. Treatment Area (red, yellow, green, black flags and ban-
ner), Treatment Officer
4. Ambulance Loading Area, Transport Officer
5. Staging Area, Staging Officer
6. Mortuary Area, Mortuary Officer

3. Logistics need- 1. Personnel


ed at the site 2. Communication equipment
3. Medical equipment
4. Medical supplies (toxicology kit, trauma kit)
5. Emergency drugs
6. Defibrillator; suction machine
7. Electrical supplies/generator
8. Jump and/or emergency kits
9. Cot beds, intravenous stand, tents
10. Food and water provision – mess area at staging/R&R
area
11. Personal protective equipment

235
SOP III: HANDLING OF EQUIPMENT
ATTACHED TO THE PATIENT

STEPS PROCEDURES

1. Role or re- 1. There should be proper documentation.


sponsibility 2. Equipment should be properly labeled.
of the receiv- 3. Standard form should be used for retrieval purposes.
ing hospital in 4. There should be a standing agreement between the
the handling of receiving hospital and responding units for temporary
medical equip- non-disposable gadgets/supplies and equipment, and
ment hooked/ for final turnover at a later time.
attached or 5. In case receiving hospital has no available gadgets/
connected to equipment for exchange, proper documentation using
the victims standard form should be accomplished for easy retrieval.
6. Form should be accomplished and duly signed by the
nurse supervisor and by the team leader of the respond-
ing unit.
7. The hospital should designate an area/person where the
referring team can retrieve such equipment later.
8. A person should be assigned to handle the equipment.

2. Equipment/ 1. Splint
gadgets that a. Traction splints
should not be b. Foam-padded splints
removed from c. Cravats
the patient un- d. Vacuum splints
less advised e. Air splints
by the doctor 2. Cervical collar
3. Bag valve apparatus
4. Thoracostomy bottle
5. ET and oral airway
6. Spine board
7. Medical anti-shock trouser
8. Kendricks extrication device
9. Thoracostomy and tracheostomy tubes
10. Traction device
11. Vacuum mattress
12. Foley catheter
13. NGT
14. Monitoring patches
15. Bandages
16. Needles

236
237
Forms
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
Annexes
258
ANNEX 1
Considerations in Hospital Design,
Energy and Communications

INTRODUCTION

The types of disasters that may occur during the useful life of a hospital are earth-
quakes, fires, floods and explosions. The frequency and intensity of these hazards will
differ according to the building’s location. Owing to the highly important function per-
formed by hospitals in times of disaster, the safety provisions for the protection of hu-
man lives and equipment are the same regardless of the type of disaster.(PAHO, 1983).
Minimum requirements to be met by all hospitals are discussed below.

STRUCTURE

The structure should be designed in accordance with the national anti-seismic regula-
tions. It should follow all national regulations, such as the Building Code, the Fire Safety
Code, the Sanitation Code, etc.

It will be necessary to calculate the seismic risk over the useful life of the building, using
attenuation coefficients appropriate to the place. The structure will be designed for the
highest-intensity earthquake expected during that period.

The construction materials used should be reinforced concrete or steel, depending on


the availability and cost of each. In all cases, the parts of the structure should be rein-
forced to attain a 180-minute resistance to fire (RFA 180). The inner walls and partitions
should be RFA 120.

Stairwells should be located so as not to produce a torque effect on the structure when it
is subjected to horizontal forces.

The structure of the stairways should have the same resistance to fire specified for the
structure of the building.

LOCATION WITHIN THE PROPERTY

The main façade of all the buildings of the hospital should face a public thoroughfare.
Another façade should face a private street or inner court at least 10 meters wide where
vehicles can enter.

ISOLATION OF AREAS

Anesthesia and pharmacy rooms and other areas used for storing dangerous supplies
(such as chemical reagents, radioactive materials, fuel, etc.) should be isolated com-
partments protected with fireproof walls. In buildings four or more stories high, escape
routes of bedroom areas should be compartmentalized. 259
ESCAPE ROUTES

All doors should open in the direction of traffic exiting through an escape route. Auto-
matically closing doors with “antipanic” locks should be installed in places designed to
accommodate 50 or more people. Hospital and infirmary exits should be at least 1.2
meters wide.

Wards of 15 or more persons should have at least two exits, one at each end. Ward
exits should open directly onto hallways.

Hallways should be at least 1.5 meters wide. A hallway along which beds or stretchers
are moved should be at least 2.4 meters wide.

In buildings of two or more stories, ramps should be provided as part of the escape
route so that bed patients may be evacuated.

All doors opening into an escape route should be at least 1.1 meters wide.

SIGNS

The following signs should be put in place:


a. Signs indicating the escape routes
b. Signs indicating equipment
c. Building layout diagrams

“Exit” signs should be placed at all emergency exit doors providing access routes and
leading to stairways. These signs should be placed over the door at a height 2.25 me-
ters above the floor.

All signs should be lit as long as the building is occupied.

All buildings should contain diagrams showing the location of the various types of alarm
and firefighting equipment. Such diagrams should be placed on each floor of the build-
ing in places where they are visible to building personnel.

All firefighting equipment that can be used by the staff should have precise instructions
beside the equipment itself.

A diagram showing a person’s location in relation to escapes routes should be installed


in each area.

FIRE DETECTION, ALARM AND CONTROL EQUIPMENT

Ionic-type, linear-operation fire detection equipment should be installed at the rate of


one detector for every 50 m2 of floor space. The building should have an alarm center,
preferably in the basement.

The building should be equipped with ABC type portable extinguisher for every 200 m2
260 of floor space and at least one per floor. An extinguisher should never be more than 20
meters away.
SERVICES

Water supply

The fire extinguishing system should consist of a tank with a capacity of at least 30
m2,,a pumping system capable of providing a pressure of 75 lbs./inch2, and
iron piping. The system’s distribution line should have a built-in automatic
extinguisher system with automatic sprinklers. There should be one sprinkler for
every 15 m2 of floor space.

Drains

The drainage system should be of the separator type; if there is no connection to the
public sewer system, a septic tank or seepage pit should be provided.

Contaminants and/or radioactive materials

If it is necessary to dispose of this type of contaminants or radioactive materials


within the perimeters of the hospital, an underground reinforced concrete tank should
be constructed as far away from the building as possible. The tank should be
covered by a layer of soil at least 2 meters thick.

Electric energy

The following points should be checked with respect to:

Hospital’s electrical installations

1. Have available and up-to-date installation plans.


2. Check type of switchover to the emergency power plant.
• If automatic, check to see that it is operating normally.
If not automatic, determine the procedure to be followed to transfer the
load.
• If the switchover is normal, step-by-step instructions for transferring the
load should be available in an accessible place.
3. Check the length of time the emergency plant’s fuel reserves will last.
4. Check the equipment once a month.
5. Keep the fuel tank full.
6. Identify the equipment and installations that operate with the emergency plant.

Energy source

1. Request for a generator with at least 40 percent of the transformer capacity of


the hospital, if the hospital does not have an emergency plant. Know the
cycles (60 or 50 Hz) of the generator required, the type of connection to the
distribution line (delta or star), and the voltage of the hospital’s system

Take the following steps:

• Determine where the generator will be placed and how it will be connected.
Bear in mind noise and contamination problems. 261
• Determine the fuel consumption of the generator to be installed per 24-
hour period.
• Determine how fuel is to be supplied to the generator to keep it in opera
tion.
• Have a diagram showing the distribution boxes that must be disconnected
in order for the generator to function correctly.

2. Know the source of electric supply for the X-ray equipment:


• If it is connected to the main distribution box, it may be fed by either the
hospital’s emergency plant, if one exists, or by the generator furnished for
the emergency.
• If the X-ray equipment has its own feeder system, it will be necessary to
install a generator solely for that equipment; the generator’s capacity
should be that of the X-ray equipment. The first three steps in installing
a generator (No. 1 above) should be considered.

3. Determine if a special system provides emergency service in operating rooms


and intensive care units. This system provides uninterrupted energy supply to
those areas. An emergency system refers to a direct current system and is an
alternative to the systems described above.

4. Check the batteries (charge and acid) at least once a week. Know exactly how
long the batteries will continue to hold the charge with all the equipment in
operation. Determine the source of power for charging the batteries in the
event of failure of the power distribution network.

5. Know the hospital substation’s transformer capacity.

Communication service

Have the hospital’s communications diagram available and updated. For this pur-
pose, do the following:

1. Determine the point of origin of the telephone trunk lines feeding the hospital.
2. Determine how the communications equipment is supplied with energy in the
event of a failure in the power distribution network. Determine:
a. Whether it will be fed by the hospital’s emergency plant (the hospital’s own
generator or a borrowed one); or
b. Whether it will be fed by a generator operating exclusively for hospital com-
munications;
c. The size of the generator in relation to the communications system’s load,
cycles (50 or 60 Hz), type of connection, and feeder voltage of the commu-
nication network.
d. Where the generator will be placed and how it will be connected.
e. The generator’s consumption of fuel in a 24-hour period and the type of
fuel it uses.
3. Locate and identify all of the hospital’s secondary telephone lines.
4. Locate all the loudspeakers of the hospital’s public address system.
5. Check the operation of the telephone switchboard and the public address
system, if any. Preferably, there should be a switchboard for the reserve
262 loudspeakers and the use of the switchboards should be alternated.
6. Check the operation of the blinker paging system or any hospital communica-
tion equipment at least once every two weeks.
7. Have in mind a place for locating and feeding a set of equipment for communi-
cation with the outside world in the event of failure of the telephone lines.
Preferably, the hospital should always have equipment of this type on hand
and its operation should be checked daily.
8. Keep on hand for emergencies some battery-operated portable speakers.

DRILLS

Simulation exercise for any type of disaster should be conducted at least once a year.
Each member of the hospital should be assigned a specific function to facilitate
evacuation of the building.

263
ANNEX S18.1
Five Types of Evaluation Exercises:
Characteristics and Guidelines

ORIENTATION SEMINAR

As the name suggests, an orientation seminar is an overview or introduction. Its pur-


pose is to familiarize participants with roles, plans, procedures or equipment. It can also
be used to resolve questions of coordination

Orientation Seminar Characteristics

Format The orientation seminar is a very low-stress event, usually presented


as an informal discussion in a group setting. There is little or no simu-
lation. It is for this reason that orientations are not usually recognized
as exercises, but they are an important part of the cycle. A variety of
seminar formats can be used, including:
■ Lecture
■ Discussion
■ Slide or video presentation
■ Computer demonstration
■ Panel discussion
■ Guest lecturers

Applications The orientation seminar can be used for a wide variety of purposes,
including:
■ Discussing a topic or problem in a group setting.
■ Introducing something new (e.g., policies, plans and resources).
■ Explaining existing plans to new people (e.g., staff, newly elected
officials or executives who need an explanation of the EOP and
their role at the EOC; new employees who need an orientation to
operational plans as they relate to emergencies).
■ Introducing a cycle of exercises or preparing participants for suc-
cess in more complex exercises.
■ Motivating people for participation in subsequent exercises.

Leadership Orientations are led by a facilitator, who presents information and


guides the discussion. The facilitator should have some leadership
skills, but very little other training is required.

Participants A seminar may be cross-functional – involving one or two participants


from each function or service being discussed (e.g., management, pol-
icy, coordination, and operations staff). Or, it may be geared to several
people from a single agency or department.

Facilities A conference room or any other fixed facility may be used, depending
264 on the purposes of the orientation.
Continuation of Orientation Seminar Characteristics

Time Orientations should last a maximum of 1 to 2 hours.

Preparation An orientation is quite simple to prepare (two weeks’ preparation time


is usually sufficient) and conduct. Participants need no previous train-
ing.

Guidelines in Conducting an Orientation Seminar

There are no cut-and-dried rules for an effective orientation; its purpose will determine
its format. Here are the general guidelines:

■ Be creative. You can use various discussion and presentation methods. Think of
interesting classes that you have attended in other subjects, and borrow the tech-
niques of good teachers and presenters. For example, you might call on people
one by one to give ideas, plan a panel discussion, hold a brainstorming session,
present case studies for problem solving, or give an illustrated lecture.

■ Get organized and plan ahead. Even though orientation seminars are less complex
than other activities, it is no time to “wing it.”

■ Be ready to facilitate a successful orientation seminar. Discourage long tirades, keep


exchanges crisp and to the point, focus on the subject at hand, and help everyone
feel good about being there.

DRILL

A drill is a coordinated, supervised exercise activity, normally used to test a single spe-
cific operation or function. With a drill, there is no attempt to coordinate organizations
or fully activate the EOC. Its role in an exercise program is to practice and perfect one
small part of the response plan and help prepare for more extensive exercises, in which
several functions will be coordinated and tested. The effectiveness of a drill is its focus
on a single, relatively limited portion of the overall emergency management system. It
makes possible a tight focus on a potential problem area.

Drill Characteristics

Format A drill involves actual field or facility response for an EOC operation. It
should be as realistic as possible, employing any equipment or appa-
ratus for the function being drilled.

Applications Drills are used to test a specific operation. They are also used to
provide training with new equipment, to develop new policies or pro-
cedures, or to practice and maintain current skills. Drills are a routine
part of the daily job and organizational training in the field, in a facil-
ity, or at the EOC. Example of a drill conducted by the hospital is an
evacuation drill. 265
Continuation of Drill Characteristics

Leadership A drill can be led by a manager, supervisor, department head, or ex-


ercise designer. Staff must have a good understanding of the single
function being tested.

Participants The number of participants depends on the function being tested. Co-
ordination, operations, and response personnel could be included.

Facilities Drills can be conducted within a facility, in the field, or at the EOC or
other operating center.

Time One-half hour to 2 hours is usually required.

Preparation Drills are one of the easiest kinds of exercise activities to design.
Preparation may take about a month. Participants usually need a short
orientation beforehand.

Guidelines in Conducting a Drill

How a drill is conducted varies according to the type of drill – ranging from simple oper-
ational procedures to more elaborate communication and command post drills. For ex-
ample, a command post drill would require participants to report to the drill site, where
a “visual narrative” would be displayed in the form of a mock emergency. Equipment,
such as vans, command boards, and other needed supplies would be made available.

Given the variety of functions that may be drilled, there is no set way to run a drill. How-
ever, some general guidelines in the conduct of drills are as follows:

■ Prepare. If operational procedures are to be tested, review them beforehand.


Review safety precautions.

■ Set the stage. It is always good to begin with a general briefing, which sets the
scene and reviews the drill purpose and objectives. Some designers like to set
the scene using films, slides or videotapes.

■ Monitor the action. After a drill has been started, it will usually continue under
its own steam. If you find that something you wanted to happen is not happening,
however, you might want to insert a message to trigger that action.

TABLETOP EXERCISE

A tabletop exercise is a facilitated analysis of an emergency situation in an informal,


stress-free environment. It is designed to elicit constructive discussion as participants
examine and resolve problems based on existing operational plans and identify where
those plans need to be refined. The success of the exercise is largely determined by
group participation in the identification of problem areas.

266 There is minimal attempt at simulation in a tabletop exercise. Equipment is not used,
resources are not deployed, and time pressures are not introduced.
Tabletop Exercises

Format The exercise begins with the reading of a short narrative, which sets
the stage for the hypothetical emergency. Then, the facilitator may
stimulate discussion in two ways:

■ Problem statements. Problem statements (describing major or


detailed events) may be addressed either to individual participants
or to participating departments or agencies. Recipients of problem
statements then discuss the actions they might take in response.
■ Simulated messages. These messages are more specific than
problem statements. Again, the recipients discuss their responses.

In either case, the discussion generated by the problem focuses on


roles (how the participants would respond in a real emergency), plans,
coordination, the effect of decisions on other organizations, and simi-
lar concerns. Often, maps, charts, and packets of materials are used
to add to the realism of the exercise.

Applications Tabletop exercises have several important applications. They:

■ Lend themselves to low-stress discussion of coordination and


policy.
■ Provide a good environment for problem solving.
■ Provide an opportunity for key agencies and stakeholders to be
come acquainted with one another, their interrelated roles, and
their respective responsibilities.
■ Provide good preparation for a functional exercise.

Leadership A facilitator leads the tabletop discussion. This person decides who
gets a message or problem statement, calls on others to participate,
asks questions, and guides the participants toward sound decisions.

Participants The objectives of the exercise dictate who should participate. The
exercise can involve many people and many organizations – essen-
tially anyone who can learn from or contribute to the planned discus-
sion items. This may include all entities that have a policy, planning or
response role.

Facilities A tabletop exercise requires a conference or meeting room where par-


ticipants can surround a table.

Time A tabletop exercise usually lasts from 1 to 4 hours but can be longer.
Discussion times are open-ended, and participants are encouraged
to take their time in arriving at in-depth decisions – without time pres-
sure. When the time is up, the activity is concluded. Although the
facilitator maintains an awareness of time allocation for each area of
discussion, the group does not have to complete every item in order
for the exercise to be a success.
267
Continuation of Tabletop Exercises

Preparation It typically takes about a month to prepare for a tabletop exercise.


Preparation also usually requires at least one orientation and some-
times one or more drills.

FUNCTIONAL EXERCISE

A functional exercise is a fully simulated interactive exercise that tests the capability of
an organization to respond to a simulated event. The exercise tests multiple functions of
the organization’s operational plan. It is a coordinated response to a situation in a time-
pressured, realistic simulation.

A functional exercise focuses on the coordination, integration, and interaction of an


organization’s policies, procedures, roles and responsibilities before, during or after the
simulated event.

Functional Exercise Characteristics

Format This is an interactive exercise – similar to a full-scale exercise without


the equipment. It simulates an incident in the most realistic manner
possible short of moving resources to an actual site. A functional exer-
cise is:

■ Geared for policy, coordination, and operations personnel – the


“players” in the exercise – who practice responding in a realistic
way to carefully planned and sequenced messages given to them
by “simulators.” The messages reflect ongoing events and prob-
lems that might actually occur in a real emergency.

■ A stressful exercise because players respond in real time, with on-


the-spot decisions and actions. All of the participants’ decisions
and actions generate real responses and consequences from other
players.

■ Complex. Messages must be carefully scripted to cause partici-


pants to make decisions and act on them. This complexity makes
the functional exercise difficult to design.

Applications Functional exercises make it possible to test several functions and


exercise several agencies or departments without incurring the cost of
a full-scale exercise. A functional exercise is always a prerequisite to a
full-scale exercise.

In some instances, taking part in a functional exercise may serve as


a full-scale exercise for a participating organization (e.g., a hospital
may conduct its own full-scale exercise as part of a community-based
268 functional exercise).
Continuation of Tabletop Exercises

Leadership Functional exercises are complex in their organization of leadership


and Partici- and the assignment of roles. The following general roles are used:
pants
■ Controller: Manages and directs the exercise
■ Players: Participants who respond as they would in a real emer
gency (Players should include policymakers; may include coordina-
tors and operational personnel directing field activities.)
■ Simulators: Assume external roles and deliver planned messages
to the players
■ Evaluators: Observers who assess performance

Facilities It is usually conducted in the EOC or other operating center. Ideally,


people gather where they would actually operate in an emergency.
Players and simulators are often seated in separate areas or rooms.
Realism is achieved by the use of telephones, radios, televisions and
maps.

Time A functional exercise requires from 3 to 8 hours, although it can run a


full day or even longer.

Preparation Plan on 6 to 18 months or more to prepare for a functional exercise,


for several reasons:

■ Staff members need considerable experience with the functions


being tested.
■ The exercise should be preceded by lower-level exercises, as
needed.
■ The controller, evaluators and simulators require training.
■ The exercise may require a significant allocation of resources and
a major commitment from organizational leaders.

FULL-SCALE EXERCISE

A full-scale exercise simulates a real event as closely as possible. It is an exercise


designed to evaluate the operational capability of emergency management systems in a
highly stressful environment that simulates actual response conditions. To accomplish
this realism, it requires the mobilization and actual movement of emergency personnel,
equipment and resources. Ideally, the full-scale exercise should test and evaluate most
functions of the emergency management plan or operational plan.

A full-scale exercise differs from a drill in that it coordinates the actions of several enti-
ties, tests several emergency functions, and activates the EOC or other operating cen-
ter. Realism is achieved through:
■ On-scene actions and decisions from Policy Groups
■ Simulated “victims”
■ Rapid Detection, Reporting and Response requirements
■ Communication devices
■ Equipment deployment 269
■ Actual resource and personnel allocation
Full-Scale Exercise Characteristics

Format The exercise begins with a description of the event, communicated to


responders in the same manner as would occur in a real event. Per-
sonnel conducting the field component must proceed to their assigned
locations, where they see a “visual narrative” in the form of a mock
emergency (e.g., a plane crash with victims, a “burning” building, a
simulated chemical spill on a highway, or a terrorist attack). From then
on, actions taken at the scene serve as input to the simulation taking
place at the EOC or operating center.

Applications Full-scale exercises are the ultimate in the testing of functions – the
“trial by fire.” Because they are expensive and time-consuming, it is
important that they be reserved for the highest priority hazards and
functions.

Leadership One or more controllers manage the exercise, and evaluators are re-
and Partici- quired. All levels of personnel take part in a full-scale exercise:
pants ■ Policy personnel
■ Coordination personnel
■ Operations personnel
■ Field personnel

Facilities The event unfolds in a realistic setting (e.g., outbreak in a community,


an IHR Event attack at a public venue). The EOC or other operating
center is activated, and field command posts may be established.

Time A full-scale exercise may be designed to be as short as 2 to 4 hours,


or to last as long as 1 or more days.

Preparation Preparation for a full-scale exercise requires an extensive investment


of time, effort and resources – 1 to 1½ years to develop a complete
exercise package. This timeframe includes multiple drills and prepa-
ratory tabletop and functional exercises. In addition, personnel and
equipment from participating agencies must be committed for a pro-
longed period of time.

270
271
References
272
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