Professional Documents
Culture Documents
The Director
Health Emergency Management Staff
Department of Health
San Lazaro Compound
Rizal Avenue, Sta. Cruz, Manila
Guidelines
for
Health Emergency Management
Second Edition
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.
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.
VISION
Asia’s model in health emergency
management systems.
MISSION
To ensure a comprehensive and integrated
health sector emergency management
system.
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
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.
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!
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.
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.
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.
11
ix
ACRONYMS
GA – Government Agency
RA – Republic Act
RDCC – Regional Disaster Coordinating Council
RESU – Regional Epidemiologic Surveillance Unit
RHEMS – Regional Health Emergency Management Staff
RMHT – Regional Mental Health Teams
UN – United Nations
UNICEF – United National Children’s Fund
UP-PGH – University of the Philippines-Philippine General Hospital
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
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.
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.
*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.
TIME EVENT
FRAME First 24 Hours End of First Week End of First Month End of 3 Months Conclusion
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.
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.
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.
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
RELEVANT LAWS
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:
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.
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.
■ 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.
■ 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.
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.
v. Mortuary Unit
■ Assists in identifying and tagging the dead;
■ Certifies to the cause of death; and
■ Supervises the proper disposal of the dead.
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.
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.
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.
■ 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:
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.
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.
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.
Coverage – Disaster victims who died or got injured during the occurrence of a natural
disaster.
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.
Proclamation No. 705 – Declaring December 6, 1995, and December 6 of every year
thereafter, as National Health Emergency Preparedness Day.
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:
■ 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”
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
■ 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).
■ 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.
■ 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.
■ 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”
■ 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”
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
Memoranda on Budget
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.
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:
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
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.
Plan (Who does what and when in order to Implement the above-stated policy)
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.)
• 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
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 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
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.
B3. CONSIDERATIONS
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).
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)
32
Figure 1. Emergencies and Health
Source: Sixth Inter-regional Course on Public Health and Emergency Management in Asia and the Pacific
(PHEMAP), WHO (WPRO, SEARO) and ADPC, 2006.
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.
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.
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.
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
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
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.
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
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.
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.
• 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
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.
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.
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.
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
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
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
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.
HEICS, the standard for health care disaster response, offers the following
features (HEMS, 2000a):
INCIDENT COMMANDER
Liaison Officer
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.
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.
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.
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.
45
Figure 5. Comprehensive Hospital Emergency Incident Command System Organiza-
tional Chart
INCIDENT COMMANDER
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
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
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.
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.)
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:
Holding Area
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.
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.
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
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
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.
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
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:
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
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.
3. For Development
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
> Organized Response Teams > Regional Response Team composed of Public
Health Personnel from Surveillance, Nutrition,
Environmental, Water and Sanitation
Knowledge and Skills > Mechanism for certifying, updating and con
Enhancement ducting refresher courses
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
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
> 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
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
1.1 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.
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.
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.
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.
Under Code Blue, the HEICS is immediately established using the six-step
response for critical incident management.
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.
B. Operations/Support Management
• 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.
• Beds
• Retention and safekeeping of personal items removed from casualties
• Isolation of victims with communicable diseases
• Segregation/isolation of victims contaminated with hazardous materials
5.11. 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
C. Extension/Termination
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.
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.
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.
a. Monitoring of Plan
b. Recording and reporting procedures
c. Documentation of processes
C. Termination
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.
Example:
Example:
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
ELEMENTS
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.
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
8. Disasters that have occurred, including the lessons learned and the gaps in re -
sponse
■ In the hospital
■ In the catchment area
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.)
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.
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).
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.
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
A. HAZARD
A1.1. Definition
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:
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
Societal
Hospital Service Areas
Hazards Vulnerable Hospital Areas
Fire
Earthquake
Volcanic eruption 75
A1.3.2. Hazard Map
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
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 ✪,✸,❍
✪,❍,✰ ✪,✦ ✪,✸,■,❍
A2.1. Definition
A2.3 Format
B. VULNERABILITY
B1.1. Definition
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:
B1.3. Format
B2.1. Definition
B2.3. Format
Functional
Human
Resources
C. RISK ASSESSMENT
C.1. Definition
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
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.
D.3. Format
C.1. Definition
1. Internal Emergency/Disaster
2. 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
C3. Format
0-2 hour
2 – 12
hours
12 – 24
hours
Expanded
Response 83
IX. HEALTH EMERGENCY RECOVERY AND RECONSTRUCTION PLAN
A. Definition
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
C. Format
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.
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.
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.
87
C - PUBLIC INFORMATION OFFICER (P.I.O)
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.
88
D - LIAISON OFFICER
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.
90
F - PLANNING SECTION CHIEF
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.
92
H - OPERATIONS SECTION CHIEF
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.
93
I - TREATMENT TEAM LEADER
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.
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.
96
L - STAGING OFFICER
97
M - FIELD MEDICAL COMMANDER
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.
99
O - MEDICAL CONTROLLER
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.
100
P - INCIDENT MEDICAL COMMANDER
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.
101
SECTION 4
Deployment of Response Teams
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.
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
For responders, the HEMS Training Needs Assessment identified the competency re-
quirements and the required training course/package, as shown in Table S4.2.
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.
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.
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
❍
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.
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)
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.)
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
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
Basic considerations in understanding a warning and alert system are described below
(Carter, 1991; SDP, 2000).
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
• 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.
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
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:
3. Other requirements:
CODE RED
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.
● 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
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
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
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.
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.
130
4. HURRICANES
HURRICANE CATEGORIES
BAROMETRIC STORM
PRESSURE WIND SPEED SURGE DAMAGE POTENTIAL
> 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.
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.
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.
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.
< 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 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
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
OBJECTIVES
INFORMATION
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)
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
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.
The health sector carries out the following activities according to priorities identified in
the assessment:
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
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.
Time
Process
Keep in mind the “Keep It Simple and Short (KISS)” principle. This helps
lessen the burden of the field workers.
Content
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?
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 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
COMMAND
SEARCH POST
RESCUE TRIAGE
Traffic Control
STABILIZATION
FIRST AID EVACUATION
Regulation or A&ED
of Evacuation
CP/AMP
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.
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.
2. Classical Approach
• First responders are trained in basic triage and field care
• Disregards the receiving hospitals from the field
• Quickly results in chaos
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.
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
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
140
Figure S8.2. Role of the Hospital in the Mass Casualty Management System (MCMS)
A. Alerting Process
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
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.
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”
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.
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.
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
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
2a. Triage
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.
FIELD CARE
HOSPITAL CARE
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
Patient classification is based on the severity of the injury and need of Emergency Medi-
cal Service and evacuation.
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
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.
• Tent/building/open/mobile
• Established if there is no hospital around or the hospital is too far from the
Impact site.
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
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.
■ 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.
Radio Links
• Transport Officer at AMP
• Hospital Admission and Emergency Department/Emergency Room
• Command Post
• Ambulance Headquarters
Ambulance Driver takes orders from Transport Officer
■ 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
Alerting Process
Dispatch/Opcen/Unqualified Observer
• Emergency Room/Admission & Emergency Department (ER/A&ED)
• Operator to activate System Recall
Mobilization
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
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
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.
153
Requirements from DOH Hospitals in MCM
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
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
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.
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).
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. 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.
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).
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.
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.
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.
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
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.
CURRENT STATE
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.
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:
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
HOSPITAL STAFF
The Hospital HEMS Coordinator considers the following concerns in support of hospital
staff including volunteers (HEMS, June 2007):
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)
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.
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:
172
SECTION 12
Networking and Coordination
POLICY BASE
DEFINITIONS
• Information sharing
• Working together with a common goal
• Avoidance of overlapping of services
• Regular communication of relevant data
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.
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:
• 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
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.
STAGES IN NETWORKING
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
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.
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.
Cluster Approach
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.
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
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.
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.
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.
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
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.
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.
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
182
Table S13.1. Training
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.
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
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.
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
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
DEFINITION
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.
A. Planning
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.
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
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.
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.
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.
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
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.
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.
• 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.
One major area to consider is the procurement, transport and storage of biological sup-
plies such as blood, plasma or vaccines.
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.
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:
DEFINITION
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.)
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 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 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 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.
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:
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.
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
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:
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
2.2.1. 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
2. Little bang – small events can become excellent venues for presenting
your advocacy arguments.
Example: Announcements during flag ceremony or community assemblies
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.
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.
B. Epidemiological 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.
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
205
II. INTERVENTION
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)
• 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.
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.
Examples:
1. Development of IEC materials
2. Media mix campaign
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
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
Redesign Accept
No Yes
Communicate Message
Evaluate
OK
End
211
REMEMBER!!!
MEDIA MANAGEMENT
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
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.
g. Legal Actions
• Inquests, coroner’s reports
• Police follow-up
• Insurance company actions
• Professional negligence, or inaction
• Suits stemming from the incident
3. Press conference
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.
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.
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.
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.)
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.
A. Organizational Component
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.
3. Referral System
F. Systems developed
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.
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 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)
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.
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.
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.
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:
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.)
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
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
227
SECTION 19
Research and Development
POLICY BASE
10. There should be a system for documentation of lessons learned from all
health emergency incidents.
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.
• 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
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.
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
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.
234
SOP II: SITE SELECTION, SIGNAGES AND LOGISTICS
STEPS PROCEDURES
235
SOP III: HANDLING OF EQUIPMENT
ATTACHED TO THE PATIENT
STEPS PROCEDURES
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.
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.
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
“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 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.
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.
Electric energy
Energy source
• 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.
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.
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
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.
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
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.”
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
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.
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.
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:
■ 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
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:
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.
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
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.
FULL-SCALE EXERCISE
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
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
270
271
References
272
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