This material was developed and produced

by the Health Emergency Management Staff

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

This manual may be reproduced or translated
into other languages without prior permission
from the HEMS, provided the parts used are
distributed free or at cost (not for prot) and
acknowledgment is given to HEMS as the
source.

The HEMS would be grateful to receive cop-
ies of any adaptations or translations of the
manual into other languages. Copies may be
addressed or delivered to:
The Director
Health Emergency Management Staff
Department of Health
San Lazaro Compound
Rizal Avenue, Sta. Cruz, Manila
Guidelines
for
Health Emergency Management
Manual for Hospitals
Second Edition
Health Emergency Management Staff
Department of Health
World Health Organization
Philippines
2008
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The Manual of Guidelines for Health Emergency Management for Hospitals is one of
the three manuals revised by the Health Emergency Management Staff. The two others
are for the Operations Center and for the Centers for Health Development.
Grateful acknowledgment is given to:
- All our colleagues whose first-hand experiences in the field their insights, pains
and successes served as the bases for the changes.
- Technical and support staff in the office that facilitated the smooth flow of
activities.
- De La Salle Health Sciences Institute, Dasmarinas, Cavite for promoting a critical
view among its contributors/writers and for administrative assistance in the
systematization and organization of the final form of the manuals.
- World Health Organization, Western Pacific Regional Office-Emergency and
Humanitarian Action, and WHO Philippines for technical assistance and financial
support in the development and production of the three manuals.
Our thanks to God Almighty for guiding and leading us along the path in the realization
of the manuals and their ultimate application for the protection and safety of our
communities and our people.
- Health Emergency Management Staff
TECHNICAL WORKING COMMITTEE
Carmencita A. Banatin, MD, MHA
Director III
Health Emergency Management Staff
Chairperson
Manual of Guidelines for Centers for Health Development
Assistant Chairperson: Marilyn V. Go, MD, MHA
Chief
Health Emergency Preparedness Division
Health Emergency Management Staff
Members:
Eng. Aida C. Barcelona Health Emergency Management Staff
Elnoria G. Bugnosen, RN Center for Health Development - CAR
Atty. Annabelle C. de Veyra, RN Center for Health Development - VIII
Florinda V. Panlilio, RND Health Emergency Management Staff
Noel G. Pasion, MD Center for Health Development - IV A
Mary Grace H. Reyes, MD, MPH Center for Health Development Metro Manila
Edgardo O. Sarmiento MD Bicol Sanitarium
Manual of Guidelines for Hospitals
Assistant Chairperson: Arnel Z. Rivera, MD
Chief
Health Emergency Division
Health Emergency Management Staff
ACKNOWLEDGMENTS
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Members:
Romeo A. Bituin, MD Dr. Jose Fabella Memorial Hospital
Emmanuel M. Bueno, MD East Avenue Medical Center
Alexis Q. Dimapilis, MD San Lazaro Hospital
Ma. Belinda B. Evangelista, RN National Kidney and Transplant Institute
Edna F. Red, MD Health Emergency Management Staff
Romeo J. Sabado, MD National Center for Mental Health
Manual of Guidelines for Operations Center
Assistant Chairperson: Teresita DJ Bakil, RN
Supervisor, Operations Center
Health Emergency Management Staff
Members
Elmer Benedict E. Collong, RMT Philippine Heart Center
Mylyn G. dela Cruz, RN Health Emergency Management Staff
Rosalie A. Espeleta, RND Center for Health Development Metro Manila
Marlene F. Galvan, RN Health Emergency Management Staff
Virgilio G. Gamlanga, RN Health Emergency Management Staff
Susana G. Juango, RN, MPH Health Emergency Management Staff
Luis Ferdinand G. Nonan, RMT Health Emergency Management Staff
Merlina M. Villamin, RN Health Emergency Management Staff
De La Salle Health Sciences Institute Project Team
Estrella P. Gonzaga, MD
Associate Professor
College of Medicine
Coordinator
Josephine M. Carnate, MD, MPH
Professor
College of Medicine
Co-Coordinator for Centers for Health Development
Cynthia Lazaro-Hipol, MD, MPH
Professor
College of Medicine
Co-Coordinator for Operations Center
Christine Serrano-Tinio, MD, MHA
Associate Professor
College of Medicine
Co-Coordinator for Hospitals
World Health Organization
Arturo M. Pesigan, MD, MPH
Emergency & Humanitarian Action
Western Pacific Regional Office
Maria Lourdes M. Barrameda, MD
Philippines
Administrative and Secretarial Support: Aida N. Gaerlan
Copy Editors: Cynthia A. Diaz, Alicia Lourdes M. De Guzman, Mary Ann B. Leones
Cover Design: Anthony E. Santos, Dario B. Noche
Layout Artist: Dario B. Noche
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VISION
Asias 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.
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Acknowledgments
Message Secretary, Philippine Department of Health
Message World Health Organization
Foreword Director, Health Emergency Management Staff
Acronyms
Glossary
PART I: The Health Emergency Management Staff
Chapter 1: Vision and Mission
Chapter 2: Policy Base: National Policy Framework on Health Emergencies and Disasters
Chapter 3: Action Base: Roles in Managing Health Risks of Emergencies
Chapter 4: Legal Mandates
PART II: Health Emergency Management in Hospitals
Chapter 1: Introduction
Roles and Responsibilities of Hospitals
Chapter 2: Activities During the Emergency Preparedness Phase
A. Development of Policies, Guidelines, Procedures and Protocols for Health Emergency
Management
B. Development of a Hospital Emergency Preparedness, Response, Recovery (HEPRR) Plan
C. Development of the Organization
D. Physical Infrastructure Development
E. Systems Development
Chapter 3: Activities During the Response Phase
A. Activation
B. Operations/Support Management
C. Extension/Termination
Chapter 4: Activities During the Recovery/Reconstruction Phase
A. Activation
B. Operations/Support Management
C. Termination
PART III: Guidelines
Section 1. Guide to Policy Formulation
Section 2. Guide to the Formulation of the HEPRR Plan
Section 3. Job Action Sheets
Section 4. Deployment of Response Teams
Section 4.1. Ambulance Services for Emergencies and Disasters
Section 5. Hospital Operations Center
Section 6. Early Warning and Alert Systems
Section 6.1A. Code Alert System for the DOH Central Ofces
Section 6.1B. Integrated Code Alert System for the Health Sector
Section 6.2. Alert Signals
Section 7. Rapid Health Assessment / Assessment for Recovery
Section 8. Mass Casualty Management
Section 9. Management of the Dead and Missing
Section 10. Public Health Services
Section 11. Mental Health and Psychosocial Support
Section 12. Coordination and Networking
Section 13. Human Resource Development
Section 14. Logistics Management
Section 15. Information Management System
Section 16A. Health Promotion and Advocacy
Section 16B. Risk Communication and Media Management
Section 16C. Risk Communication in Hospitals
Section 17. Health System in Emergency or Disaster
Section 18. Evaluation
Section19. Research and Development
STANDARD OPERATING PROCEDURES
I. Information and Dispatch
II. Advance Medical Post-Site Selection, Signage and Logistics
III. Handling Equipment Attached to Patient
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CONTENTS
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FIGURES
1. Emergencies and Health
2. Epidemic Emergencies
3. Example of a Hospital HEPRR Planning Group/Committee Structure
4. Basic Hospital Emergency Incident Command System Structure
5. Comprehensive Hospital Emergency Incident Command System Organizational Chart
6. Patient Care Stations
S8.1. Rescue Chain in a Mass Casualty Management System
S8.2. Role of the Hospital in a Mass Casualty Management System
S8.3. Victim Flow: Conveyor Belt Management Diagram
S9.1. MDM Functional Structure
S12.1. The Spectrum of Coordination Activities
S16B.1. Flow Chart: Steps in Communicating Health Risk
S17.1. Strategy for Controlling Communicable Diseases
TABLES
1. Timeline of Health Sector Roles by Health Emergency Management Phases
2. Timeline of the Three Phases of Health Emergency Management
3. Strategies Used in Health Emergency Management
4. 10 Ps of Health Emergency Management
S1.1. Comparison of Policy Content of A.O. 168 s.2004 and A.O. 2007-001B
S4.1. Human Resource Requirements by Alert Level Status in Hospital and CHD for On-scene
Response
S4.2. Competency Requirements and Required Training Course/Package for Responders
S5.1. Standard Operating Procedures for Emergency Operations Centers (EOCs)
S8.1. Triage Levels by Period, Location and Categories
S8.2. Use of Color Tag for Prioritization of Care
S11.1. Checklist of Minimum Mental Health and Psychological Services
S13.1. Training Process
S13.2. Competency Requirements and Required Training Course/Package by Roles
S15.1. Data Collection Tools
S18.1. Comparison of Key Activity Characteristics
S18.2. Reasons to Conduct Exercise Program Activities
BOXES
Examples in the Use of Terminologies
Outline of Hospital Health Emergency Preparedness, Response and Recovery Plan
Pointers in Formulating a Health Emergency Management Plan
Key Information: Readily Available and Regularly Updated
Rapid Assessment Surveys
Basic Key Questions Required Within 24 Hours of the Event
Field Organization Checklist
Requirements from DOH Hospitals in MCM
Metro Manila Hospital Network
What Not To Do During a Crisis
Seven Cardinal Rules of Risk Communication
What Does Media Like
FORMS
Form 1 HEARS Field Report
Form 2 Material Inventory
Form 2-1 Inventory Checklist
Form 3-A Rapid Health Assessment
Form 3-B Rapid Health Assessment in Mass Casualty Incident
Form 3-C Rapid Health Assessment in an Outbreak
Form 5 List of Casualties
Form 5-1 Patient List from Field Medical Commander
Form 5-2 Mass Casualty Medical Case Record
Form 6 HEMS Coordinators Final Report
Form 6-1 Post-Mission Report
ANNEXES
1. Considerations in Hospital Design, Energy and Communications
S18.1 Five Types of Evaluation Exercises: Characteristics and Guidelines
REFERENCES
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MESSAGE
Mabuhay!
FRANCISCO T.DUQUE III, MD, MSc
Secretary of Health
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MESSAGE
that this is a major step to improving further the efciency and effectiveness of health
emergency response in the country.
DR. SOE NYUNT-U
Country Representative
World Health Organization, Philippines
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FOREWORD
tation phase. In the process, I hope that every user will eventually become a contributor
to its continuous evolution.

CARMENCITA A. BANATIN MD, MHA
Director III
12 x
ACRONYMS
ACLS Advanced Cardiac Life Support
ADPC Asian Disaster Preparedness Center
AFP Armed Forces of the Philippines
AO Administrative Order
ATO Air Transportation Ofce
ATTF Anti-Terrorism Task Force
BFAD Bureau of Food and Drugs of the DOH
BFAR Bureau of Fisheries and Aquatic Resources
BFP Bureau of Fire Protection
BFP-EMS Bureau of Fire Protection - Emergency Medical Services
BFP-SRU Bureau of Fire Protection - Search and Rescue Unit
BHDT Bureau of Health Devices and Technology of the DOH
BIHC Bureau of International Health Cooperation of the DOH
BLS Basic Life Support
BOC Bureau of Customs
CBRNE Chemical, Biological, Radio-Nuclear Agents and Explosives
CHD Center for Health Development of the DOH
CHO City Health Ofcer
COA COA COA Commission on Audit
CSSR Collapsed Structure Search and Rescue
DBM Department of Budget and Management
DFA Department of Foreign Affairs
DMU Disaster Management Unit of the DOH
DND Department of National Defense
DOH Department of Health
DOT Department of Tourism
DSWD Department of Social Welfare and Development
EHS Environmental Health Service of the DOH
EO Executive Order
EOC Emergency Operations Center
EOD Emergency Ofcer-on-Duty
ER Emergency Room
FIMO Field Implementation Management Ofce
GA Government Agency
HAZMAT Hazardous Materials
HCF Health Care Facilities
HE Health Emergency
HEARS Health Emergency Alert Reporting System
HEICS Hospital Emergency Incident Command System
HEMS Health Emergency Management Staff of the DOH
HEPO Health Education Promotions Ofcer
HEPR Health Emergency Preparedness and Response
HEPRRP Health Emergency Preparedness, Response and Recovery Plan
HRD Human Resource Development
HRM Human Resource Management
IASC Inter-Agency Standing Committee
ICS Incident Command System
JAS Job Action Sheets
LCF Local Calamity Fund
LDCC Local Disaster Coordinating Council
LGE Local Government Executive
LGU Local Government Unit
LGUTMH Local Government Unit Teams for Mental Health
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LHAD Local Health Administration and Development
MCH Maternal and Child Health
MCI Mass Casualty Incident
MCM Mass Casualty Management
MDM Management of the Dead and Missing
MFI Mass Fatality Incident
MHO Municipal Health Ofcer
MIS Management Information System
MMD Materials and Management Division of DOH
MMDA Metro Manila Development Authority
MOA Memorandum of Agreement
MOU Memorandum of Understanding
NBI National Bureau of Investigation
NCDPC National Center for Disease Prevention and Control
NDCC National Disaster Coordinating Council
NEC National Epidemiology Center of the DOH
NGO Nongovernment Organization
NNC National Nutrition Council
NPCC National Poison Control Center
NPMC National Program Management Committee
NSC National Security Council
NTC National Telecommunication Commission
OCD Ofce of Civil Defense
OIC Ofcer-in-Charge
OpCen Operations Center
PAG-ASA Philippine Atmospheric, Geophysical and Astronomical Services Administration
PAR Philippine Area of Responsibility
PCG Philippine Coast Guard
P/C/MSWDO Provincial/City/Municipal Social Welfare and Development Ofcer
PD Presidential Decree
PET Pocket Emergency Tool
PGH Philippine General Hospital
PHEMAP Public Health Emergency Management in Asia and the Pacic
PHIVOLCS Philippine Institute of Volcanology and Seismology
PHO Provincial Health Ofcer
PIE Post-Incident Evaluation
PMDT Program Management and Development Teams
PNP Philippine National Police
PNP-CL Philippine National Police - Crime Laboratory
PNRC Philippine National Red Cross
PNRI Philippine Nuclear Research Institute
PO Peoples Organization
PPE Personal Protective Equipment
RA Republic Act
RDCC Regional Disaster Coordinating Council
RESU Regional Epidemiologic Surveillance Unit
RHEMS Regional Health Emergency Management Staff
RMHT Regional Mental Health Teams
SEARO Southeast Asia Regional Ofce of WHO
SOP Standard Operating Procedure
STOP DEATH Strategic Tactical Option for the Prevention of Disaster, Epidemics, Accidents and Trauma
for Health
UN United Nations
UNICEF United National Childrens Fund
UP-PGH University of the Philippines-Philippine General Hospital
WHO World Health Organization
WMD Weapons of Mass Destruction
WPRO Western Pacic Regional Ofce of WHO
xii
GLOSSARY
All-hazard An approach to emergency management based on the recognition that there are common
elements in the management of responses to virtually all emergencies, and that by standardizing a
management system to address the common elements, greater capacity is generated to address the
unique characteristics of different events
Burn-out syndrome A state of exhaustion, irritability and fatigue which markedly decreases workers
effectiveness and capability
Capacity/readiness An assessment of local capacity to respond to an emergency (a risk modier)
Casualty Victims both dead and injured, physically and/or psychologically
Certicate of missing person believed to be dead in time of disaster A document to be issued by Certicate of missing person believed to be dead in time of disaster Certicate of missing person believed to be dead in time of disaster
the National Disaster Coordinating Council indicating that the person is believed dead as a result of a
disaster based on validation and recommendation by the concerned local government unit. This docu-
ment is issued in lieu of a Death Certicate and can be used solely for the processing of claims for
benets.
Collective grave Burial of two or more dead bodies/body parts in an orderly process, preserving the
individuality of every body and maintaining individual characteristics of each body
Command post Form of site-level emergency operations center, assembled as needed by the rst
agencies to respond to an event
Community Consists of people, property, services, livelihoods and environment; a legally constituted
administrative local government unit of a country, e.g., municipality or district, that is small enough to
be able to identify its own leaders (to make participation meaningful) and large enough to control its
resources, e.g., village, district, etc
Coordination Bringing together of organizations and elements to ensure effective counter-disaster
response. It is primarily concerned with the systematic acquisition and application of resources (orga-
nization, manpower and equipment) in accordance with the requirements imposed by the threat of
impact of disaster.
Complex emergency A state where the normal social or economic order has collapsed to the extent
that the national authorities are no longer able to guarantee security or provide services to all or
part of the country
Cremation The process that reduces human remains to bone fragments of ne sand or ashes through
combustion and dehydration
Crisis A state brought about by adverse life experiences wherein the normal coping mechanism or
problem solving is not working
Critical incident Any event causing unusually strong overwhelming emotional reactions which have the
potential to interfere with work during the event or thereafter in the majority of those exposed
Death certicate Documented proof of the death of someone; a legal instrument which includes the
victims name, age, sex, the cause and manner of death, the time and date of death, as well as the
professional who conrms the death
Disaster Any actual threat to public safety and/or public health where local government and the emer- Disaster Disaster
gency services are unable to meet the immediate needs of the community; an event in which the lo-
cal emergency management measures are insufcient 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, Donor Donor
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 nal 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
effects of hazards
xiii
Emergency operations center A place activated for the duration of an emergency within which person- Emergency operations center Emergency operations center
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 efciently
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 Health Emergency Management Health Sector Health Emergency Management Health Sector
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 Incident Medical Commander Incident Medical Commander
Ofce as designated by the city/town local executive (depending on the extent of the disaster) who
shall serve as the liaison ofcer 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 insufcient resources to meet
immediate needs
Management of the Dead and Missing Persons During Emergencies or Disasters (MDM) Refers
to ve domains, namely: Search and Recovery; Identication 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 efcient 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 unidentied bodies/body parts in
the same excavated site
Medical controller A designated senior Department of Health Ofcer appointed to assume the overall Medical controller Medical controller
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 classied 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
xiv
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 specic hazard affecting a specic community (at a specic 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., oods 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 organizations 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 ones coping mechanism is not enough to maintain balance or equilibrium
Surge capacity The health care systems ability to rapidly expand beyond normal services to meet
the increased demand for qualied 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 identication 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 inuence 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 specic hazard in a specic community
(risk modiers)
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
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1 Vision and Mission
VISION
The Health Emergency Management Staff (HEMS) of the Department of Health
(DOH) was created with the vision of becoming Asias 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.
4
2 Policy Base:
National Policy Framework on Health Emergencies
and Disasters
(Administrative Order No. 168 s. 2004; Joint Administrative Order No. 2007-001b)
The DOHs 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 Asias 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 efcient 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 identied strategies of capacity building, enhance-
ment of facilities, service delivery, health information and advocacy, health policy, net-
working and social mobilization, research and development, resource mobilization, infor-
mation management system and surveillance, standards and regulation, and monitoring
and evaluation.
Programmatically, the components of Health Emergency Preparedness and Response
are the following:
Holistic Health Emergency Preparedness and Response to cover all phases of the
emergency/disaster: (1) pre-emergency/disaster phase for emergency preparedness
mitigation and prevention; (2) emergency/disaster phase for response; and (3) post-
emergency/disaster phase for recovery and reconstruction.
A focus on the Community Risk Reduction Strategy to include decreasing the haz-
ard, decreasing vulnerability, and increasing preparedness.
Comprehensive coverage for an all-hazard approach, addressing all types of disas-
ters (natural, man-made and technological) and all types of emergencies with a
potential to be a disaster through Mass Casualty Management, Public Health,
Mental Health, and recently with the Management of the Dead and the Missing.
Mental Health in Disaster as a major component institutionalized in all phases of
disaster and provided to victims, relatives of victims, as well as responders.
Health Emergency Management integrated in health programs of the community,
local government and the state.
Organizationally, all health facilities are to have a health emergency management ofce/
unit/ program, under the supervision of the highest ofcer, such as the Regional Direc-
tor/Chief of Hospital or its equivalent ofcer, to ensure faster decision-making in times of
emergencies and disasters.
5
3 Action Base:
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 Pacic 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 Pacic (PHE-
MAP), 2006. Module 1: Health Emergency Management. Challenges and Roles. WHO (WPRO, SEARO) and ADPC.
TIME 0---------------
------------ N
Table 1. Timeline of Health Sector Roles by Health Emergency Management Phases*
--- EVENT -------- --- EVENT --------

6
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 magnies 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.
*Adapted from the Sixth Inter-regional Training Course in Public Health and Emergency Management in Asia and the Pacic (PHE-
MAP), 2006. Module 1: Health Emergency Management. Challenges and Roles. WHO (WPRO, SEARO) and ADPC.
Control of diseases of
public health signi-
cance
Control of acute
intestinal and respira-
tory diseases
Care of the dead
General curative
services
Nutritional surveillance
and support (including
micronutrient supple-
mentation)
Measles vaccination
Vitamin A
Specic training
programs
Health informa-
tion campaigns/
health education
programs
Disability and
psychosocial care
Revision of
policies, guide-
lines, procedures
Upgrade of
knowledge and
skills, attitude
change
Restoration of
preventive health
care services such
as EPI, MCH, etc
Restoration of
services for non-
communicable
diseases/obstetrics
Care of the disabled
Immediate
End of First Month
Medium Term
End of First Week
Short Term
Conclusion End of 3 Months
Long Term
Compensation/
reconstruction
Restitution/
rehabilitation
Prevention
and prepared-
ness
Education
Agriculture
Environmental
protection
Protection (legal
and physical)
Employment
Public transport
Public Communica -
tions
Psychosocial
services
Emergency
communication,
Logistics and
reporting
systems
(including injury
and disability
registers)
Search and
rescue
Search and
recovery (dead)
Evacuation/shelter
Food
Water
Public informa-
tion system
First aid
Triage
Primary medical
care
Transport/
ambulances
Acute medical
and surgical care
Emergency epidemio-
logical surveil-lance for
vector-born diseases,
vaccine-preventable
diseases, diseases of
epidemic potential
Reconstruction
and rehabilitation
Evaluation of
lessons learned
Establishment/
re-establishment of
health information
system
Security
Energy (fuel,
heating, light, etc)
Environmental
health services for
- vector control
- personal hygiene
- sanitation, waste
disposal, etc
First 24 Hours
EVENT
Table 2. Timeline of the Three Phases of Health Emergency Management*
0 -------------------
----- ----------- ------------- N
Event
------------- N ----- -----------
0 -------------------
7
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 specically 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 efcient disaster management programs, the
Department of Health identies and enjoins all the major stakeholders of the health sec-
tor to develop their inter-operability for a more effective and efcient 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 xture in disaster-related laws. This
means that in every disaster or emergency, protecting the life and health of the popula-
tion is the core of the Disaster Management System in the country. The DOH, thus, has
always played a key role in all disaster management efforts. Milestone legislations in
Philippine health emergency management include:
1. Two Executive Orders (E.O.) issued by the late President Manuel L. Quezon
during the Commonwealth era, namely, Executive Order Nos. 335 and 337.
a. Executive Order No. 335 Created the Civilian Emergency Administration
(CEA) which was tasked primarily through the National Emergency Commis-
sion (NEC) to formulate and execute policies and plans for the protection and
welfare of the civilian population under extraordinary and emergency conditions.
The overall manager of the NEC was the Philippine National Red Cross. Local
emergency committees (LEC) from the provincial, city and municipal levels were
likewise organized and headed by the local chief executive. The sanitary ofcer
was an ofcial member of the LEC.
b. Executive Order No. 337 Empowered the volunteer guards to assist in the
maintenance of peace and order in the locality, safeguard public utilities, and
provide assistance and aid to people during natural or man-made disasters.
2. Executive Order No. 36 issued by the late President Jose P. Laurel during the
Japanese occupation Created the Civilian Protection Service (CPS) tasked to for-
mulate and execute plans and policies for the protection of civilians during air raids
and other national emergencies. The CPS was handled by the Civilian Protection
8
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 ofcials treasury, justice, engineering, schools, health and the police.
3. Republic Act 1190 or the Civil Defense Act of 1954 Disaster Preparedness Ini-
tiatives which created the National Civil Defense Administration (NCDA), whose
principal task was to provide protection and welfare to the civilian population during
war or other national emergencies of equally grave character. Under this law, civil
defense councils from national, provincial, city and municipal civil defense councils
were established. Its operating services at all levels (provincial, city and municipal)
were as follows: Warden Service, Police Service, Fire Service, Health Service, Res-
cue and Engineering Service, Emergency Welfare Service, Transportation Service,
Communication Service, Air Raid Warning Service, and Auxiliary Service.
4. Administrative Order No. 151 (December 2, 1968) Created a National Com-
mittee on Disaster Operation in view of the collapse of the Ruby Tower building in
Manila caused by a powerful earthquake. The committee was composed of the
Executive Secretary as chairman, and as members: the department secretaries
of Social Welfare, National Defense, Health, Public Works and Natural Resources,
Commerce and Industry, Education, Community Development, and Commission on
Budget; the secretary-general of the Philippine National Red Cross; and a designa-
ted national coordinator. Under this order, the national committee ensured effec-
tive coordination of operations of the different agencies during disasters caused by
typhoons, oods, res, earthquakes and other calamities.
5. Formulation of the Disaster and Calamities Plan (1970) Prepared on Octo-
ber 19, 1970, after Typhoon Seniang, by an Inter-Departmental Planning Group on
Disasters and Calamities as approved by then President Ferdinand E. Marcos. The
plan created the National Disaster Control Center that was composed of the follow-
ing: chairman Secretary of National Defense, overall coordinator Executive
Secretary, and members Secretary of Health, Secretary of Public Works and Com-
munications, Secretary of Agriculture and Natural Resources, Secretary of Com-
merce and Industry, and Secretary of Community Development.
6. Presidential Decree 1566 of 1978: Strengthening of the Philippine Disaster Control
Capability and Establishing the National Program on Community Preparedness
7. Republic Act 7160 or the Local Government Code of 1991 Contains provisions
supportive of the goals and objectives of the disaster preparedness, prevention and
mitigation programs. These provisions reinforce the pursuit of a Disaster Manage-
ment Program at the local government level.
8. Department of Health policies on institutionalization of the Health Emergency
Preparedness and Response Program at the local level.
9
RELEVANT LAWS
Presidential Decree No. 1566 of 1978: Strengthening Philippine Disaster Control
Capability and Establishing National Program on Community Disaster Prepared-
ness
Promulgated on June 11, 1978, P.D. 1566 is the basic law in the implementation of the
Disaster Management Program in the Philippines. It contains the following provisions:
Section 2 Creation of National Disaster Coordinating Council (NDCC).
The Department of Health is a member of the National Disaster Coordinating Coun-
cil (NDCC) and the head of the Medical Service; it assumes command over the
health sector.
Creation of the multilevel organizations in charge of disaster management.
This multilevel organization starts from the National Disaster Coordinating Council,
the Regional Disaster Coordinating Council, the Provincial Disaster Coordinating
Council down to the Municipal Disaster Coordinating Council.
Funding for a 2% reserve for calamities.
PD 1566 authorizes the local government to program funds for use in disaster pre-
paredness, such as the organization of Disaster Coordinating Councils, the estab-
lishment of physical facilities, and the equipping and training of disaster action
teams.
These are the salient provisions of P.D. 1566:
State policy on self-reliance among local ofcials 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 Ofce of Civil
Defense and implementation of plans by NDCC and member agencies.
Conduct of periodic drills and exercises.
Authority of government units to program their funds for disaster preparedness ac-
tivities, in addition to the 2% calamity fund as provided for in P.D. 474 (amended
by R.A. 8185).
10
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 ofces and
bureaus under it.
The Department of Health organizes Health Service Units in all regions, provinces,
cities, municipalities and barangays.
a. Constitution of Health Service Units
Chairman: Department of Health
Members (suggested as but not limited to):
Representatives of the Philippine National Red Cross
Medical and allied professionals
Chief of public/private hospitals/clinics/institutions
AFP medical reserve personnel on inactive status in the community
b. Purpose of Health Service Units
To protect life through health and medical care of the populace.
To preserve life through proper medical aid and provision of medical facilities.
To minimize casualties through proper information and mobilization of all
medical resources.
c. Sub-units of the Health Service Unit
i. Medical and First-Aid Unit
ii. Field Emergency Hospital
iii. Sanitation Service Unit
iv. Health Supply Unit
v. Transportation and Ambulance Unit
vi. Mortuary Unit
vii. Records Unit
d. Responsibilities
The DOH Secretary is responsible for organizing, training and supplying all
Health Service elements in the Philippines.
The DOH Regional Director is responsible for providing support to the Health
Services in the provincial, municipal and city levels.
11
The DOH ofcials at the provincial, city and municipal levels are responsible for
organizing their respective units.
The local government heads are responsible for the operation and support of
Health Services.
The Philippine National Red Cross (PNRC) and the Department of Social Wel-
fare and Development (DSWD), within their respective capabilities, are respon-
sible for providing support to the Health Service.
e. Functions of the Health Service Sub-units
i. Medical and First Aid Unit
Sorts cases at the scene of the disaster;
Administers rst aid;
Attends to the cases referred to emergency aid and stations;
Evacuates patients to emergency hospitals; and
Detects and controls communicable diseases in coordination with other
agencies specically assigned for the purpose.
ii. Field Emergency Unit
Pre-determines sites of facilities that may be used as eld hospitals;
Administers appropriate treatment to less serious patients and attends to all
dispensary cases; and
Attends to all medical cases, which should be referred to appropriate medi cal
institutions.
iii. Sanitation Service Units
Supervises the sanitary conditions of the community during and after emer-
gency;
Enforces sanitary regulations relative to housing facilities and shelter; and
Promulgates and implements control measures in contaminated areas and
in evacuation centers.
iv. Health Supply Unit
Procures, stores and issues medical supplies and equipment during emer-
gencies; and
Keeps an accounting of the medical and rst aid instruments and supplies.
v. Mortuary Unit
Assists in identifying and tagging the dead;
Certies to the cause of death; and
Supervises the proper disposal of the dead.
vi. Records Unit
Keeps records of the dead, injured, and sick; and
Issues certicates pertaining to persons who were ill, injured and recovered,
or died, pursuant to existing, laws, rules and regulations.
Republic Act No. 7160: The Local Government Code of 1991
The Local Government Code of 1991 provides for the transfer of responsibilities from
the national to the local government units (LGUs) thereby giving more powers, authority,
12
responsibilities and resources to the LGUs. Below are its provisions pertinent to emer-
gency and disaster management.
Section 16 General Welfare
Every local government unit shall exercise the powers granted, those necessarily
implied therefrom, as well as powers necessary, appropriate or incidental for its
efcient 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,
scientic 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 ve 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, ood control and irrigation systems,
reclamation projects, and similar facilities.
Immediate and direct response to emergencies/disasters is the primary responsibil-
ity of the local government units. However, in cases where disasters have reached
proportions which are beyond the capacity of the local government unit, the national
government takes control (Under Section 105).
Section 105 Direct National Supervision and Control by the DOH
In cases of epidemics, pestilence, and other widespread public health dangers, the
Secretary of Health may, upon the direction of the President and in consultation with
the local government unit concerned, temporarily assume direct supervision
and control over health operations in any local government unit for the duration
of the emergency, but in no case exceeding a cumulative period of six (6) months.
Chapter 11 of the Department of Health Rules and Regulations Implementing the
Local Government Code of 1991 provides the legal basis for the DOH to establish
13
and maintain an effective health emergency preparedness and response program.
Section 389 and 391 Powers, Duties and Functions of the Punong Barangay and
Sangguniang Barangay.
Section 444 and 447 Powers, Duties and Functions of the Municipal Mayor and
Sangguniang Bayan.
Section 455 and 458 Powers, Duties and Functions of the City Mayor and Sanggu-
niang Panlunsod.
Section 465 and 468 Powers, Duties and Functions of the Provincial Governor and
Sangguniang Panlalawigan.
Generally, under the above provisions of RA 7160, the local chief executives and
Sanggunian are expected to carry out the following disaster management func-
tions and responsibilities:
Local Chief Executives:
1. Implement the emergency measures during and in the aftermath of a disaster or
emergency.
2. Submit supplemental reports to higher authority or the Ofce of the President
regarding extent of damages incurred due to the disasters or calamities affecting
the inhabitants.
3. Call upon law enforcement agencies to suppress civil defense/disturbance/
uprising.
4. Promote the general welfare and ensure delivery of basic services.
Sanggunian:
1. Adopt measures to protect the inhabitants from the harmful effects of natural or
man-made disasters.
2. Provide relief and rehabilitation services/assistance to victims.
3. Adopt comprehensive land use plan.
4. Enact/review zoning ordinances.
Section 324(d) as amended by R.A. 8185 s.1997 States that 5% of the estimated
revenue from regular sources shall be set aside as annual lump sum appropriations
for relief, rehabilitation, reconstruction and other works and services in connection
with calamities occurring during the budget year. Provided however, that such
fund shall be used only in the area, or a portion thereof, of the local government
unit, or other areas affected by a disaster or calamity, as determined and declared
by the local Sanggunian concerned.
Requisites for the use of the 5% Local Calamity Fund (LCF):
1. Appropriation in the local government budget as annual lump sum appropriations
for disaster relief, rehabilitation and reconstruction;
2. To be used for calamities occurring during the budget year in the LGU or other
LGUs affected by a disaster or calamity.
3. Passage of a Sanggunian resolution regarding declaration of calamity or disaster.
14
4. In case of re, the LCF can be used only for relief operations.
It will be noted that the 5% LCF cannot be used for disaster preparedness activities of
the local government units unlike the National Calamity Fund (NCF). One of the rea-
sons given by the authors of RA 8185 was that local government units should already
program their preparedness activities in their respective budgets for the ensuing year.
Procedures for the allocation, release, accounting and reporting of Local Calamity Fund:
1. In case of calamity and upon recommendation of the local chief executive based on
the reports of the local disaster coordinating council (LDCC), the local Sanggu -
nian shall immediately convene within 24 hours from the occurrence of the calamity
and pass a resolution declaring a state of calamity in the area(s) of the LGU
affected by the calamity, and adopt measures to protect lives and properties in the
area and implement disaster mitigation.
The Sangguniang Panlalawigan need not review the Sanggunian Bayan Resolution
embodying the declaration. However, when the whole province is being affected by
a calamity, the Sangguniang Panlalawigan, upon the recommendation of the Provin-
cial Governor, shall declare the whole province under a state of calamity. In such
cases, the Sangguniang Bayan of the respective municipalities need not declare
their areas as calamity areas.
2. The local budget ofcer shall release the allotment of 50% of the Calamity Fund
within 24 hours from the occurrence of the calamity, provided the following are
present:
Approved disbursement voucher
Sanggunian resolution containing the calamity area declaration
Local Disaster Coordinating Council report on damages
3. Pending the passage of the Sanggunian resolution on the declaration of the calamity
area, the local chief executive may already draw cash advances from the General
Fund which should not exceed 50% of the total Local Calamity Fund, subject to
replacement after receipt of the above Sanggunian resolution.
4. The local treasurer shall submit a utilization report, duly approved by the local chief
executive, to the Sanggunian concerned, Commission on Audit, and the Local
Development Council, with copy furnished to the Local Disaster Coordinating
Council.
5. Unused or unexpended balance of the LCF at the end of the current year shall be
reverted to the unappropriated surplus for reappropriation during the succeed-
ing year, except unused funds for capital outlay which shall be valid until fully spent
or reverted.
Republic Act 8185 of 1997: Emergency Powers of the Local
Government Units
Criteria for Calamity Area Declaration
At least two or more of the following conditions are present in the affected areas and
lasting for at least four (4) days:
15
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, shing boats, vehicles).
Major roads and bridges are destroyed and impassable thus disrupting the ow
of transport and commerce.
There is widespread destruction of shponds, 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 specic group of
people over a particular period of time. To determine whether the number
is more than the expected, the number should be compared with the number
of cases during the past weeks or months or a comparable period during the
last few years (at least 5 years).
2. There is a clustering of cases in a given area over a particular time.
Duration of Calamity Area Declaration
One year from the effectivity of the declaration.
Exception: When the effects of the disaster is recurring or protracted, in which
case, the declaration shall be a continuing one.
Once 85% of the repair and rehabilitation works have been done and services
have been restored, the declaration of a state of calamity may be terminated
or lifted by the President of the Philippines or the local Sanggunian.
Memorandum No. 13 s. 1998 Amended Policies and Procedures on the
Provision of Financial Assistance to Victims of Disasters
Coverage Disaster victims who died or got injured during the occurrence of a natural
disaster.
Exception Victims of man-made disasters such as res, vehicular accidents, grenade/
bombing incidents, armed conicts, and air/sea mishaps, unless directed or ap-
proved by the President of the Philippines upon the recommendation of the National
Disaster Coordinating Council (NDCC).
Amount of Financial Assistance:
Php10,000.00 for dead victims
Php 5,000.00 for injured victims
Validity of Claim Within one (1) year from the occurrence of the disaster.
Procedure:
1. All claims for nancial assistance shall be led 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 certicate
16
Certication from the barangay captain
Proof of lial relationship with the victim
Endorsement for the payment of claims from the LDDC and RDCC chairmen
For injured persons:
Medical certicate from the hospital or clinic where victim was conned 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 benets to disaster volunteer
workers (still for enforcement).
Proclamation No.296s. 1988 as amended by E.O. 137 s. 1999 Declaring the rst
week of July of every year as Natural Disaster Consciousness Week, now, the whole
month of July as National Disaster Consciousness Month.
PMO No. 36 s. 1995 as amended by PMO No. 42 s. 1997 Establishment of a special
facility for the importation and donation of relief goods and equipment in calamity-strick-
en areas.
Proclamation No. 705 Declaring December 6, 1995, and December 6 of every year
thereafter, as National Health Emergency Preparedness Day.
RELEVANT EXECUTIVE/ADMINISTRATIVE ORDERS
DOH Administrative Order No. 6-B of 1999: Institutionalization of a Health Emer-
gency Preparedness and Response Program Within the Department of Health
Institutionalized the Health Emergency Preparedness and Response Program of
DOH.
Created the STOP DEATH Program as a comprehensive, integrated and re-
sponsive emergency/disaster-related, service and research-oriented program.
Aimed to promote health emergency preparedness among the general public
and strengthen health sectors capability to respond to emergency/disaster.
The program likewise gives advice and policy directions regarding health emer-
gencies.
Executive Order No. 102: Institutionalization of the Health Emergency Manage-
ment Staff (HEMS)
In view of the re-engineering of the DOH, the Disaster Management Unit (DMU) and
STOP DEATH Program were merged.
The HEMS organizational structure places it directly under the Ofce of the Secretary.
It has two divisions: the Preparedness Division and the Response Division. Below are
their respective functions:
Functions of the Preparedness Division
Develop plans, policies, programs, standards and guidelines for the preven-
tion and mitigation of health emergencies.
17
Provide leadership in organizing and coordinating the health sector efforts for
health emergency preparedness.
Provide technical assistance, consultative and advisory services to imple-
menting agencies.
Facilitate capability building of implementing agencies.
Initiate advocacy activities.
Maintain/update the information center for emergencies and disasters.
Conduct/coordinate studies and researches related to health emergencies.
Conduct/facilitate monitoring and evaluation activities.
Functions of the Response Division
Maintain a 24-hour Operation Center to monitor health and health events na-
tionwide.
Collect emergency and disaster reports nationwide, for the use of the Health
Secretary, NDCC and other agencies and the public.
Lead in mobilizing health teams in anticipation of or in response to health
emergencies.
Coordinate and integrate health sector response to emergencies and
disasters.
Develop networks with government agencies (GAs), nongovernment organi-
zations (NGOs), peoples organizations (POs), and health sector responders.
Develop plans, policies, programs, standards, guidelines and protocols for
emergency response.
Conduct/coordinate studies and researches related to emergency response.
Conduct/coordinate monitoring and evaluation activities.
Administrative Order No. 182 s. 2001: Adoption and Implementation of Code
Alert System for DOH Hospitals During Emergencies and Disasters
Mandates that all hospitals must get ready to respond whenever disasters are
forseen and/or declared.
Introduces organizational shift and code alert system as mechanisms in the hos-
pital set-up for the provision of medical services during emergencies or disasters.
Provides general guidelines on disaster codes: Code White, Blue and Red.
Denes 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
Denes the rules of engagement, procedures, coordination and sharing of re-
sources and responsibilities, to include the varying levels of state of prepared
ness and the desired response to emergencies and disasters in the health sector.
Applies to all DOH ofces, hospitals, and its attached agencies, as well as to
all disciplines and institutions, whether government, nongovernment or private
entities whose functions and activities contribute to health emergency prepared
ness and response.
Embodies the framework of Health Emergency Management (HEM), HEM strat-
egies, organizational structure, human resource development, support systems,
and roles and responsibilities of HEMS, DOH ofces and attached agencies, and
the health sector.
Denes program components as focused on community Risk Reduction for all
phases and all types of disaster. It should cover mass casualty management,
mental health and all types of emergencies with a potential to be a disaster,
18
Administrative Order No. 155 s. 2004: Implementing Guidelines for Managing
Mass Casualty Incidents During Emergencies and Disasters
Includes pre-established procedures for resource mobilization, eld management
and hospital reception in Mass Casualty Management (MCM).
Incorporates links between eld and health care facilities through a command
post.
Acknowledges the need for multi-sectoral response for triage, eld stabilization
and evacuation to appropriate health care facilities.
Covers mass casualty incidents related to weapons of mass destruction (WMD).
Exemplies the components of MCM, which are: Policy and Planning; Capability
Building; Operation Center/Surveillance System; Facilities Development; Docu-
mentation and Research.
Table 3. Strategies Used in Health Emergency Management
Activities
Training on health emergency preparedness at all levels of the
health sector from the community to the tertiary hospital level
Enhancing facilities to improve the capacities of involved
institutions
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
Activities informing the public on prevention and preparedness
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
Development of plans, (EPRP, WFP/OPlan)
Development of policies, procedures, guidelines, protocols
Development of health emergency management systems
Building up network
Networking meetings and other activities
Multi-sectoral activities (drills, benchmarking, etc.)
Establishment of MOAs and MOUs
Other collaborating activities
Conduct of research studies
Case reports or other paper presentations
Activities pertaining to resource generation and distribution
(logistics, human resources, nances)
Mobilization of response teams
Mobilization of ambulance teams
Information generation, storage, and dissemination
Standards setting, accreditation criteria setting
Activities empowering regulations
Documentation of events and lessons learned
Post-mortem evaluation
Activities for sharing of good practices (e.g.,conventions)
Drills or simulation exercises
19
Includes roles and responsibilities of various DOH Ofces/Bureaus/Units in mass
casualty management.
Provides guidelines on emergency response and dispatch.
Administrative Order No. 2007-001B: National Policy on the Management of the
Dead and Missing Persons During Emergencies and Disasters
Acknowledges the critical role of government in standardizing and guiding the
tasks of handling the dead bodies, ensuring that legal norms are followed and
guaranteeing that the dignity of the deceased and their families is respected in
accordance with their cultural values and religious beliefs.
Articulates the Guiding Principles in handling of the dead.
Highlights a multi-sectoral approach for a comprehensive, integrated and coordi-
nated response to Management of the Dead and Missing Persons
(MDM) with the establishment of a coordinated body under the National Disaster
Coordinating Council and led by the Department of Health.
Identies the local health ofcer of the concerned local government unit as the
leader/ coordinator of MDM.
Denes the guidelines and procedures of the ve domains of Management of the
Dead and Missing Persons During Emergencies or Disasters, namely: Search
and Recovery; Identication of the Dead; Final Arrangement of the Dead;
Handling the Missing Persons; and Assistance to the Bereaved Families.
Includes the Management of Mass Fatality Incidents/MDM in the Emergency
Preparedness, Response and Recovery Plan and as a component of the Emer-
gency/ Disaster Management Program.
Applies to all Department of Health ofces including its attached agencies, part-
ner agencies, and stakeholders in the MDM.
Administrative Order No. 2007-0009: Operational Framework for the Sustainable
Establishment of a Mental Health Program
Highlights goals of the National Mental Health Program with guidelines in service
delivery, nancing, regulation and governance.
Sets objectives and strategies for the four priority sub-programs, namely: Well
ness of Daily Living, Extreme Life Experience (such as disaster, epidemic,
trauma) which threatens personal equilibrium, Substance Abuse and other forms
of addiction, and Mental Disorder.
Adopts nine key approaches and strategies, namely: Health Promotion and Advo-
cacy, Service Provision, Policy and Legislation, Development of Research Cul-
ture and Capacity, Capacity Building, Public-Private Partnership, Establishment of
Data Base and Information System, Development of Model Programs, and
Monitoring and Evaluation.
Outlines the composition and functions of the implementing mechanisms Na-
tional Program Management Committee (NMPC), the Program Development and
Management Teams (PDMT), the Regional Mental Health Teams (RMHT) and the
Local Government Unit Teams for Mental Health (LGUTMH).
Administrative Order No. 2007-0017: Guidelines on the Acceptance and Process-
ing of Foreign and Local Donations During Emergency and Disaster Situations
Highlights the critical role of the Secretary of Health in the formal acceptance of
donations.
Species 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.
20
Sets criteria for acceptance of items, e.g., food stuffs, and packaging of drugs.
Excludes infant formula items.
Reserves the right to distribution with the Department of Health, disallowing its
use for election purposes.

Memorandum Circular, National Disaster Coordinating Council, May 10, 2007:
Institutionalization of the Cluster Approach in the Philippine Disaster Manage-
ment System, Designation of Cluster Leads and Their Terms of Reference at the
National, Regional and Provincial Level
Designates government cluster leads to serve as main interlocutors for the dif-
ferent clusters and the counterpart Inter-Agency Standing Committee Country
Team as support with dened roles and responsibilities.
Identies deliverables at regional and provincial levels.
Forms nine clusters with the Department of Health as lead in four Health,
Nu trition, Water and Sanitation Hygiene (WASH), and psychosocial clusters.
Administrative Order No. 2008-0024: Adoption and Institutionalization of an Inte-
grated Code Alert System for the Department of Health
Contains the implementing guidelines for the conditions, human resource re-
quirements, and other support requirements for each of the tri-color code alert
status white, blue and red in the HEMS Central Ofce, Center for Health
Development, Hospitals and DOH Central Ofces.
In the declaration, raising, lowering and suspension of code alert status, identies
the Secretary of Health and Director of HEMS Central Ofce as key national
authorities, as well as the respective authorized designates for the HEMS Central
Ofce, Center of Health Development, Hospitals and Medical Centers.
Administrative Order No. FAE 007 s.1998: Policies and Guidelines on the Trans-
fer and Referral of Patients Between DOH Metro Manila Hospitals
Focuses on Coordination, Networking, and Referral System.
Contains guidelines and procedures in transferring emergency room (ER)
patients, as well as in referrals of admitted patients.
Applies to all DOH hospitals in Metro Manila and all additional hospitals placed
under DOH.
Includes: general guidelines in the emergency room; guidelines in transferring ER
patients; guidelines for inter-hospital referral or request for procedures; guidelines
for transferring in-patients; and guidelines for transferring of patients during disas-
ters and emergencies.
Department Order No. 1-J, s. 2000: Reporting Mechanism of Health Emergency
Management Staff (HEMS) at the Central Ofce and Its Units at the Centers for
Health Development and DOH Hospitals
Emphasizes that the Health Emergency Management Staff shall report directly to
the Ofce 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 CHDs geographical jurisdiction.
Indicates that hospitals in Metro Manila shall report to the HEMS director through
their respective Medical Center or Hospital director/chief during disaster response.
Memorandum No. 120 s. 2003: Personnel and Ambulance Services for Emergen-
cies and Disasters
Pertains to resource mobilization.
Reiterates the ever readiness of hospitals to respond to emergencies.
Directs all hospital directors to actively be on top of any untoward event, espe-
cially in mass casualty incidents.
States that personnel trained in emergencies, such as BLS, ACLS, EMT, MFR,
MCM and other related trainings, shall be included in the response teams of the
hospital.
Orders that an ambulance be assigned for emergencies for easy dispatch of
teams and be furnished with the necessary equipment, medicines, supplies, and
necessary communication for proper coordination.
Emphasizes the authority of HEMS coordinators in the dispatch of these ambu-
lances to prevent delays and the authority of any member of the team to drive in
case there is no available driver.
Department Orders on Health Staff/Personnel
Department Order 2004-1679 Creation of the Health Task Force on Health Emer-
gency Management (DOH-HEMS Task Force)
Department Order 2004 Creation of the Steering Committee and Technical Work -
ing Groups in the Health Sector Responding to Emergencies and Disasters
Department Personnel Order 205-1324 Amendment to Department No. 193-D s.
2003,dated October 8, 2003, Designation and Responsibilities of the Health
Emergency Management Staff (HEMS) Coordinators of the Centers for Health
Development and DOH Hospitals
Department Order 2003-193D Amendment to Department Order no. 136-1 s.
2001 dated May 28, 2001, Designation and Responsibilities of the Health
Emergency Management Staff (HEMS) Coordinators of the Centers for Health
Development and DOH-Retained Hospitals
Department Order 2001-136-1 Designation and Responsibilities of the Health
Emergency Management Staff (HEMS)-Stop Death Coordinators of the Centers for
Health Development and DOH Hospitals
Administrative Orders on Communications: Cell Phones
Administrative Order 2004-131 Amendment to Administrative Order No. 164 s.
2000 re: Policies and Procedures for the Acquisition, Operation and Maintenance of
Cellular Phones at the Central Ofce
Administrative Order 2000-164 Policies and Procedures for the Acquisition,
Operation and Maintenance of Cellular Phones at the Central Ofce
Memoranda on Budget
Memorandum 2000 101-A Amendment to Memorandum No. 82 s. 2000 dated
June 22, 2000, Stop Death Budget for CY 2000
Memorandum 2000 82 Stop Death Budget for CY 2000
21
22
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1 Introduction
Every type of natural, human-generated, technological or societal disaster creates its
own particular set of catastrophic features. Some events can be fairly predicted, such as
typhoons, oods, and drought, whereas earthquakes, landslides and ashoods, given
the suddenness and swiftness of their occurrence, result in unexpected outcomes.
People have continually been vulnerable to natural hazards but have further exposed
themselves to various kinds of self-made disasters, such as war, riots, accidents, re,
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 hospitals 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 denitive patient care services. No longer
limited to receiving patients, the role of the hospitals has expanded to include delivery of
pre-hospital care.
Institutional preparedness of the hospital enhances the utilization of available resources
during the response. Of crucial value is a thorough, carefully developed and updated
hospital emergency plan that is activated when the need arises.
The hospitals, in crafting their plans, adopt an all-hazard approach that covers all phas-
es of the health emergency/disaster cycle from preparedness to response to recovery
and rehabilitation. This approach considers the new challenges of natural, human-gen-
erated emergencies, terrorist-related incidents especially the possible use of biological,
chemical, radio-nuclear agents and explosives, and of emerging and re-emerging dis-
eases.
Mass casualty incidents, a constant challenge to hospitals, test the surge capacity of the
facility. Planning therefore centers on preparing the hospital in Mass Casualty Manage-
ment. Equally important, the hospitals Health Emergency Preparedness, Response and
Recovery (HEPRR) plan should be written, simple, disseminated, tested and updated.
This provides clarity in the identication 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.
26
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.
27
2 Activities During the Emergency Preparedness
Phase
The hospital prior to a health emergency event undertakes development activities to en-
hance its capacity to manage all types of hazards and systematically carry out response
to recovery, ensuring a better level of function in health emergency management. (Go,
2007; DOH-HEMS, 2007a; WHO, ADPC, 2006). These activities are:
1. Development of policies, guidelines, procedures and protocols for health emer-
gency management
2. Development of Health Emergency Preparedness, Response, and Recovery and
Rehabilitation Plans
3. Development of the Organization
4. Physical Infrastructure Development
5. Systems Development
For the hospital to set Health Emergency Management as its appropriate priority and
allocate needed resources for it, policies, guidelines, procedures, and protocols must
be formulated consistent with those of the national plan but more importantly, they
must be responsive to local settings. The subsequent sections provide details in the
development process.
A1. DEFINITIONS
Policy is a formal statement by a government, organization or institution that Policy Policy
expresses a set of goals, the priorities within those goals, and the preferred
strategies for achieving those goals. It is primarily based on the mandate of the
institution. It is the statement of what must be done. Guidelines state how to
implement the policy; they deal more with the technical know-how required in
implementation. Procedures likewise explain how to implement the policy but
they are focused more on administrative know-how. Protocols still explain how
to implement the policy, highlighting the observance of certain codes of eti-
quette and precedence. Plan, on the other hand, pertains to who does what
and when in order to implement the policy.
These terms represent an interrelated set of processes in a sequential manner
such that mandates are needed to set policies, policies are needed to dene
guidelines and set procedures, and guidelines and procedures are needed to
make plans.
The policy development process requires: the legal mandate of the institution;
the authority (national, regional, hospital, local) of the agency; managerial and
technical competence (such as in technical writing, etc); political will and support
from the head of the agency; and that the policy be acceptable and doable.
28
Examples in the Use of Terminologies

Every dead victim has the right to be found, identied and returned to his/her
family according to acceptable norm.
Guidelines (Technical know-how to implement the stated policy)
Guidelines must contain the following:
How to identify the dead
How to perform autopsy, DNA analysis, etc.
How to do the tagging and labeling of the dead bodies
Procedures (Administrative know-how to implement the policy)
Procedures must contain the following:
How to procure the reagents, equipment, the supplies for identication
of the dead
How to get funds for the procurement
How to distribute reagents and supplies to all the laboratories
Protocol (Code of etiquette and precedence on how to implement the policy)
Communication protocol must contain the following:
LGU request for assistance is coursed through the Center for Health
Development, which channels to the HEMS Coordinator. The response
follows the reverse direction.
Plan (Who does what and when in order to Implement the above-stated policy)
The plan must contain the following:
Objective
Strategies and activities
Person responsible
Resource requirement
Time frame
Performance indicator
A2. POLICY DEVELOPMENT PROCESS
The policy development process includes:
a. Creation of Technical Working Group
b. Review of existing policies at different levels (Republic Acts, Executive
Orders, Administrative Orders, etc)
c. Consultations (Multisectoral)
d. Presentations for approval and signing
e. Dissemination and orientation
f. Monitoring and evaluation
An ad hoc Technical Working Group shall be formally created through an order
(department order, hospital order, or regional order) which states their functions
and outputs. With certain operational or program issues at hand awaiting
directions, the group develops the policy to address these concerns. They re-
view existing policies at different levels, such as Republic Acts, Executive
29
Orders, Administrative Orders, etc. before starting to craft the policy. Multisec-
toral stakeholders are consulted in the whole development process to get their
views through interactive brainstorming and critiquing sessions. The nal draft
should be presented for approval prior to the signing by the head of agency.
Policy never serves its purpose unless disseminated to all concerned implement-
ers. Its implementation needs constant monitoring and evaluation to determine
its sustained effectiveness or ineffectiveness, which may require updating or
revision.
A3. POLICY CONTENT

Below is an outline of what a policy should contain:
I. Background/Rationale
II. Denitions of Terms
III. Objectives
IV. Scope and Coverage
V. Framework
VI. Strategies
VII. Policy Statement
VIII. Implementing Mechanism
IX. Separability Clause
X. Repealing Clause
XI. Effectivity

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

Hospital emergency management policy may be needed in the following areas:
Interaction between the hospital and other hospitals and medical centers
Interaction between the hospital and rescue, volunteer, and government
organizations
Assignment of major responsibilities within the hospital for emergency
prevention, preparedness and response
Acquisition and maintenance of emergency resources
Criteria for major evacuation of the hospital and for hospital relocation

The Hospital Health Emergency Preparedness, Response and Recovery Plan is
also known as the Hospital Risk Reduction Plan. Considerations in its development
are described below. (Go, 2007; DOH-HEMS 2007a; WHO, ADPC, 2006)
30
B1. RISK MANAGEMENT
The Department of Health adopts the Risk Management Approach in its manage-
ment process to deal with the actual or implied effects of hazards.
Risk Management is a comprehensive strategy for reducing threats and conse- Risk Management Risk Management
quences to public health and safety of the community by:
Preventing exposure to hazards (target = hazards)
Reducing vulnerabilities (target group = community)
Developing response and recovery capacities (target group = response
agencies)
Risk management includes the process of: selecting a hazard; identifying the
communities exposed to that hazard; predicting the consequences of that haz-
ard interacting with that community; analyzing each of the ve 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:

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 communitys 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
Denition of the seven common terms in risk management:
1. Hazard - Any substance, phenomenon or event that has the potential to
cause disruption or damage to communities.
- Any potential threat to public safety and/or public health.
2. Vulnerabilities - Factors that increase the risks arising from a specic
hazard in a specic community (risk modiers). Examples of vulnerabilities of
people:
Access to health care
Measles vaccination coverage rate
Under - nutrition rate
Under-5 mortality rate
Access to sanitation
3. Risks - Anticipated consequences of a specic hazard interacting with a
specic community (at a specic time).
Hazard x Risk = Hazard x Hazard x
Capacity
Vulnerability
31
Consequences of hazards (risks):
Death
Injury (mental and physical)
Disease (mental and physical)
Secondary hazards (re, disease, etc.)
Contamination
Displacement
Breakdown in security
Damage to infrastructure
Breakdown in essential services
Loss of property
Loss of income
4. Emergency - Any situation in which there is imminent or actual disruption or
damage to communities, i.e., any actual threat to public health and safety
which the community is able to cope with or manage.
5. Disaster - Any actual threat to public safety and/or public health where local
government and the emergency services are unable to meet the immediate
needs of the community, whereby the event is managed from outside the
affected communities.
6. Capacities - An assessment of the ability to manage to an emergency (a
risk modier). Total capacity is measured as readiness.
7. Community - People, property, services, livelihood and environment, i.e., the
elements exposed to hazards. There are specic vulnerabilities or risks for
each element of the community.
B3. CONSIDERATIONS
B3.1. General Considerations
In planning the Hospital HEPRR operations, the following general consider-
ations should be taken into account (Stop Death Program, 2000a):
1. Disasters occur at any time without warning or signal. Everyone should
be prepared at all times to render emergency response.
2. Disaster victims often needing quick medical assessment and prompt emer-
gency care should be attended to immediately.
3. Disaster victims, often hurt and confused, should be treated with sensitivity
and compassion.
4. Given that the volume of demand and the urgency of need for medical atten-
tion are unusually high during disasters, every human and material resources
must be available, readily mobilized and organized for quick action.
5. Safety of personnel, patients, victims and the general population is of utmost
importance in the delivery of services.
32
B3.2. Specic 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 internal, external
internal/external (Stop Death Program, 2000a). Thus, there are three basic internal/external internal/external
scenarios that hospital emergency planning must satisfy:
An emergency that disrupts the ability of the hospital to provide its normal
services, but that does not cause harm to the community (an internal
emergency);
An emergency that causes harm to the community requiring increased
health/medical services, but that does not disrupt the ability of the hospital to
provide medical services (an external emergency);
An emergency that causes harm to the community requiring increased medi-
cal services, and that also disrupts the ability of the hospital to provide medi-
cal services (an internal/external emergency).
Internal emergencies can be caused by a number of hazards, including re,
explosion, hazardous material incident, food contamination, or loss of electricity
supply, water supply, or other service. Internal emergencies can quickly
multiply into a number of contingent emergencies. For example, a re may
cause injury to patients and staff resulting in an overload on hospital services,
hazardous materials incidents may lead to res or explosions, etc.
Catchment area vulnerability should be assessed to determine the likely
demands on a hospital or hospital system (a series of linked hospitals and medi-
cal centers). The hospital must be prepared for a number of external emer-
gency scenarios that may produce unusual medical demands on its existing
capacity.
The capacity to manage routine emergencies is the foundation for further devel-
oping the capacity to manage the less frequent events of health emergen-
cies which, in turn, provides the working base to build capacity in Mass Casu-
alty Management. This existing capacity is known as surge capacity or the surge capacity surge capacity
health care systems ability to rapidly expand beyond normal services to meet
the increased demand for qualied personnel, medical care and public health in
the event of large-scale public emergencies or disasters (a working denition
from the Agency for Health Care Research and Quality, USA, 2005). The essen-
tial components are: trained and skilled staff, equipment, pharmaceuticals, sup-
plies, and both physical structure and management systems such as Incident
Management System. (WHO-WPRO, 2007a)
B3.3. Response Considerations
An overview of risk assessment and health response is presented as two frame
works in Figures 1 and 2. (WHO, ADPC, 2006)
33
Source: Sixth Inter-regional Course on Public Health and Emergency Management in Asia and the Pacic
(PHEMAP), WHO (WPRO, SEARO) and ADPC, 2006.
Figure 1. Emergencies and Health
Community
DIRECT
IMPACTS
VULNER-
ABILITIES
CAPACITIES
Damage
and
Needs
ASSOCIATED FACTORS
Climate/weather/time of day
Location
Security situation
Political environment
Economic environment
Socio-cultural environment
Morale, solidarity, spirit
Competence, corruption
HEALTH RESPONSE
Search and rescue
First aid
Triage
Medical evacuation
Primary care
Disease surveillance and control
Curative care
Blood banks
Laboratories
Referral system
Special units (burns, spinal)
Evacuation centres
Shelter
Water
Food and nutrition
Energy
Security
Environmental health
Primary health care
Care of the dead
Psychosocial care
Disability care
Recovery
Reconstruction
INDIRECT
IMPACTS
EMERGENCY
Source: Sixth Inter-regional Course on Public Health and Emergency Management in Asia and the Pacic (PHE-
MAP), WHO (WPRO, SEARO) and ADPC, 2006.
Figure 2. Epidemic Emergencies
HEALTH RESPONSE
Case denition
Admission criteria
Case conrmation
Case management
Discharge criteria
Contact tracing
Vector control
Environmental controls
Surveillance system
Referral system
Professional education
Public information and
awareness
Laboratory plans
Hospital plans
Supplies and equipment
Border controls
Quarantine
Animal culling
Commerce/trade
Needs
OUTBREAK
Specic
morbidity and
mortality
- in the
community
- in health
facilities
Risks for health and lab workers
Difcult access
Agent unknown
Spread
of infec-
tion
34
Emergencies require a multisectoral response, as presented below. The contribution
of health is highlighted in bold print.
A Search and Rescue/Search and Recovery plan: In the Philippines, search
and rescue is not a primary responsibility of the Department of Health. The
conditions for its involvement have to be specied and only by request.
Search and Rescue (Mass Casualty Incident); Search and Recovery (Man-
agement of Dead and Missing)
An Evacuation/Temporary Shelter plan in coordination with other agencies
A Mass Casualty Management plan (networking multiple hospitals with the
pre-hospital care system)
A Security plan
Specic Sectoral Relief plans (social welfare, public health, energy, shelter,
sanitation, food/nutrition, water, etc.)
B3.4. Recovery Considerations
The recovery phase in the hospital setting centers on the return of the response
personnel and the hospital to normal operations the earliest time possible. Limited
recovery or failure to recover can worsencurrent vulnerabilities or create new ones
to future stressful situations. This is clearly seen when the hospital responds to an
external emergency. The continuity of critical and essential functions of the hospital
is vital, particularly in hazard-prone regions. The restoration may be on a short-term
(i.e., within hours) or long-term basis (when services are disrupted for weeks or
months). In the latter case, the hospital focuses on relocation of services within the
facility or to an alternative facility either temporarily or permanently with construction
of new facilities or change of hospital sites.
Recovery considerations are often described from the community perspective as
shown below (WHO, ADPC, 2006b). This may provide the hospital insights in
determining its contribution to this phase, when involved in external emergencies.
It has to derive similarities and differences that will be useful in crafting its own
recovery plan when affected by an internal emergency.
From Relief to Recovery
Disasters change social, political, economic and even demographic realities.
People begin almost immediately to re-house themselves and reestablish
their social and economic networks after a disaster.
Most people have good ideas of what they want to do to rebuild their lives. It
is essential to take their views into account when planning for recovery.
There is no clear-cut boundary between relief and recovery processes.
Purpose
To assist communities in reestablishing themselves quickly and effectively,
recognizing that there will be a short-term need for external support to supple
ment the personal, organizational and social structures which have been
disrupted by the event.
Denition
Management plan and process to restore the community to an appropriate
level of functioning; to restore emotional, social, nancial 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 difcult process, i.e., creates conicts 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: reects on social processes and physical recon-
struction.
A well-managed recovery process helps a community/health care facility to return
not only to its normal functions but to a better level of functioning and capability
to address future disaster. Full recovery with satisfactory coping may be prolonged in
hazard-prone and highly vulnerable communities.
The transition between response and recovery is a recognized gray area. Hospi-
tals of the DOH need to be familiar with the existing denition of the local
government to determine implications to its recovery plan. Republic Act. 8185 of
1997: Emergency Powers of the Local Government Units states the duration of Ca-
lamity Area Declaration to be one year from the effectivity of the declaration.
The declaration of the state may be terminated once 85% of the repair and
rehabilitation works and services have been restored. However, when the disaster
effects are recurring or protracted, the declaration shall be a continuing one.
In practice, recovery is often viewed to be more within the function of the Depart-
ment of Social Welfare and Development.
B4. PLANNING
B4.1. Process

Planning in health emergency management is a sequence of steps, listed as follows:
1. Determine the authority responsible for the process.
2. Establish a planning committee.
3. Conduct a risk analysis hazards and community vulnerabilities.
4. Set the planning objectives.
5. Dene the management structure for the process.
6. Assign responsibilities.
7. Identify and analyze capacities and resources.
8. Develop the emergency management systems and arrangements.
35
36
9. Document the plan.
10. Test the plan.
11. Review and update the plan on a regular basis.
These steps are generic to a planning process. Specic for risk management are
the tools used in Steps 3 and 7 that focus on risk assessment, risk analysis and
risk reduction.

B4.2. Outputs
In Risk Management, three plans are of utmost importance:
a. A set of Health Emergency Preparedness or Risk Reduction plans how
can we prevent emergencies from occurring in the community. These
include:
A Hazard Prevention plan
A Vulnerability Reduction plan
A Capacity Development plan (commonly referred to as Prepared-
ness Plan)
In the Philippine setting, the Capacity Development plan centers on the
elements of successful Health Emergency Management or the 10Ps,
namely:
Policies, protocols, guidelines, procedures
Plans
People
Partnership building
Program development
Physical infrastructure development
Practices
Peso and logistics
Promotion of health
Package of services at the community, evacuation centers, hospi-
tals, regional ofces
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., ow 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
sub-plans, collectively known as the Emergency Preparedness, Response and
37
Recovery Plan. For the Health Sector, this plan becomes the Health Emer-
gency Preparedness, Response and Recovery (HEPRR) Plan.
At the national level, the Health Emergency Management Staff develops its: (1)
National Strategic and Developmental Plan, (2) Annual Work and Financial/Opera-
tional Plan, (3) Emergency Preparedness Plan in support of its Emergency
Preparedness Program, (4) National Response Plan, (5) Recovery/Reconstruction
Plan, and (6) Contingency Plan.
Contingency planning is a management tool used to analyze the impact of potential
crises and to ensure that adequate arrangements are made in advance. It involves
a predictive response element to an impending emergency by ensuring the
availability of nancial, human and material resources, and by installing a mecha-
nism for decision-making that can shorten disaster response. (UNICEF, 2007)
All plans promote greater coordination, networking, resource mobilization, dis-
patching of response teams for local and international humanitarian assistance, and
logistics management (such as management of donations).
Hospital HEPRR planning is an integral part of both the multisectoral community Hospital HEPRR Hospital HEPRR
emergency plan and the health sector emergency plan.
Hospital HEPRR Plan has two aspects:
Protection of the hospital, hospital services, patients and hospital staff from
harm caused either internally or externally; and
Provision of hospital services to the community before, during and after an
emergency.
B4.3. Outline of Hospital Health Emergency Preparedness, Response and
Recovery Plan
The planning committee formulates and documents the HEPRR Plan as guided by
the following suggested format. (Details of the formulation of an HEPRR Plan are in
Section 2 in Part III of this manual.)
38
Outline of Hospital Health Emergency Outline of Hospital Health Emergency
Preparedness, Response and Recovery Plan Preparedness, Response and Recovery Plan
I. Background
II. Plan description II. Plan description
III. Goals and objectives III. Goals and objectives
IV. Planning group IV. Planning group
V. Management structures V. Management structures
VI. Roles and responsibilities VI. Roles and responsibilities
VII. Hospital Emergency Preparedness Plan VII. Hospital Emergency Preparedness Plan
A. Hazards prevention A. Hazards prevention
B. Vulnerabilities reduction B. Vulnerabilities reduction
C. Capacity development C. Capacity development
VIII. Hospital Response Plan VIII. Hospital Response Plan
A. Organization A. Organization
B. Systems activation B. Systems activation
C. Resource mobilization C. Resource mobilization
D. Partnership D. Partnership
IX. Hospital Recovery and Reconstruction Plan IX. Hospital Recovery and Reconstruction Plan
A. Damage assessment and needs analysis A. Damage assessment and needs analysis
B. Psychosocial support B. Psychosocial support
C. Restoration of utilized/damaged resources and services C. Restoration of utilized/damaged resources and services
D. Post incident evaluation D. Post incident evaluation
X. Annexes X. Annexes
A. Glossary A. Glossary
B. Abbreviations B. Abbreviations
C. Directory of contact persons C. Directory of contact persons
D. Inventory of resources/assets of the hospital and partner D. Inventory of resources/assets of the hospital and partner
agencies agencies
E. Hospital policies, guidelines, protocols, and other issuances E. Hospital policies, guidelines, protocols, and other issuances
relevant to emergency or disaster management relevant to emergency or disaster management
B4.4. Next Steps
In Health Emergency Management, the process of plan formulation is the sec-
ond critical step to save more lives, both of victims and of responders. To ensure
that the consensus reached takes its form, is understood by all, is validated and
practiced in its evidence-based mode, the hospital takes the following steps, an
elaboration of Steps 9 to 11 in B4.1 Planning Process above.
1. Write the Hospital HEPRR Plan and have it approved by the Chief of
Hospital. The Plan is not a plan until written and approved by the highest
authority. A plan should be documented so as not to be forgotten.
2. Disseminate the plan to all the stakeholders and all the hospital staff.
Everyone needs to know the plan so that in an emergency no one would
say he does nothing because he knows nothing. A plan should be
simple to be understood. A plan should be disseminated to be in the
hands of those who will implement it.
3. Test the plan. A plan is believed to be effective only when it is tested, i.e., to
know its functionality, acceptability, and doability in the hands of the imple-
menters. A plan should be tested to know the gaps and problems.
39
C1. PREPAREDNESS PHASE
C1.1. Planning Group/Committee
Health Emergency Preparedness, Response, Recovery and Reconstruction
planning is a local activity carried out by end-users and it applies to specic
circumstances. It is done by a group of authorized key individuals or imple-
menters and not by a single person. The Planning Group/Committee of the
hospital shall consist of all the hospitals major decision-makers, including
a representative from the community. The community representative may be
a member of the Disaster Coordinating Council, a local ofcial, NGO or
volunteer group, or a member of a health professional society (e.g., medical
or nursing society).
The planning group may be an ad hoc group convened specically for the
formulation of new plans or for the update of existing plans after drills or after
the emergency/disaster post-event evaluation.
Composition of the Hospital HEPRR Planning Group/Committee:
Hospital director
HEM coordinator/assistant coordinator
Representative from the areas of hospital operation
Representative from the hospitals administrative unit (the administrative
ofcer or nance and logistics ofcers, or their representatives)
Representative from the hospitals planning unit
Representative from the community (representative from the Disaster
Coordinating Council, from the medical society, or from any nongovern-
ment organization)
4. Implement the plan.
5. Monitor and evaluate the implementation of the plan.
6. Review and update. A Plan should be updated regularly to conform with
the times.
Pointers in Formulating a Health Emergency Management Plan
Write it down or it will not be remembered.
Make it simple or it will not be understood.
Disseminate it or it will not be in the hands of those who need it.
Test it or it will not be practical.
Revise it or it will not be up-to-date.
(Source: Banatin, 2005)
40
Functions of a Hospital HEPRR Planning Committee:
1. Develops, reviews and updates the Hospital HEPRR plan after every drill or ac-
tual disaster.
2. Gathers required information and gains the commitment of key people and orga-
nizations.
3. Initiates testing of the plan for its functionality and revises/updates it according to
adaptability to the current situation.
4. Develops an Annual Operation Plan and other plans relevant to Health
Emergency Management.
C1.2. Management Structures
The management structures in Health Emergencies and Disasters in the Hospital
are provided for in A.O. 168 s. 2004 (Section V. Policy Statements, A. Organizational
Structure) which states that:
1. All health facilities should have an Emergency Preparedness and Response Plan
and a Health Emergency Management Ofce/Unit/Program. Such ofces, units
or programs shall be under the supervision of the highest ofcer, such as the
Regional Director, Chief of Hospitals or the equivalent ofcer 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 nance group.
3. An emergency coordinator shall be designated in all health facilities. He/she
should be an integral member of any crisis or consequence management in his/
Figure 3. Example of a Hospital HEPRR Planning Group/Committee Structure
Chief of Hospital/
HEM Coordinator
Representa-
tives from
the Areas
of Hospital
Operation
Represen-
tative from
Administra-
tive Unit
(nance/
logistics
ofcer,
transport)
Represen-
tative from
Planning
Unit
Representa-
tive from the
Community
41
her respective facility or institution. As such, he/she shall coordinate directly with
higher ofcials for technical aspects during emergencies, and administratively,
shall be answerable to his/her mother unit. He/she shall be given proper authority
and support (personnel and material) by the management during operations.
4. An ofcial spokesperson who is accessible and available to the media shall also
be designated. He shall be responsible for disseminating information that is
accurate and updated.
C1.2a. Crisis and Consequence Management Committee
The Crisis and Consequence Management Committee is a lower committee that
will provide technical as well as operational support to the Executive Committee
and provide inputs for decisions and policy directions in crisis, emergency and
disaster. Given the legal basis, a suggested composition of the Crisis and Conse-
quence Management Committee is as follows:
Membership
1. Medical Center Chief II/Hospital Director
2. HEM Coordinator/Assistant Coordinator
3. Chief of Clinics
4. Chief Administrative Ofcer
5. Chief of Nursing Service
6. Head of Emergency Department
7. Public Health Unit/Epidemiology
Optional membership
8. Chief of Surgery
9. Chief of Anesthesia
10. Chief of Medicine
11. Chief of Orthopedics
12. Chief of Pediatrics
13. Chief of Obstetrics/Gynecology
14. Chairperson of Security on Critical Infrastructure Program
15. Chief Security
16. Head of Maintenance Section
17. Chairperson of Hospital Center of Wellness Program
Health emergency function is a concurrent function of the assigned hospital
staff. Under normal conditions, the assigned hospital Health Emergency Staff
Coordinator/Assistant Coordinator may be part of a department (e.g., Medicine,
Emergency Room, Surgery).
The Medical Center Chief/ Hospital Director shall exercise discretion in the for-
mation and composition of the committee to t 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.
42
C1.2b. Hospital Health Emergency Management Staff (HEMS) Coordinator
As stated in Department Order No. 136-I s. 2001 and afrmed in Department
Personnel Order No. 2005-1324 dated June 14, 2005, the responsibilities of the
Hospital HEMS Coordinator and the Assistant Coordinator are:
Coordinator
1. Reports directly to his respective director in the hospital or CHD, and coordi-
nates with the HEMS Director in times of emergencies and disasters.
2. Takes the lead in the preparation of the Emergency Preparedness Plan of the
CHD/hospital, duly approved by his chief, disseminated to all the staff, and
regularly tested, evaluated and updated.
3. Prepares the annual work and nancial 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 hospitals/CHDs 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 ofcer on health emergency and disaster.
3. Acts on behalf of the coordinator in the latters absence.
4. Acts as training ofcer in relation to health emergencies and disasters.
43
C2. HEALTH EMERGENCY RESPONSE PHASE
During emergency response, management structure is of prime importance as it
shows the specic chain of command, control and coordination. Reecting the roles,
functions and responsibilities of all key players involved, the management structure
shows the ow of reporting, coordination and communication. The structure is best
represented and explained with diagrams.
C2.1. Hospital Emergency Incident Command System (HEICS) vis--vis the
Incident Command System (ICS)
Incident Command System (ICS) is a management system used in responding
to an incident. There are two types of ICS: Single Command involving only one
agency, and Unied Command involving several agencies responding to the
incident. This is a generic nomenclature and can be applied to any facility (WHO
and ADPC, 2006). Hence, if the facility is a hospital where all responders are
coming from the same agency, it is a single command type of ICS.
The hospital in responding to an incident at Code Blue alert now activates the
Hospital Emergency Incident Command System (HEICS) which involves an
organizational shift to an emergency mode. While the basic structure of an
Incident Command System is the same for all facilities, the command,
coordination and control system can be adapted to the hospital conditions.
During an emergency/disaster, as the hospital is in an emergency mode,
other staff of the hospital may assume roles and functions as needed in an
emergency. The HEMS Coordinator may assume the role of the Incident
Commander, an operations head or a spokesman as deemed necessary by the
hospital chief.
C2.2. Hospital Emergency Incident Command System
C2.2a. Hospital Emergency Incident Command System Structure
The HEICS is the prescribed organizational structure for command, control
and coordination as stated in A.O. 168 s. 2004. It is a system which employs
a logical management structure, dened responsibilities, clear reporting chan-
nels, and a common nomenclature to help unify hospitals with other emergen-
cy responders.
HEICS, the standard for health care disaster response, offers the following
features (HEMS, 2000a):
Predictable chain of management
Flexible organizational chart which allows exible response to spe
cic emergencies
Prioritized response checklists
Accountability of position function
Improved documentation for improved accountability and cost
recovery
Common language to promote communication and facilitate outside
assistance
Cost-effective emergency planning within health care organizations
44
The HEICS has ve basic personnel consisting of an Incident Commander, Op-
erations Ofcer, Planning Ofcer, Finance Ofcer and Logistics Ofcer. Three
other personnel Security Ofcer, Liaison Ofcer and Public Information Ofcer
serve as staff to the Incident Commander and altogether compose the
command staff. (See Figure 4.)
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 ofce transactions are
suspended and the hospital is shifted to emergency/disaster mode.
C2.2b. Job Action Sheets
The Job Action Sheets (JAS) or job descriptions tell responding staff what they
are going to do; when they are going to do it; and, who they will report it to after
they have done it. Of the JAS content, the job title and the mission statement
should not be changed under any circumstances. These are universal state-
ments which allow emergency responders from different organizations to com-
municate quickly and clearly with other practitioners of the Incident Command
System (WHO, ADPC, 2006). With regular use, the content may be updated or
modied 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 ofcers.
Job Action Sheets
A. Incident Commander
B. Safety and Security Ofcer
C. Public Information Ofcer
D. Liaison Ofcer
E. Logistic Section Chief
F. Planning Section Chief
G. Finance Section Chief
H. Operations Section Chief
I. Treatment Team Leader
J. Triage (Initial) Team Leader
Figure 4. Basic Hospital Emergency Incident Command System (HEICS) Structure
Operations Planning
Administrative
and Finance
Security Ofcer
INCIDENT COMMANDER
Liaison Ofcer
Public Information Ofcer
Logistics
45
K. Transport Group Supervisor
L. Staging Ofcer
M. Field Medical Commander
N. Morgue Manager
O. Medical Controller
P. Incident Medical Commander (for pre-hospital incident)
In Mass Casualty Incidents, there are two positions for medical concerns at the
Command Post (pre-hospital) based on A.O. 155 s. 2004. These are the Medical
Controller and the Incident Medical Commander.
The Medical Controller is a designated senior Department of Health ofcer ap- Medical Controller Medical Controller
pointed to assume the overall direction of the medical response to mass casualty
incidents and disasters. Control is established from a designated Operations
Center either in the Central Operations Center or the Regional Operations Center
and whose main responsibility is to coordinate all the services of the sector.
The Incident Medical Commander is the highest representative of the Depart- Incident Medical Commander Incident Medical Commander
ment of Health or the local health ofce as designated by the local chief ex ecu-
tive depending on the extent of the disaster. He serves as the liaison ofcer of
the Health Sector to the Command Post headed by the Incident Commander.
For regional disasters, the Incident Medical Commander should be the highest
representative from the DOH CHD.
For quick retrieval and repeated use of the Job Action Sheets, the hospital
species 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 efciency in the accomplish-
ment of tasks.
C2.2c. Organizational Chart
A comprehensive HEICS Organizational Chart for a hospital is presented in
Figure 5 (Stop Death Program, 2000a). The positions are lled up based on
the priorities created by the emergency/disaster and their importance to
minimizing the harmful consequences. The rst assignments are given to
those immediately needed while some are for later hours (particularly if the
emergency occurs at night) or even for succeeding days. Some positions
need not be lled up or a person may assume two or more positions depend-
ing on the human resources available and the capability of the hospital.
Cognizant of the uniqueness of each health emergency/disaster and of the
limitation of human health resources, the plan has to provide for delegation of
more than one job to an individual or for re-prioritization of needs given the
emergencys evolving conditions.
46
C2.3. Roles and Responsibilities of the Hospital
In Mass Casualty Management, the hospital can be a responding facility, a
receiving facility, and can be both a responding and receiving facility. This
would depend on the classication, designation and capability of the hospital.
To become a responding facility, the hospital must have a competent re-
sponse team always available and ready to be dispatched in times of emer-
gency. The response team is composed of a physician (or Hospital HEM Co-
ordinator), a nurse, Emergency Medical Technician (EMT), trained non-medi-
cal staff, and an ambulance driver with an equipped ambulance. The team
must have the capability to undertake the following:
a. Incident Command System - Team Leader or the HEM Coordinator must
have the capability to establish command, control and coordination in the
eld, or must be capable of becoming an Incident Commander
Safety and Security Ofcer
INCIDENT COMMANDER
Liaison Ofcer
Public Information Ofcer
Logistics Chief
Facility Unit
Leader
Damage
Assesment
and Control
Ofcer
Sanitation
and
Systems
Ofcer
Communications
Unit Leader
Transportation
Unit Leader
Materials Supply
Unit Leader
Nutritional Supply
Unit Leader
Planning Chief
Situation Status
Unit Leader
Labor Pool Unit
Leader
Medical Staff
Unit Leader
Nursing Unit
Leader
Patient
Tracking
Ofcer
Patient
Information
Ofcer
Finance Chief
Time
Unit Leader
Procurement
Unit Leader
Claims
Unit Leader
Cost
Unit Leader
Medical Care
Director
Medical Staff
Director
In-Patient Areas
Supervisor
Surgical Services
Unit Leader
Maternal Child
Unit Leader
Critical Care
Unit Leader
General Nur-
sing Care
Unit Leader
Out-Patient
Services Unit
Leader
Treatment Areas
Supervisor
Triage Unit
Leader
Immediate Treat-
ment Unit Leader
Delayed Treat-
ment Unit Leader
Minor Treatment
Unit Leader
Discharge Unit
Leader
Morgue Unit
Leader
Ancillary Ser-
vices Director
Operations Chief
Human Services
Director
Laboratory
Unit Leader
Radiology
Unit Leader
Pharmacy
Unit Leader
Cardiopulomonary
Unit Leader
Staff Support
Unit Leader
Psychological
Support Unit
Leader
Dependent
Care
Unit Leader
Figure 5. Comprehensive Hospital Emergency Incident Command System Organiza-
tional Chart
47
b. Rapid Health Assessment
c. Triaging
d. Life support Basic Life Support (BLS), Standard First Aid, EMT, or
Advanced Cardiac Life Support (ACLS)
e. Proper communication
f. Proper coordination
g. Establishment of Emergency Operations Center on-site
h. Evaluation and provision of medical/health care to the victims
The hospital as a receiving facility must possess the following capacities: receiving facility receiving facility
a. Emergency room equipped for emergency care to handle all types of
MCI
b. Equipped critical areas to accommodate and provide necessary deni-
tive care to the victims (Operating Room, Recovery Room, Burn Unit,
Trauma Unit, Morgue, ICCU/CCU, Ancillary Services, Pharmacy, etc)
c. Competent staff to provide denitive care to the victims
d. Pre-identied rooms or wards to accommodate inux of patients
As a receiving hospital it must be able to manage the surge of victims/patients
through the following:
a. Expansion of key services to accommodate inux of patients.
b. Having operating rooms which can serve beyond their normal load of
patients.
c. Handling additional laboratory and radiological procedures, and other
support services requirements.
d. Postponement/cancellation of elective operations.
e. Facilitation of rapid turnover of patients or coordination with other hos-
pitals for patients transfer.
f. Mobilization of additional human resources within the area or tapping
the HEMS system using the entire DOH network.
The hospital can be both a responding and receiving facility if it pos-
sesses both of the above capacities and capabilities.
C 2.4. Response Teams
C 2.4a. In-Hospital Response Team
The In-Hospital Response team provides the denitive 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 Ofcer and team
c. Treatment Ofcer and team
d. OR personnel
48
C2.4b. On-Scene Response Team
This is a small group of competent and certied physicians, nurses, ad-
ministrative workers (utility workers) and drivers deployed to the emer-
gency/ disaster site outside the hospital for external emergencies and/or
inside the hospital for internal emergencies. They are responsible for the
management of the eld/on-site activities from assessment, triage, treat-
ment, evacuation and transport in coordination with the Command Post/
Hospital Operation Center, Receiving Hospital Facility and the CHD and
HEMS Operation Center. (Other details are in Section 4. Deployment of
Response Teams.)

The on-scene response team is composed of:
a. On-scene Response Ofcer (Team Leader)
b. Surgeon/Anesthesiologist
c. Internal Medicine
d. Nurses/EMT
e. First Aiders/Helpers
f. Driver
The physical infrastructure is a critical resource to be examined in the hospitals
preparedness for health emergencies. The relevant sections of the WHO-WPRO
Field Manual for Capacity Assessment of Health Facilities in Responding to Emer-
gencies may serve as a guide in such a review process for the hospital in general
and for particular sites. (WHO-WPRO, 2006)
The physical infrastructure involved are:

1. Health Emergency Management Unit/Ofce
The HEM unit/ofce 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 Ofce/Unit/Program under the supervision of the Chief of Hospital. Often,
the unit/ofce is located in the mother unit of the designated emergency coordi-
nator and assistant coordinator who perform these roles as concurrent functions.
2. Hospital Operations Center (Hospital OpCen)
This is the Nerve Center with the ability for command, control, coordination and
communication in dealing with emergency or disaster situations. This is where
the Incident Commander and his staff are located, and thus constitutes the head-
quarters or focal control point from which the hospital emergency response plan
is directed and coordinated. (Details of the physical design and functions are in
Section 5.)
3. Hospital Service Areas
It is essential that certain areas of the hospital be designated for specic functions
49
Figure 6. Patient Care Stations
Source: Sixth Inter-regional Course on Public Health and Emergency Management in Asia and the Source: Sixth Inter-regional
Course on Public Health and Emergency Management in Asia and the Pacic (PHEMAP), WHO (WPRO, SEARO) and ADPC, 2006.
Holding Area
Red Area
Command
Post
Triage
Area
Accident
and E
Department
such as reception of casualties, treatment, and discharge of patients (DOH-SDP,
2000b). The plan should be specic as to the function of these areas, stafng re-
quirements, basic supplies to be utilized, and other necessary features like venti-
lation, alternative sources of energy, communication, and waste disposal. Some
considerations in hospital design, energy source and communications are given
in Annex 1. The development of these areas may involve either the improvement
and/or upgrading of existing areas or construction of new ones as deemed ap-
propriate for the hospital in compliance with the technical requirements of such
areas. The hospital must have the following areas for managing health emergen-
cies:
a. Emergency Room Most important area for reception of mass casualties,
triage and treatment. The emergency room must have:
Reception Area/Admission The area should be available on short notice
to receive multiple casualties for registration and admission.
Triage Area The primary function of a triage area is rapid assessment
of all incoming casualties, the assignment of priorities for management,
and distribution of patients to various other patient care areas in the hos-
pital. Without a triage area to manage the patient ow, the major treatment
area may become overloaded.
Decontamination Area Physically located before the entrance of the
emergency room, the decontamination area is provided with facilities for
security and privacy of the patient, bathing of the patient, disposal of con-
taminated clothing and other materials, contaminated water disposal/drain-
age, and draping of decontaminated patients and decontamination team.
The decontamination team members should be provided with the appropri-
ate personal protective equipment. Decontamination is not routinely done
50
to all patients. It is specically used only if there is a high index of suspi-
cion for biological, chemical and radionuclear incidents.
Patient Care Stations One suggested method of organizing patient
care stations is the designation of areas physically located in the Emer-
gency Department for color-tagged patients (See Figure 6) (WHO and
ADPC, 2006). Stations may be designated as:
Red Immediate Care Area: red tag patients
Yellow Urgent Care Area: yellow tag patients
Green Delayed Care Area: green tag patients
b. Admission Pre-surgical Holding
Most trauma patients stabilized in the Red Area (emergency department)
will be sent to the Admission Pre-surgical Holding area.
c. Operating Room
The number of operating rooms that can be staffed is the main limiting fac-
tor in the provision of denitive care for a large number of severely injured
casualties. The most senior surgeon available must take the responsibility to
prioritize and assign cases as rapidly as possible.
d. Intensive Care Units (Coronary/Medical/Surgical)
e. Special units
Burn Unit
Toxicology Center
Infectious Units (isolation rooms for SARS, etc)
Disability Care
f. Ancillary units
Laboratory
X-ray/other Radiologic Services (CT Scan, MRI, etc.)
Blood Bank Facilities
g. Psychosocial Care Area
This is physically located in a designated area in the out-patient department for
individual and group consultations. Hysterical and difcult to control persons,
whether patients, visitors or staff, who can be extremely disruptive to hospital
disaster operations shall be placed in a separate isolated area and later trans-
ported to Regional Centers and/or the National Center for Mental Health.
h. Morgue
Many disasters can result in a large number of fatalities. This may require that
present morgue capacities be expanded or other outside facilities (such as
a church or stadium) be temporarily utilized. The disposal of the dead shall
follow the existing standard operating procedure for hospitals and the relevant
guidelines from the National Policy on Management of the Mass Dead.
51
i. Family Waiting Area
A separate area must be pre-designated for family members seeking information.
Previous experiences with disasters have shown that families and friends would
converge en masse to the hospital seeking information about victims. This con-
vergence can seriously interfere with efforts of the hospital to respond effectively
to the situation. This area may also be utilized to discharge in-hospital patients
and victims of the disaster.
j. Social Worker Ofce/Area
Given the confusion and the anxiety of converging families and friends of the
victims, an area is designated to allow prompt, systematic and compassionate
technical assistance for families inquiring about and seeking access to support
from government and nongovernment resources.

k. Accommodations for Responders

Sleeping/rest areas are provided to responders in-between duty shifts.
l. Media Room
There should be a designated area to hold and brief the media. The room should
not be near the area where patients are treated like the Emergency Room or the
Operating Rooms. Furthermore, provision should be made to conduct regular
press conferences or give out press releases.
The effectiveness and efciency of Health Emergency Preparedness and Response
of a health facility entail an understanding of a systems perspective the develop-
ment of connected parts functioning together for a common goal. Given the com-
plex nature of an all-hazard approach, some of the component systems by them-
selves are unique to the approach (such as the Early Warning and Alert System and
Mass Casualty Management). The others are existing ones that need to be modied
to support the approach (such as Training, Logistics, and Information Management).
These systems, guidelines and protocols specic 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 dened level of function:
1. Early Warning and Alert System Section 6
2. Damage Assessment and Needs Analysis/
Rapid Health Assessment Section 7
3. Emergency Operations Center Section 5
4. Mass Casualty Management System Section 8
5. Management of Mass Dead and Missing Section 9
6. Public Health Services Section 10
7. Mental Health and Psychosocial Support Section 11
8. Coordination and Networking Section 12
52
9. Human Resource Development Section 13
10. Logistics Section 14
11. Information Management Section15
12. Health Promotion and Advocacy Section 16A
Risk Communication and Media Management Section 16B
Risk Communication in Hospitals Section 16C
13. Health Systems in Emergency/Disaster Section 17
14. Evaluations Section18
15. Research and Development Section 19
In the design of these systems, the hospital develops or adapts the policies, guide
lines and protocols that have been set at the national level for activation during the
Emergency Response, as follows:
1. For Adoption/Adaptation
Early Warning System/Code Alert System/Integrated Code Alert System
(A.O. 182 s. 2001; A.O. 2008-0024)
Health Emergencies and Disasters (A.O. 168 s. 2004)
Logistics Management System on Donations (A.O. 2007-0017)
Mass Casualty Management (A.O. 155 s. 2004)
Management of the Dead and the Missing (A.O. 2007-001B)
Health Information Management System (D.O. 1-J, s. 2003)
Coordination, Networking, and Referral System (A.O. FAE 007 s.1998)
(for Metro Manila only)
Resource Mobilization (A.O, 13 s. 199; Memo No. 120 s. 2003)
Manual on Treatment Protocols of Common Communicable Diseases
and Other Ailments During Emergencies and Disasters
Guidelines on WMD Response for the Philippines (A.O. 155)
Key Health Messages for Emergencies (compendium)
The policies cover specic provisions for operations such as emergency dis-
patch, identication of the dead, etc. and for organizational structure, human
resource development, logistics, communication, information management,
networking and collaboration, and nance in support of the response operations.
2. For Adaptation from Other Ofces
Epidemiology and Surveillance
Guidelines on Control of Communicable Diseases
Guidelines on SARS, Emerging and Re-emerging Infections
Guidelines on Infection Control (Hospital SOP)
3. For Development
Guidelines and Procedures in Evacuation
Public Information System and Management of the Media
Guidelines on Risk Communication
Guidelines on Communication
Guidelines and Procedures on Emergency Response
Guidelines on Biological, Chemical, Radio-Nuclear and Explosives
Others
53
Table 4. 10 Ps of Health Emergency Management (Based on A.O. 168 and A.O. 155)
Standards Targets 10 Ps


> HEM Coordinator
> Crisis and Consequence

> Ofcial Spokesperson
The hospital should not be limited to developing/adapting its policies and guidelines to
the aforementioned existing ones. It should be continuously vigilant in identifying con-
cerns that can be addressed by policies/standard procedures.
Overall Framework for the Health Emergency Management System: 10 Ps
The ten essential elements known as 10Ps 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.
54
Continuation of Table 4
Standards Targets 10 Ps
55
Continuation of Table 4
Standards Targets
> All hospitals have equipped emergency rooms
> Tertiary hospitals have special units based on
> All responding hospitals equipped with
> Receiving hospitals have equipped ER to
> Allocation for Preparedness activities from
> Buffer stocks of medicines (10%) of available
> HEM Coordinators in Metro Manila and
> Hospitals have designated ambulance for
emergencies with equipment, supplies and
> Pre-positioned medicines, drugs, medical
10 Ps
56
Targets
10 Ps Standards
Continuation of Table 4
57
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 denitive 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.
1. Activation of the Alerting Process
1.1 Declaration
As provided in the Integrated Code Alert System, 2008 (See Section 6.1),
the Hospital Code Alert shall be declared by the Secretary of Health or by the
Director of HEMS in cases of external emergencies; and by the Medical Cen-
ter Chiefs, Chiefs of Hospital or Hospital HEMS Coordinator, for emergencies
within their catchment area. The alert level is raised, lowered or suspended by
these authorities or their designates. The designates who receive and give the
initial notication have been pre-assigned on a 24-hour basis per day to en-
sure notication during the evening hours, weekends and holidays.
Conditions to raise or suspend the alert level
Raise - arrival of patients in the hospitals to warrant raising; increase in
threat.
Suspend/terminate when threat is no longer present; when no signi-
cant incident is monitored and the hazard or condition (typhoon, elec-
tion, bombing, etc.) is nished and/or contained
1.2 Notication
Notication is carried out within the hospital following the prescribed process,
which species the chain of command in notifying those on duty and other
appropriate hospital staff of the hospitals status. In case of problems in the
system, the alternative system of notication, which is adapted to the hospi-
tals realities of people, equipment and procedures, is activated. Example: In
the case of re, any person with knowledge of the situation immediately
activates the re alarm system of the hospital. Although there are guideline
58
for the code alert, each hospital shall develop their own procedures for
activating, elevating and suspending the code.
2. Activation of the Plan
With the declaration of the code alert, the plan is activated. Depending on the
alert level status, corresponding human resource and other requirements are
mobilized.
3. Activation of the Hospital Operations Center
For the Operations Center, the earliest response mechanism is established at
the lowest alert level Code White. Non-permanent centers are activated within
one hour and secured. This serves as the Command Post when Code Blue is
raised.
The Hospital Operations Center continuously reports and coordinates with the
Regional and National HEMS Operations Center and with Regional/Provincial
Disaster Coordinating Councils. In the event of failure of existing communication
system, the alternatives are activated.
4. Activation of the Hospital Emergency Incident Command System (HEICS)
Under Code Blue, the HEICS is immediately established using the six-step
response for critical incident management.
Step 1. Assume command. Someone should immediately assume command.
Step 2. Assess situation. Assess magnitude of the incident from sources and
the network.
Step 3. Identify critical areas. These include emergency rooms, decontamina-
tion, triage, treatment, security, media, etc.
Step 4. Activate or identify the Operations Center. Coordinate with HEMS
Opcen; assign staff and ensure communication system is in place.
Step 5. Identify the Safety Ofcer. The Safety Ofcer is the one to go around
the compound to ensure safety of the staff, the hospital, and patients.
Step 6. Secure the hospital and critical areas. Identify area for ambulances,
points of ingress and egress.
Job actions sheets are distributed to designated ofcers. 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).
Denes incident objectives (how to get there) and strategies to meet the de -
ned goals.
Adequately disseminates information, including the following, to achieve co -
ordination throughout the incident:
Response goals, objectives and strategies
Situation status reports
Resource status updates
59
Safety issues for responders
Communication methods for responders
Evaluates strategies and tactics for effectiveness in achieving objectives and
monitors ongoing circumstances.
Revises the objectives, strategies and tactics as dictated by incident cir-
cumstances.

The outputs of these actions are:
Incident Action Plan
Establishment of:
- Gold or Strategic Command These are the people managing the
event, providing strategic direction as well as policy direction. In the
hospital, this is the Incident Commander together with the heads
of the Operations, Planning and Administration. Their role is to plan,
assess and give directions, respond to media, etc. They should not
micromanage.
- Silver or Tactical command These are the people receiving orders
from the gold. They carry out the orders by supervising their people.
In the hospital setting this could be the heads of the emergency room,
the Logistics Ofcer, the Administrative Ofcer, etc. They ensure that
the needs and requirements are met.
- Bronze or Operational Command In the hospital setting, these are
the doctors treating the patients, the social workers listening to the
relatives, the psychosocial worker doing debrieng, etc.
5. Implementation of the Response Standard Operating Procedures/Protocols
for Internal and External Emergencies
These procedures/protocols include (WHO, ADPC, 2006):
5.1. Callback/management of staff
The notication process of staff mobilization deployment or stand-by is
carried out as prescribed according to the alert status level. The staff should
have the proper identication to gain access to the hospital when called back
on duty.
5.2. Management of eld/on-site activities
a. Deployment of on-scene response team
(SOP I: Standard Operating Procedure on Information and Dispatch)
b. Predetermination of eld areas by the rst responding team
c. Assessment of scene using Rapid Health Assessment
d. Establishment of Command Post or linkage with Command Post through
Field Medical Commander as Incident Medical Commander (Unied
Medical Command); assignment of a Field Medical Commander in cases
of multiple on-scene response teams
e Conduct of measures for site safety
f. Establishment of Advance Medical Post
60
(SOP II: Site Selection, Signage and Logistics)
g. Evacuation and transport
h. Establishment of Field Hospital/evacuation site or temporary shelter
i. Triage (second at Advance Medical Post, third during evacuation/transport)
j. Evaluation, care (rst aid, medical care, etc) and stabilization of casual-
ties at impact site, Advance Medical Post, and during evacuation/
transport
(SOP III: Handling of Equipment Attached to Patient) f Equipment f Equipment
k. Continuing coordination/monitoring with Regional/ DOH Central Opera-
tions Center and receiving hospital
l. Extension of services/termination of operations
m. Post-mission debrieng
n. Accomplishment of reporting forms HEARS Field Report, Rapid Health
Assessment Forms, Inventory Checklist, List of Casualties, Patient List,
Mass Casualty Case Record, Health Situation Updates, Post-Mission
Reports, Final Reports
5.3. Management of Emergency Department /Unit
This includes designation of area and provision of skilled personnel and
logistics for handling multiple casualties.
5.4. Management of casualties
Availability of Emergency Unit/ Department at short notice to receive mul-
tiple casualties who are identied, registered, triaged and treated in des-
ignated treatment areas, and admitted or transferred (SOP III: Handling of
Equipment Attached to Patient)
Implementation of procedures for:
- clearance of all non-emergency patients and visitors from the emer-
gency department;
- cancellation of all elective admissions and elective surgery;
- determination of rapidly available or open beds; and
- determination of the number of patients who can be transferred or
discharged
5.5. Timely provision of 24-hour services by the following:
Administration
Emergency
Nursing
Radiology
Laboratory including Blood Bank
Pharmacy
Critical Care
Central Supply
Maintenance and Engineering
Security
Dietetics
Housekeeping and Laundry
Psychosocial/Pastoral
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Mortuary
These services are for mass casualties, patients, hospital staff and responders.
5.6. Maintenance of 24-hour supply of drugs, medical supplies, diagnostic sup-
plies (e.g., X-ray lms, laboratory reagents), and equipment; also including
management of donations
5.7. Management of logistic and personnel support by concerned units for:
Beds
Retention and safekeeping of personal items removed from casualties
Isolation of victims with communicable diseases
Segregation/isolation of victims contaminated with hazardous materials
5.8.Management and use of ambulance
5.9. Assessment and maintenance of security services, particularly the protec
tion of critical services
5.10. Assessment and maintenance of communication services, including the
activation of an alternative communication system
5.11. Management of Internal and External Trafc Flow and Control, including
secured trafc access to the Emergency Department and controlled access
to allow timely ambulance turnaround

5.12. Management of Hospital Evacuation/Relocation of Patients and Staff, in
cluding use of alternative sites when original area is unavailable
5.13. Management of volunteers for medical and other services
6. Provision of the Public Health Services of the hospital which includes:
6.1. Damage Assessment and Needs Analysis/Rapid Health Assessment
6.2. Establishment and maintenance of Epidemiologic Surveillance System
6.3. Immunization
6.4. Therapeutic Nutrition Services
6.5. Laboratory Services (diagnostic)
6.6. Provision of Blood Services
6.7. Communicable Disease Prevention and Control
6.8. Management of the Dead (Identication of the dead/Mortuary)
6.9. Health Promotion and Advocacy/Risk Communication in Public Informa-
tion and in Media Management
7. Initiation and maintenance of coordination and networking for referral of
cases
8. Initiation and maintenance of Mental Health and Psychosocial Support
Services for casualties, patients, hospital staff, other responders, and the
bereaved
Services for casualties, patients, hospital staff, other responders, and the Services for casualties, patients, hospital staff, other responders, and the
62
9. Management of information Monitoring of Plan
- Recording and reporting procedures, e.g., accomplishment of reporting
forms (Inventory Checklist, Health Situation Updates, Post-Mission Reports,
Final Reports)
- Documentation of processes
10. Activation of plan in the event of complete isolation of hospital for
auxilia ry power, water and food rationing, medication/dressing rationing,
waste and garbage disposal, staff and patient morale
11. Declaration and Notication Process for:
- Continuation of or change in alert status (extension of services)
- Termination/closedown of Command Post/Operation Center
12. Conduct of Post-Incident Evaluation
13. Review and Updating of Plan including amendments to policies and
procedures
63
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.
1. Activation of the Recovery Plan. There is no identied time for the activation
of the Recovery Plan. It may start immediately after the response. Unlike the re-
covery plan for the communities, the hospital can initiate activation as soon as
possible. Hence the recovery plan can be activated right away.
B. Operations/Support Management
2. Suspension of the HEICS. This is done as soon as possible as the code alert is
lifted, then the hospital returns to its pre-disaster situation.
3. Implementation of the Recovery Standard Operating Procedures/ Protocols
for Internal and External Emergencies. These include (WHO, ADPC, 2006e):
3.1. Assessment Damage Assessment and Needs Analysis
3.2. Provision of services
a. Provision of mental health and psychosocial services for both acute and
long-term physical and mental health effects sustained by mass incident
casualties and hospital staff during the response.
b. Continuing provision of hospital medical services.
c. Continuing surveillance water and sanitation, food safety, emergent and
re-emergent endemic diseases, nutritional status.
3.3. Management of hospital facilities/logistics
a. Evaluation, clean-up and/or repair of damages to the hospital building/fa-
cilities/equipment; may include, where necessary, relocation of hospital
site/facilities.
b. Accounting and recording of available and utilized materials, medicines,
supplies and equipment, indicating also their respective sources.
c. Estimating cost of damages and response.
d. Requisitioning and replenishment of utilized materials and logistics.
e. Decontamination of areas, ambulance and equipment.
3.4. Management of Human Resource
a. Awarding and recognition rites for responders.
b. Provision of overtime compensation for responders.
c. Provision of assistance to hospital staff.
64
d. Re-training of hospital on technical and administrative procedures.
3.5. Maintenance of Coordination
Continuing coordination with HEMS and with the Regional Ofce is main-
tained to report the return of hospital to normal operations and the completion
of its recovery.
3.6. Information Management
a. Monitoring of Plan
b. Recording and reporting procedures
c. Documentation of processes
4. Conduct of in-depth evaluation of how the response system functioned
under stress. Based on the identied strengths and weaknesses, strategies are
proposed to improve the hospitals capacity to respond to future emergencies
and disasters, particularly in hazard-prone regions.
5. Review and update of the Hospital HEPRR plan and procedures. The modi-
cation reects the application of the lessons learned.
P
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I
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s
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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).
The parts of a policy are described below. To illustrate, examples from Administrative
Order No. 168 s. 2004: National Policy on Health Emergencies and Disasters are
given for some parts.
Background/Rationale the present situation or condition of the country, re-
gion, community or hospital-relevant emergencies or disasters, leading to the
reasons that triggers the development of the policy
Denition of Terms list of words or terminologies seen in the policy which are
not commonly used, or which are highly technical, and merit explanation
Objectives itemized reasons why this policy is being developed; everything
stated in the policy must address or attain the objectives
Scope and Coverage the extent and limitations of who will implement and the
application of the policy
Framework of Health Emergency Management includes the vision, mission,
goals/objectives
Strategies detailed scheme for reaching a goal or intention which will be the
basis for making activities
Policy Statements broad statements that express a set of goals, the priorities
within those goals, and the preferred strategies for achieving those goals; give
direction in achieving the goal
Example:
A.O. 168 policy statements cover:
Organizational Structure
Human Resource Development (Capability Building)
Support System (Logistics, Media Management, MIS,
Communication, System of Documentation, etc)
Program Development
Program Components
Networking and Collaboration
Finance
Implementing Mechanism includes the roles and responsibilities of the imple
menters in achieving the goal
Example:
A.O. 168 s. 2004 implementers consist of:
Department of Health
Hospitals
Centers for health development
Other government agencies
Nongovernment organizations
DOH central ofces
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 countrys 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 amplication of one element in Health Emergency Manage-
ment (i.e., management of the dead) provides details of guidelines and procedures.
Note that the policy identication 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 modied in 2007 with the rst four gures representing the year of
issuance.
While seven elements are constant (namely, Background, Objectives, Scope and Cov-
erage, Denition 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 specic units/groups (A.O. 168).
68
Table S1.1. Table S1.1. Comparison of Policy Content of A.O. 168 s. 2004 and A.O. 2007-001B
NATIONAL POLICY
A B
ELEMENTS
69
70
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.
Write a narrative on the background of your hospital and its catchment area, location
with reference to national geography, and location of the facility in the community/
LGU, using the template below. Present the qualitative or quantitative data/infor
mation either as narratives or as tables, graphs, illustrations and maps for easy, fast
and better understanding of the reader.
1. Name of the hospital, category and address
2. Geographic description of the hospital and its catchment area
Description of the community/catchment area total land area
Along the coastal area
Location in relation to a fault line (e.g., West Valley)
Low-lying area
Location in relation to other hazardous elements like oil depot,
industrial establishments, military camps, etc.
Distribution and concentration of vulnerable populations (squatters
area, land-locked or water-locked area, etc.)
Characteristics of the location of the hospital total area, terrain, built
on a hill, along the river bank, along the railroad, etc.
3. Demographic prole
Of the hospitals 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 reect capacity of the hospital to
manage emergencies
4. Health statistics
Of the catchment area - provinces, cities, municipalities
Leading causes of morbidity and mortality
Infant mortality rate
Maternal mortality rate
Malnutrition rate
Vaccination coverage
Indicators for basic hospital services, basic health services and
preventive health programs
Of the hospital
Leading causes of morbidity and mortality
Leading causes of consultation
Leading causes of discharge
Infant mortality rate
Maternal mortality rate
Malnutrition rate
Vaccination coverage
Indicators for basic hospital services
Indicators for basic health services and preventive health programs
5. Health facilities
In the catchment area provinces, cities, municipalities indicating if
government or private
Hospitals (private, LGU; category primary, secondary or tertiary)
Lying-in clinics, birthing places
Laboratories
Blood banks
Halfway houses
Health centers, etc.
6. Health facilities (hospitals) with special areas/services
Burn unit
Trauma unit
Isolation rooms
ICU, CCU, NICU
Decontamination area
Reference laboratories
Inventory of resources or assets of hospital in all various services
Emergency Room
Operating Room
Nuclear Medicine
Radiological Service
Laboratory
Others

7. Health human resource
Of the catchment area by facility and administrative area province, city,
mu nicipality
Physicians
Nurses
Midwives
Sanitary engineers
Sanitary inspectors
Nutritionists/dieticians
71
72
Health promotion ofcers
Dentists
Laboratory technicians
X-ray technicians
Psychologists
Barangay health workers
Of the hospital
Physicians
Nurses
Midwives
Institutional workers
Engineers
Nutritionists/dieticians
Health promotion ofcers
Social workers
Dentists
Medical technologists
Laboratory aides
Radiologic technologists
Psychologists
8. Disasters that have occurred, including the lessons learned and the gaps in re -
sponse
In the hospital
In the catchment area
9. Legal basis whereby the hospital is authorized to act in disaster situations
Law creating the existence of the hospital (R.A.; E.O.)

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

The (Name of Hospital) Health Emergency Preparedness, Response and Recov-
ery Plan denes the direction of the hospital in preparing for effective and ef-
cient response and recovery in any event of emergency or disaster within its
facilities and/or its catchment area. This embodies a set of strategies and activi-
ties based on the hazards and vulnerabilities or risk analysis of the hospital and
its catchment area.
Content of the Plan
The (Name of Hospital ) Preparedness Plan contains strategies and activities
that the hospital will carry out to build and enhance its capacity to respond to
emergency or disaster, whereas its Response Plan lays down the strategies
and activities in utilizing hospital resources for effective and efcient response
during an emergency or disaster. Policies, protocols, guidelines and procedures
pertaining to various emergency management systems for more efcient re-
sponse are included. The third plan, the Recovery or Rehabilitation Plan contains
the strategies and activities in mainstreaming and/or restoring the facility and its
services back to its prepared position for any forthcoming eventuality.
The (Name of Hospital) Health Emergency Preparedness Response and Recov-
ery Plan contains the inventory of its internal and external resources, in the form
of inventory lists and directories, in the context of human resources, logistics,
nancial sources, existing systems and services. These are all in the annexes of
the plan.
Scope of the Plan
This Plan shall be implemented by (Name of Hospital) together with, but not lim-
ited to, all the members of the health sector concerned with emergency or disas-
ter management in the catchment area.
Write a statement of the purpose of the plan from broad to more specic perspec-
tives. A hierarchy of the intent is described through goals and objectives. Well-written
objectives are simple, measurable, attainable, realistic and time-bound (SMART).
EXAMPLE: GOAL AND OBJECTIVES
Goal:
To enhance the hospitals capacity for prompt and effective attendance to the
largest possible number of people requiring medical and health care in a health
emergency or disaster ultimately reducing mortality, morbidity and disability and
promoting their recovery.
Objectives:
To provide policy for effective response to both internal and external disaster
situations that will affect the operation of the hospital and its staff, patients
and the community.
To identify the hospitals capability to handle mass casualty.
To identify responsibilities of individuals and departments in a disaster situation.
To identify Standard Operating Guidelines for emergency activities and
responses.
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74
To document best practices and lessons learned during simulation exer
cises, emergencies and disasters.
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.

Conduct a review of the existing committees and their performance of functions to
nalize the appropriate structure, i.e., use existing structures or develop new ones
for the Crisis and Consequence Management Committees and the Hospital Incident
Command System (HEICS).

Describe adequately the capacity of the hospital either as a responding facility, a
receiving facility or both, indicating the bases for such capacity.
VII. HEALTH EMERGENCY PREPAREDNESS PLAN
A. HAZARD
A1. HAZARD ASSESSMENT
A1.1. Denition
Hazard assessment is the process of identifying all the possible hazards
with the potential to affect the community. This is done in order to have an
idea of the possible areas to be affected, to predict the vulnerabilities of
such areas, and to anticipate the possible consequences or risks of such
hazards in these areas. There are four types of hazards that may affect the
community and the hospital:
Natural: Typhoon, earthquake, ood, landslide, tsunami, drought,
etc.
Biological: Disease outbreak (dengue, cholera, SARS, avian inu-
enza, red tide, etc.)
Technological: Chemical spill, food poisoning, re, gas explosion,
mercury poisoning, etc.
Societal: Rallies, stampede, war, armed conict, etc.
Prioritizing the hazards is important for the purpose of equitable utilization
or distribution of existing meager resources in doing hazard prevention
activities. Hazards can be prioritized based on the following considera-
tions:
Severity
Frequency
Extent
Duration
Manageability
A1.2. Mechanics of Hazard Assessment
1. Identify the all possible hazards that have affected or have the potential to
affect the catchment area and the hospital facility. Catchment area data
can be taken from the Center for Health Development. The hospital pro -
vides details based on observations of the locality.
2. Prioritize the hazards based on severity, frequency, extent, duration and
manageability. (A1.3.1.)
Example:
On a scale of 1-5 with 5 as the highest, rate each hazard by Severity,
Frequency, Extent, Duration, and Manageability. To get the total score for
each hazard, get the sum of the scores for Severity, Frequency, Extent
and Duration minus the score for Manageability [(A+B+C+D) E]. Arrange
the hazard scores from the highest to the lowest. The highest score repre-
sents the highest priority, least manageable, and highest risk-developing
hazard while the lowest reects the more manageable and least priority
hazard.
3. Prepare a hazard map. Indicate all the hazards that can possibly affect all
the areas. (A1.3.2.)
- Of the catchment area (CHD data)
- Of the hospital
A1.3. Format

A1.3.1. Hazard Assessment Matrices
Hazard Severity Frequency Extent Duration Manageability Total
Natural

Biological

Technological

Societal
Hazard Severity Frequency Extent Duration Manageability Total Hazard Severity Frequency Extent Duration Manageability Total Hazard Severity Frequency Extent Duration Manageability Total Hazard Severity Frequency Extent Duration Manageability Total Hazard Severity Frequency Extent Duration Manageability Total Hazard Severity Frequency Extent Duration Manageability Total
Hospital Catchment Area and Hospital Facility
Hospital Service Areas
Fire
Earthquake
Volcanic eruption
Hazards Vulnerable Hospital Areas Hazards
75
76
A1.3.2. Hazard Map
Layout/map all service areas of the hospital.
Identify areas likely to be exposed to hazard.
Pinpoint areas exposed to specic hazards.
Place the code of hazard in each service area (numbers or color
codes).
Place a legend.
MEDICAL WARD
1,2,4
PEDIA WARD
1,2,4
SURGICAL WARD
1,2,4
OB-GYNE WARD
1,2,4
NUCLEAR MED.
DEPT.1,2,7
MAINTENANCE
2
HOSPITAL LOBBY
2,5
OPD
1,2,4,5
EMERGENCY ROOM
1,2,3,4
RADIOLOGY
DEPT. 2,4,7
DIETARY
1,6
LAB
1,2,3,4
MEDICAL WARD
,,
PEDIA WARD
,,
SURGICAL WARD
,,
OB-GYNE WARD
,,
NUCLEAR MED. DEPT.
,,
MAINTENANCE

HOSPITAL LOBBY
,
OPD
,,,
EMERGENCY ROOM
,,,
RADIOLOGY DEPT.
,,
DIETARY
,
LAB
,,,
A2. HAZARD REDUCTION/PREVENTION PLAN
A2.1. Denition
A Hazard Reduction/Prevention Plan contains strategies and activities meant
to reduce or prevent the occurrence of hazards in the community and in the
hospital. The plan targets the hazard. To check if the plan is done correctly,
one must be able to answer this question: If you carry out the strategy/activ-
ity you planned, will the hazard no longer occur in your community? In your
hospital?
A2.2. Mechanics of Hazard Reduction/Prevention Planning:
Using the Hazard Prevention Plan Matrix below (A2.3):
1. List the identied hazards.
2. Identify the prevention strategies and the activities.
3. Write the time frame when the activities will be carried out and nished.
77
78
4. Specify the resource requirements the required resources, those
available, and the gaps or decits, if any. Indicate the sources to ll the
gaps.
5. Assign the person responsible to carry out each activity and to source
out the lacking resource requirements.
6. Write the performance indicators, i.e., outcomes or evidences that ac-
tivities have been carried out or done successfully. These are the areas
for monitoring.
A2.3 Format
B. VULNERABILITY
B.1. VULNERABILITY ASSESSMENT
B1.1. Denition
In vulnerability assessment, it is important to identify the factors that increase
the risks arising from specic hazards. The presence of vulnerable areas
decreases the ability of the hospital to cope with the hazards. This process
determines the likely harm to the hospital. It determines the health needs
before, during, and after an emergency or disaster.
Example:
The Laboratory Room is vulnerable to re with the use of volatile and
ammable gases or reagents in the routine examinations.
Hazard
Vulnerable area
Vulnerability of property
Vulnerability of people
Vulnerability of services
Vulnerability of environment
Fire
Laboratory Room
Use of volatile and ammable gases or re-
agents in routine laboratory examination
Lack of knowledge on proper storage of
reagents
No alternate place of service delivery
Lack of proper waste management
Hazard Reduction/Prevention Plan Matrix
Hazards Preventive
Strategies/
Activities
Indicators Time
Frame
Resource
Requirements
Person
Responsible
Required Available Source
79
The details of a vulnerability assessment are provided in WHO-WPRO, A Field
Manual for Capacity Assessment of Health Facilities in Responding to Emergen-
cies, 2006. Vulnerability is categorized as:
Structural Related to construction of the facility.
Non-structural The non-structural elements of a building include ceilings,
windows, doors, mechanical, electrical, plumbing equipment and instal -
lations.
Functional There are three aspects: (1) deals with general physical lay-
out of facility, including location, accessibility and distribution of areas
within the facility; (2) individual services: medical (supplies and equipment)
and non-medical (utilities, transportation and communication vital to con-
tinuous operation of facility); and (3) public services and safety measures.
Human Resources Includes: organization of the health facility (e.g.,
emergency planning group, subcommittees); inventory and mobilization of
personnel; and preparedness activities for the personnel (e.g., hazard and
vulnerability analysis, drills and training, community involvement and
evacuation).
The guide provides an assessment of preparedness for specic emergencies
such as industrial emergency preparedness, infectious disease outbreak, etc.
B1.2. Mechanics of Vulnerability Assessment
Using the Vulnerability Assessment Matrix below (B1.3):
1. List the hazards that may affect the hospital, based on the hazard map
made.
2. Identify the vulnerabilities of the hospital (See earlier matrix).
B1.3. Format
B2. VULNERABILITY REDUCTION PLAN
B2.1. Denition
The Vulnerability Reduction Plan is developed purposely to reduce the conse-
quences of exposure to hazards. The vulnerabilities specic to the four elements
of the facility and of the hospital catchment area are identied and this serves as
the basis for building the resilience of the hospital to withstand the impact and
consequences of a hazard.
Vulnerability Assessment Matrix
Hazard Vulnerable
Areas
Vulnerabilities
People Structural Non-structural Functional
80
B2.2. Mechanics of Vulnerability Reduction Planning:
Using the Vulnerability Reduction Plan Matrix below (B2.3):
1. List all the identied hazards of the catchment area and the hospital.
2. State all the areas vulnerable to the hazards.
3. Spell out all the vulnerabilities of the facility structural, non-structural,
functional, and the assessment of human resources.
4. List the strategies/activities to reduce the vulnerabilities.
5. Specify the time frame, when the activities will be carried out and done.
6. Identify the resource requirements, what is required, what is available in
the community, and the gaps or decits. Identify sources to ll the gaps.
7. Indicate the person responsible for carrying out each activity and for
looking for the source of decient hospital requirements.
B2.3. Format
Vulnerability Reduction Plan Matrix
Hazards Vulnera-
bility
Prevention
Strategies/
Activities
Strategies/ Strategies/
Person
Responsible
Required Available Source
Earth-
quake
Time
Frame
Resource Requirement
Structural
Non-struc-
tural
Functional
Human
Resources
C. RISK ASSESSMENT
C.1. Denition
Risk assessment is a process of analyzing or anticipating the possible conse-
quences of hazard once it has affected the hospital and the catchment area. This
is the basis in developing the capacity development plan of the hospital.
C.2. Mechanics of Risk Assessment
1. Identify the risks or probable consequences to public health and safety of the
catchment area and of the hospital being exposed to hazard:
Probability of death
Probability of disease or injury (mental, physical)
Probability of secondary hazard (re, disease, etc.)
Probability of contamination
Probability of displacement
Probability of loss of lifelines
Probability of loss of income or property
81
Probability of breakdown in security
Probability off damage to infrastructure
Probability of breakdown in essential services
2. Describe why the risks or consequences of the hazard happen.
D. HEALTH EMERGENCY CAPACITY DEVELOPMENT PLAN
D1. Denition
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
efciently respond to emergency or disaster in terms of the 10 Ps Elements of
Successful Health Emergency Management. The 10 Ps are: Policy, Procedures,
Protocols and Guidelines; Plans; People; Health Promotion; Partnership Building;
Physical Infrastructure Development; Program Development; Practices; Peso
and Logistics; and Package of Services. As in the other plans, a resource analysis is
done and written in the plan.
What resources are required for response and recovery
What are available in the hospital? In the catchment area?
What are the differences between the required and available resources or
what are lacking?
Where can one get the resource to ll the decit
Who is responsible for acquiring these resources
D.2. Mechanics of Capacity Development Planning
Using the Capacity Development Planning Matrix below (D.3):
1. List all identied risks.
2. Identify the capacity of the hospital needed to manage the risk.
3. Develop strategies and activities to come up with these needed capacities.
4. Write the time frame when to carry out such activities.
5. Identify the required resources, what are available in the hospital and in the
catchment area, the decit and the source of the resources to ll the decit.
6. Assign the responsible person to carry out the activities and to source out the
decient resources.
7. Identify the indicators to prove that the activities have been carried out.
D.3. Format
Hospital Health Emergency Capacity Development Plan Matrix
Risks Capacity
needed
Prepared-
ness Strate-
Prepared- Prepared-
gies/Activi-
ties
gies/Activi- gies/Activi-
Person
Respon-
sible
Required Available Source
Time
Frame
Resource Requirement
Indica-
tors
82
A. POLICIES, GUIDELINES, PROTOCOLS FOR ACTIVATION OF
THE DEVELOPED SYSTEMS

B. JOB ACTION SHEETS
C. HOSPITAL EMERGENCY RESPONSE PLAN
C.1. Denition
An Emergency Response Plan is meant to utilize the existing capacities to
deliver relief or response. Using the developed systems for emergency
management, it entails resource mobilization. It involves the actual imple-
mentation of guidelines for the developed systems.
Basic conditions that the Emergency Response Plan must satisfy:
1. Internal Emergency/Disaster
a. Assignment of personnel with a system for notication and recall.
b. Use of alarm and sign systems, including availability and accessi-
bility of instructional materials/protocols on response to all types of
hazards.
c. Rapid assessment of extent of damage to buildings and structures
and threat to safety of patients and personnel.
d. Protection of critical facilities and lifelines.
e. Evacuation procedures and routes (include patients and facilities).
f. Quick restoration of facilities and lifelines (maintain service opera-
tion).
g. Maintaining communications and security of hospital and patients.
h. Fireghting methods and directions (location of equipment).
i. Networking and coordination.
j. Search and rescue operations.
2. External Emergency

a. Evaluation of hospitals autonomy in terms of its services, source
of electricity, gas, water, food and medical supplies.
b. Efcient systems of alerts and staff assignments.
c. Unied command.
d. On-scene response team (team leader, surgical resident, internal
medicine resident, aides/helpers and driver)
e. Conversion of usable space into clearly dened areas ((triage,
observation and immediate care)
f. Prompt removal of casualties when necessary (after preliminary
medical and surgical services have been performed) to the places
where medical care facilities are more appropriate and denitive.
g. Special medical census disaster-related cases.
h. Procedures for prompt transfer within hospital.
i. Security arrangement.
j. Prior establishment of Emergency Operation Center, Public Infor-
mation System and for Media/VIPs
83
3. Internal/External Emergency
Apart from planning for Mass Casualty, the hospital has to deal with the
continuity of operations- essential functions of the hospital, regardless of
size, during internal or external emergencies that may disrupt usual, nor-
mal operations. This is critical in hazard prone regions of the country.
It focuses on the recovery of critical and essential operations including
security and evacuation concerns on either:
Short-term basis, like a power failure, where having a backup capabil-
ity (systems, personnel, processes, les, and etc.) can quickly resolve
the situation.
Long- term such as in typhoons, re or earthquakes where services
are affected for several days, weeks or even months. In this case, the
hospital needs to plan for relocation to an alternative facility tempo-
rary hospital or construction of new facility or change of hospital site.
C2. Mechanics
Using the Emergency Response Plan Matrix below (C3):
1. For the following response time rst 2 hours, 2-12 hours, 12- 24 hours,
Expanded Response identify the capacity of the hospital to address spe-
cic concerns.
2. Develop strategies and activities to come up with these needed capaci-
ties. The activities during the response phase as discussed in Part II are
the ones actually carried out in an emergency response operation.This
becomes part and parcel of the Emergency Plan which is activated in the
event of an emergency or a disaster.
3. Write the time frame when to carry out such activities.
4. Identify the required resources, what are available in the hospital, the de-
cit and the source of the resources to ll the decit.
5. Assign the responsible person to carry out the activities and to source out
the decient resources.
6. Identify the indicators to prove that the activities have been carried out.
C3. Format
Emergency Response Plan Matrix
Re-
sponse
time
Capacity Strategies/
Activities
Person
Respon-
sible
Required Available Source
Time
Frame
Resource Requirement
Indica-
tors
0-2 hour 0-2 hour 0-2 hour

2 12
hours hours hours

12 24
hours hours hours

Expanded
Response
84

A. Denition
A Recovery and Reconstruction Plan in Health for a facility or a dened geograph-
ical area, as in the other sectors of Public Works, Education, and Agriculture, lays
down the activities needed to restore services and replace damaged elements.
The hospital recognizes that an updated plan is implemented to repair the dam-
ages and/or reconstruct facilities so as to ensure the return of health services
to pre-disaster status or advancement to a better level of access and/or perfor-
mance. This underscores the importance of the damage assessment and needs
analysis. The following activities are planned for:
Damage Assessment and Needs Analysis to include cost (including man-
power). This is very important especially if you are asked to estimate the
nancial cost of the event, but it is also an opportunity to request funds.
Psychosocial interventions for direct/indirect/hidden victims
Repair of damaged hospital facilities and lifelines
Relocation of hospital site/construction of new facility
Post-mortem evaluation
Documentation of lessons
Research and development
Review and update of Hospital Health Emergency Preparedness and
Response Plan
Inventory, return and replenishment of utilized health resources
Awarding and recognition rites for the major key players
Provision of overtime compensation, as well as respite, to the responders
B. Mechanics
Using the Recovery/Reconstruction Planning Matrix below (C):
1. List all recovery/reconstruction activities.
2. Write the time frame when to carry out such activities.
3. Identify the required resources, what are available in the hospital/commu-
nity, the decit and the source of the resources to ll the decit.
4. Assign the responsible person to carry out the activities and to source out
the decient resources.
5. Identify the indicators to prove that the activities have been carried out.
C. Format
Recovery/Reconstruction Planning Matrix
Recovery/
Reconstruction
Recovery/ Recovery/
Activities
Person
Responsible
Required Available Source
Time
Frame
Resource Requirement
Indicators Dam-
ages and
needs
ages and ages and

Glossary
Abbreviations
Hazard maps
Flow charts
Directory of contact persons
Inventory of resources or assets of hospital and partner agencies
Hospital/Regional/Ofce orders for health emergency management
85
86
Mission
Qualications
Functions &
Responsibili-
ties
Identication
Perform overall direction for the eld and/or facility operations
and if needed, authorize evacuation.
Must be an Emergency Manager for Field; CHD Director, Hospital
Director for Facilities or his designate.
Preferably has experience in handling on-scene Mass Casualty
Incident for Field; has experience in management situations for
facilities.
Must possess good communication skills.
Must have leadership qualities.
Must be a good coordinator; must have good command and con-
trol abilities
Initiate the Incident Command System (ICS) by assuming the role
of the Incident Commander and put any identication mark.
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, ll up the organization assignment list, the needed
positions relevant to the situation.
In major MCI, the following should be lled up: Safety Ofcer, Liai-
son Ofcer, Public Information Ofcer, Operations Manager, Triage
Ofcer, Treatment Ofcer, Staging Ofcer, Transport Ofcer and
Morgue Ofcer.
The Planning Ofcer, Logistic Ofcer and Administrative Ofcer
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 briengs 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.
Proper signages (hard hat with mark of Incident Commander or
a vest)
SECTION 3
Job Action Sheets:
Incident Command System Organization
87
Mission
Qualications
Functions &
Responsibilities
Identication
Monitor and have authority over the safety of rescue
operations and hazardous conditions. Organize and
enforce scene/facility protection and trafc security.
Knowledgeable on safety precautions, procedures.
Preferably with various training in emergencies relating
to bombing, re, hazardous materials, structural assess
ment, security procedures and safety of responding
personnel.
Has had experiences in emergencies and disasters.
Good decision-making abilities.
Has sound knowledge in evacuation procedures.
Obtain appointment and brieng from the Incident Com-
mander.
Implement the emergency lockdown policy and person-
nel identication policy.
Establish Security Command Post.
Remove unauthorized persons from restricted areas.
Establish ambulance entry and exit route in cooperation
with Transportation and Staging Ofcers.
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 re, police agencies through the Liai-
son Ofcer, when necessary.
Advise the Incident Commander and others immediately
of any unsafe, hazardous or security-related conditions.
Confer with Public Information Ofcer to establish areas
for media personnel.
Establish routine briengs with Incident Commander.
Provide vehicular and pedestrian trafc control.
Secure food, water, medical, and blood resources.
Document all actions and observations.
Can order stoppage of operation if unsafe.
Use of any identication hat or vest.
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
88
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
Provide information to the public and the media.
Knowledgeable on communication aspects es-
pecially in collating relevant information needed.
Knowledgeable in media handling.
Preferably with experience in emergencies and
disasters.
Preferably with understanding of Mass Casualty
Management.
Good communication skills and interpersonal
relationships.
Sensitive on restrictions in contents of news and
patient care activities.
Obtain appointment and brieng 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 Ofcer.
Contact other scene agencies to coordinate
released information.
Direct calls from those who wish to volunteer to
Liaison Ofcer. Contact Operations to de-
termine requests to be made to the public via
the media.
Proper signages (hard hat with a mark of Public
Information Ofcer or a vest).
Mission
Qualications
Functions & Responsibilities
Identication
89
Mission
Qualications
Functions &
Responsibilities


Identication
Function as incident contact person for representatives from
other agencies (government or private).
Preferably with experience in liaison procedures and coordination.
Good or excellent public relations skills.
Preferably with understanding of Mass Casualty Management.
Understands the bureaucracy and working relationships of the
different government as well as private agencies responding to
emergencies and disasters.
Good grasp of patient care and management in mass casualty
situations; informed on inter-hospital emergency communica-
tion network, municipal operation centers and/or province, region
or national as appropriate.
Knowledge on the inventory of resources available in the area/
country.
Understands municipal (provincial, regional, national) organiza-
tional charts to determine appropriate contacts and message routing.
Obtain appointment and brieng from the Incident Commander.
In coordination with the Public Information Ofcer 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 Ofcers 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.
Use of any identication (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
90
Mission
Qualications
Functions &
Responsibilities
Identication
Organize and direct those associated with maintenance
of the physical environment, and adequate levels of food,
shelter, supplies and other resources needed to support the
objectives of the incident.
Preferably with experience in logistics management.
Preferably with experience in emergencies and disasters.
Understands the bureaucracy and working relationships of
the different units in government especially in procurement
and emergency purchases.
Good grasp of procurement procedures; knowledgeable in
accessing supplies, medicines and equipment needed during
emergencies.
Good coordination with pharmaceuticals, companies and
suppliers and knowledgeable on database of available
resources in the market.
Obtain appointment and brieng from the Incident
Commander.
Establish Logistics Section Center in proximity to the
Command Post.
Brief all his staff on current situation; outline action plan and
designate time for next brieng.
Attend damage assessment meeting with Incident Com-
mander.
Coordinate with companies regarding stock level, available
supply and equipment.
Anticipate needed logistical requirements.
Obtain information and updates regularly; maintain current
status of all areas; communicate frequently with Emergency
Incident Commander.
Obtain needed supplies with assistance of the Finance
Section Chief and Liaison Unit Leader.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
91
Mission
Qualications
Functions &
Responsibilities
Identication
Organize and direct all aspects of Planning Section
operations. Ensure the distribution of critical informa-
tion/data. Compile scenario/resource projections from
all areas and effect long-range planning. Document all
activities.
Preferably a senior ofcial with adequate knowledge in
planning and decision-making.
Has had experiences in emergencies and disaster situ-
ations in addition to crises management.
Adequate knowledge of the government bureaucracy
and the role of the different government entities
responding to emergencies and disasters.
Good coordination and networking skills.
Obtain appointment and brieng from the Incident Com-
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-specic 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 Ofcer and Labor especially
with regards to manpower requirements.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
92
Mission:
Qualications
Functions &
Responsibilities
Identication
Monitor the utilization of nancial assets. Oversee the
acquisition of supplies and services necessary to carry out
the objective of the incident. Supervise the documentation
of expenditures relevant to the emergency incident.
Preferably a senior ofcial with adequate knowledge in
nancial management.
Had experiences in emergencies and disaster situation
Adequate knowledge on the government bureaucracy and
the role of the different government entities responding to
emergencies and disasters.
Good resource manager; knowledgeable on tapping other
resources
Obtain appointment and brieng from the Incident Com-
mander.
Appoint members of his staff preferably the following: Time
Unit Leader, Procurement Unit Leader, Claims Unit Leader,
Cost Unit Leader and other appropriate positions as he de-
sires.
Establish a Financial Section Operations Center. Ensure
adequate documentation/recording personnel. His station
need not be within the area of incident.
Confer with Unit Leaders after meeting with Incident Com-
mander and develop an action plan.
Approve a cost-to-date incident nancial status report
eight hours summarizing nancial data relative to person-
nel, supplies and miscellaneous expenses.
Obtain briengs and updates from Incident Commander as
appropriate. Relate pertinent nancial status reports to ap-
propriate chiefs and unit leaders.
Schedule planning meetings to include Finance Section unit
leaders to discuss updating the sections incident action
plan and termination procedures.
Proper signage (hat or vest)
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
Mission
Qualications
Functions &
Responsibilities
Identication
Organize and direct aspects relating to the Operations.
Carry out directives of the Incident Commander.
Knowledgeable on Operation Procedures; understands
well the organizational chart in MCI.
Preferably has experience in handling on-scene Mass
Casualty Incident with varied knowledge of all types of
operations (Search and Rescue, Fire, Medical etc.)
Must be a crisis manager and with leadership skills.
Good communicator and can stand pressures.
Must know capabilities of people for proper assignments.
Obtain appointment and brieng from the Incident Com-
mander.
Responsible for all specic 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 Ofcers on current situation and de-
velop the sections initial plan.
Designate times for briengs and updates with all Opera-
tions Ofcers to develop/update sections 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.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
93

94
Mission
Qualications
Functions &
Responsibilities
Identication
Responsible for the management of the Treatment Area and
assigning of responsible supervisor for specic areas (Red,
Yellow and Green subsections). Assure treatment of casualties
according to triage categories. Provide for a controlled patient
discharge and transfer to appropriate hospitals.
Preferably a general surgeon/trauma/emergency/anesthesia/
family medicine physician.
Knowledgeable on Mass Casualty Management and the or-
ganization chart.
Should have on-scene experience in MCI; knowledgeable
on triaging and skilled in eld care and eld operation.
Skilled in emergency procedures, especially in life sustaining
and stabilization of patients.
Good in personnel management, especially in stress situations.
Receive appointment and brieng from Incident Commander/
Operations Chief/ Field Medical Commander.
Organize the treatment area assigning all members to their
specic assignments and responsibilities. In cases of WMD,
treatment area should be at the cold zone.
Appoint unit leaders for the following treatment areas in
pre-established locations: Second Triage; Immediate
Treatment (Red); Delayed Treatment (Yellow); Minor
Treatment (Green); Discharge.
Supervise the receiving of patient from the Initial Triage from
the site, re-triage the victims and institute measures to sta-
bilize the victims; ensure that all victims are continuously
monitored.
Assess problems and treatment needs, and customize the
stafng and supplies in each area.
Receive, coordinate and forward requests for personnel and
supplies to the Field Medical Commander and/or Staging ofcer.
Contact the Safety and Security Ofcer for any security
needs in the area.
Establish 2-way communication (radio or runner) with Field
Medical Commander, Triage, Transport and Staging Ofcers.
Coordinate with Transport Ofcer, decide on the order of
transfer of victims, the mode of transport, escort and place of
transfer.
Document everything with regards to every individual patient
brought to the area using the individual treatment form.
Regularly report to the Field Medical Commander.
Observe and assist any staff that exhibits signs of stress and
fatigue. Report any concerns to Psychological Supervisor.
Provide for staff rest periods and relief.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
Mission:
Qualications
Duties &
Responsibilities
Identication
Sort casualties at the site according to priority of injuries, and
transfer (according to tagging priorities) to the treatment area.
Any of the following:
Doctor of Medicine preferably trained in emergency
medical care and triaging.
Nurse, paramedic with appropriate training in emergency,
medical care and basic triaging.
Knowledgeable on mass casualty management and has had
experience in on-site mass casualty incident; skilled in eld
care and eld operations.
Receive appointment and brieng from the Field Medical Com-
mander or previously designated by the Incident commander.
Assess rst 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 rst 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 rst all walking wounded to go to an identied 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 specic
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 Ofcer regarding security and
trafc ow 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.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
95
96
Mission
Qualications
Duties &
Responsibilities
Identication
Coordinate the transfer of patient received from the Treat-
ment Area to the appropriate hospitals
Preferably a paramedic, nurse or doctor with basic training
in Basic Life Support.
Experienced and knowledgeable in Mass Casualty Man-
agement.
Skilled in ambulance trafc control; skilled in radio commu-
nications.
Sound knowledge of countrys transportation resources.
Sound knowledge of access routes to health care facilities.
Familiar with terrain, road maps, alternate routes.
Has sufcient knowledge in the return time of the ambu-
lance.
Receive appointment and brieng from the Incident Com-
mander/ Field Medical Commander.
Establish immediately an ambulance loading zone, observ-
ing principles on way trafc ow; identify access routes
and communicate trafc ow 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 ofcer, 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, trafc ow, location of the
receiving hospital and the procedures in the endorsement
of the patient.
Coordinate regularly with the Treatment Team Leader/
Staging Ofcer 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.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
97
Mission
Qualications
Duties and
Responsibilities
Identication
Coordinate all resources arriving at the scene. For
manpower resources, referring them to appropriate
area of assignment. For transportation resources,
organizing them and dispatching them as required.
At least a paramedic or an EMT.
Preferably with knowledge in Mass Casualty Manage-
ment and understands the organizational chart.
Receive appointment and brieng from the Incident
Commander/ Operations Section Chief.
Identify suitable place for the Staging Area usually
away from the incident.
Organize, classify all transportation resources.
Coordinate with Transport Supervisor.
Dispatch appropriate vehicle as requested by Trans-
port Supervisor.
Coordinate with appropriate agencies with regards to
trafc ow and access routes within the site.
Direct all incoming responding teams to the Field
Medical Commander.
Document all resources.
Any identication mark (hats or vests).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
98
Mission
Qualications
Duties &
Responsibilities
Identication
Organize, prioritize and assign ofcers under its jurisdiction to
areas where medical care is being delivered. Advice the Op-
erations Section Chief/Incident Commander on issues related
to handling of the victims.
Must be a Doctor of Medicine.
Must possess managerial skills in disaster.
Preferably with training and experience in MCI management
situations.
Knowledgeable in the hospital capability and networking; having
sound knowledge of countrys health resources.
Skilled in pre-hospital care; skilled in radio communications.
Skilled in staff management; skilled in logistical operations.
In the absence of the above the rst who arrives at the scene
preferably one of the following:
a. Municipal Health Ofcer, City Health Ofcer, any Emer-
gency Health Physician
b. Emergency Critical Nurse (in the absence of an MD)
c. Private MD with experience in emergency care
Can rst assume the position and later endorse (face to face)
providing an orderly transfer of command to the next incoming
qualied medical personnel.
Receive appointment from the Incident Commander/Operations
Section Chief.
Identify the suitable site for the Advance Medical Post and in
form everybody.
Responsible for the different members of his team (if not yet
identied): Triage Ofcer, Treatment Ofcer, Transport Ofcer,
Mortuary Ofcer.
Responsible that all the needed medical resources be mobilized
and available.
Report and coordinate with the Operations/Incident Command-
er; likewise attend meetings and press conferences.
Ensure the welfare and safety of the medical team, including
relief and sustenance (decking, scheduling, pullback, etc.)
Conduct regular meetings with his designated ofcers in the area.
Anticipate other concerns and regularly confer with the Opera-
tions Ofcer/Incident Commander.
Responsible that all the necessary recording of the events be done
and all required reports to all the authorities be submitted on time.
Evaluate the whole activity and make the necessary recommen-
dations to improve future responses.
Coordinate and regularly report to the Medical Controller of the
DOH Operations Center/Regional Operation Center.
Proper signages (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
99
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
Mission:
Qualications
Duties & Respon-
sibilities

Identication
Collect, protect and identify deceased patients
Doctor of Medicine aided by a social worker, a psychosocial
support ofcer.
For medico-legal cases forensic experts from the PNP Crime
Laboratory or the National bureau of Investigation will be part
of the team.
Receive appointment and brieng from the Triage Ofcer/Field
Medical Commander.
Identify and establish the Morgue Area; coordinate with the Tri-
age Ofcer and Treatment Ofcer.
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 identied 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 identication and for evi-
dence collection and preservation.
Keep Triage/Treatment ofcers appraised of number of de-
ceased.
Contact the Safety and Security Ofcer 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 debrieng.
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 documenters recording of
actions/decisions in the Morgue Area.
Proper signage (hat or vest).
100
Mission:
Qualications
Duties &
Responsibilities

Identication
Coordinate all activities of the Department of Health/
Health Sector in response to the Mass Casualty Situation
Doctor of Medicine/Nurse familiar with the Operation
Center (Central, Regional and Hospital).
Good knowledge of the DOH organization as well as
members of the Health Sector responding to emergencies
and disasters.
Good resource mobilizer.
Knowledgeable on the manpower resources, hospital
capabilities, dispatching and radio communications.
Articulate and good spokesperson.
Excellent coordinator.
Designated by the ofce and assume the position in case
of Mass Casualty Situations.
Supervise the Operation Center and make all decisions in
relation to the dispatch and subsequent elding 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 ofcials, 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.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
101
Mission
Qualications
Duties &
Responsibilities
Identication
Represent the Department of Health in the Field Command
Post and coordinate all health activities/requirements in
cases of Regional Emergencies/Disasters.
Highest ofcial designated by the Regional Health Ofce.
Good knowledge of the DOH organization as well as mem
bers of the Health Sector responding to emergencies and
disasters; sound knowledge of the regions health
resources.
Knowledgeable in Mass Casualty Management and its
organization.
Skilled in logistical operation and staff management.
Knowledgeable in both public health and pre-hospital care.
Designated by the CHD and assume the position in case of
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 briengs and conferences.
Document and make his own evaluation of the incident.
Proper signage (hat or vest).
Position assigned to:
You report to: _____________________________________ (Incident Commander)
Command Post: ______________________________ Telephone: ______________
102
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 conrming 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 ofces 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. Table S4.1. Human Resource Requirements by Alert Level Status in Hospital and
CHD for On-scene Response CHD for On-scene Response
CHD
One Rapid Assessment Team ready for
dispatch to include the following:
DOH representative
Nurse
Driver
May coordinate with Regional Hospitals
for backup teams.
Mobilize Rapid Assessment Teams
(RAT) and other appropriate teams.
Three (3) teams on standby. (environ-
mental/ surveillance/ medical)
Health Promotions Ofcer as necessary
Driver
All DOH REPS in the affected area
should be available at the LGU.
All other regional staff on standby for
immediate mobilization.
HOSPITAL
First response team ready for dispatch
to include the following:
2 doctors preferably surgeon,
internist, anesthesiologist
2 nurses
First aiders/ EMT
Driver
Second response team should be on call
On-Scene Response Team
For responders, the HEMS Training Needs Assessment identied the competency re-
quirements and the required training course/package, as shown in Table S4.2.
Table S4.2. Competency Requirements and Required Training Course/Package for
Responders
Responders
Position, Roles/
Functions
Competency Requirement
(Functional)
Required Training
Course/ Package
103
104
Depending on the available human resources, the response team may have the full
human resource complement or may have few health staff but with multiple functions.
Upon dispatch, the teams are equipped with the following:
Emergency kits and equipment (Refer to Sec 4.1. Ambulance Services)
Communication equipment
Food and water
Personal protective equipment (PPE), mask, goggles (A.O. 155)
Flashlight, whistle
Writing supplies report forms/pens/clipboard
Reference materials, e.g., Directory, Pocket Emergency Tool 2nd edition, etc.
Contingency Funds
Emergency Manager Deployment Checklist
YES NO
1. Did you receive your orders?
2. Is/are the mission objective/s clear?
3. Did you inform your family?
4. Do you have with you
a. Mission order?
b. Identication 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 Ofce for Western Pacic.
p. 78.
SECTION 4.1
Ambulance Services for Emergencies and Disasters
The hospital must be ready at all times to immediately dispatch the emergency medical
response team with an ambulance to the disaster site, in accordance to: Administrative
Order No. 13 s. 1997: Policy and Guidelines on the Management and Use of Ambulanc-
es; Memorandum No. 120 s. 2003; and Administrative Order 155 s. 2004: Implementing
Guidelines for Managing Mass Casualty Incidents During Emergencies and Disasters.
An update of the ambulance team composition lists the following:
1. Licensed physician trained and certied in Advance Cardiac Life Support
2. Licensed nurse trained and certied in Basic Life Support, Advanced Cardiac Life
and Standard First Aid
Ambulance driver trained and certied in Basic Life Support and First Aid; and
as proposed: Basic Emergency Medical Technician, Emergency Vehicle Driving
Course
3. Utility workers trained in handling and transport of patients
According to A.O. 155, the responding medical team must be properly equipped to treat
a minimum of 10 serious casualties and the responding team in their ambulance must
have the capability for treating and transporting a minimum of 3 to 5 serious patients.
These policies afrm 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 drivers 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 drivers 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 u, 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
106
Medical Equipment/Supplies and Monitoring Devices
4. Cardiac monitor, portable
5. Automated external debrillator (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 identication (e.g., vests, etc.)
Communication
21. Handheld radio
22. Public address communication system
107
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.
Administrative Order 155 describes the functions of an Operations and Dispatch
Center as follows:
1. Receives all warning messages via connections with all major ofces/ser-
vices that are monitoring and responding to emergencies through telephone,
fax machines, radio, etc.
2. Serves as dispatch center in times of emergencies.
3. Anticipates scenarios and alerts additional teams needed by receiving hospitals.
4. Reviews required logistics.
In an update of these functions, the following were added:
1. Monitors ongoing operations.
2. Mobilizes resources as needed by the On-scene Response Team or Emer-
gency Room.
3. Coordinates with DOH-OpCen.
4. Documents events and responses and submits reports.
5. For Code Blue and Code Red, runs as the Center of Control, Command and
Coordination of the hospital (Command Post).
Hospital identies a dedicated space within its ofces 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 Ofce, re, 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 ofce furnishing and supplies for OpCen staff.
Designated area for conference/brieng room(s) for brieng ofcials and other
important persons and for progress meetings and discussions.
108
Information room (preferably separate from the main OpCen) for brieng
media representatives and releasing information to the public.
Designated areas for rest facilities.
Emergency power supplies and back-up facilities/supplies.
Other aspects, such as storage space, vehicle access and parking facili-
ties, and any other requirements to meet specic circumstances.
The considerations for the design are described in detail in the Manual of Guide-
lines for the Operations Center.
With the raising of Code Alert White, the hospital should activate the Operations
Center and assign Emergency Ofcers 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.
For adequate and effective communication facilities necessary for any emergency/
disaster setting, the considerations are as follows:
Provide adequate facilities for the normal day-to-day functioning of the organization.
Be capable of extending from the day-to-day role into the wider and more
demanding functions of response operations.
When necessary, provide a mobile capability.
Have adequate reserve or back-up capacity to meet emergency demands.
Given nancial and other constraints, the provision of a special communications
facility to fulll the above needs may not be possible. This may mean utilizing the
most procient available network (e.g., a police communication system and
other communications networks) and supporting this with other networks for back-up
or standby emergency purposes.
The matrix in Table S5.1, which is suitable for a non-permanent type of Operations
Center, provides an overview of the standard operating procedures for the activation,
operation and closing-down of a Hospital Operations Center. Of these procedures that of
opening and closing are not applicable for a 24/7 OpCen. The hospital may adapt the
written procedures and protocols in the Manual of HEMS Operations Center.
Table S5.1. Standard Operating Procedures for Emergency Operations Centers (EOCs)
Activation
Open EOC
Operation
Message ow
Closing-down
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
Hospital Catchment Area Maps
Topography
Population size and distribution
Hazard
Disaster prole
Location of
o Health facilities and services provided
o Potential evacuation areas
o Stocks of food, medicine, health and water treatment and other sanitation
supplies in government stores, commercial warehouses and international
agencies and major NGOs
Directory
Key people and organizations responsible for Response Phase (names, con-
tact phone numbers and addresses)
Individuals with special competencies and experiences who may be mobi-
lized on secondment from their institutions or as consultants in case of
need (names, contact phone numbers and addresses)
Regular resource persons ready to translate technical information into local
dialects (e.g., traditional healers, indigenous health workers, barangay cap-
tains, etc.)
Resources Available for Use at All Times
Vehicles
Communications equipment
Back-up power supplies
Computers, printers, facsimiles and photocopying machines
Water-testing sets
Food supplements
Temporary shelter capacities
Funding requirements
Personal protective equipment
Suggested Guidelines for the Hospital Operations Center
The Hospital Operations Center shall be organized with the following arrangements:
All Hospital Operations Centers should be ideally manned by at least two Emer-
gency Ofcers 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, ow charts, SOPs and guide
lines on health emergency and disaster are available and such are strictly
109
(Source: Adapted from the Pocket Emergency Tool, 2nd edition, Department of Health -Health Emergency
Management Staff, Emergency Humanitarian Action, World Health Organization Regional Ofce for Western
Pacic. pp. 9- 10)
110
followed/observed and implemented by all staff.
Hospitals must ensure that it has established communication links with DOH-
OpCen, Centers for Health Development (Regional Ofce), 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 eld (external emergencies) are received,
collected and veried 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.
111
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 rst 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 ofces, key central ofces and the HEMS Central ofce. 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.
It is a known fact that the occurrence of all hazards cannot be predicted.
Earthquakes may occur without warning.
Some hazards can be predicted as to
Occurrence
Impact on the community
Outcome whether emergency or disaster
Consequences or risks
Hazards such as typhoons, volcanic eruptions, or threats of civil disorders, can
be anticipated several hours before they occur, giving at least ample time to get
ready to respond before emergencies or disasters are foreseen and/or declared.
Guidelines for Effective Early Warning and Alert Systems
Basic considerations in understanding a warning and alert system are described below
(Carter, 1991; SDP, 2000).
Timely warning of an imminent or probable hazard with a potential to cause an emer-
gency or a disaster will possibly prevent the occurrence or lessen the severity of its
consequences. The extent of such reduction depends upon the interaction of three ele-
ments, namely:
Accuracy of warning
Length of time between the warning being raised/declared and the expected
onset of the event
State of Emergency/Disaster Preparedness
112
Requirements for Effective Warning include the capability to:

Receive international warning
Example: cyclone warnings from Tropical Cyclone Warning Centers in various lo-
cations; meteorological indications from weather satellites of possibly developing
threats
Initiate in-country warnings necessary in cases such as oods, landslides, volca-
nic eruptions, earthquake
Transmit warning from national level and other key government levels; mostly
done by radio links or broadcast systems
Transmit warning at local community level; may be done by local radio stations,
sirens, loud hailers, bells, messengers
Receive warning and act upon it. This requires:
possession of or access to a radio receiver or similar facility
being in hearing/seeing distance of signals
knowing what various warnings mean
Alerting consists of a number of response phases, namely:
Alert Alert
Standby Standby
Call-out Call-out
Stand-down Stand-down
The period when it is believed that resources may be required
to enable an increased level of preparedness
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
The command to deploy resources
The period when the controlling organization has declared
that the emergency is controlled and that resources may be
recalled
To implement these phases, there needs to be:
A protocol of which organizations to alert for which emergencies and what tasks;
A contact list for all organizations;
Duty ofcer 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.
A community warning should cause appropriate public responses to minimize harm.
Warning messages should:
Provide timely information about an impending emergency.
State the action that should be taken to reduce loss of life, injury and property
damage.
State the consequences of not heeding the warning.
Provide feedback to response managers on the extent of community compliance.
Be short, simple and precise.
Have a personal context.
Contain active verbs.
Repeat information regularly.
The different alert signals for typhoons, earthquakes, tsunami, oods, lahar and volca-
nic eruptions are given in Section 6.2.
113
114
SECTION 6.1A
Code Alert System for DOH Central Ofces
CODE WHITE
1. Conditions for adopting Code White:
Strong possibility of a military operation, e.g., coup attempt/armed conict which
has a national implication
Any planned mass action or demonstration which has a national implication
Forecast typhoons (Signal No. 2 up)
National or local elections and other political exercises
National events, holidays or celebrations with potential for MCI
Notication of reliable information of terrorist/attack activities
Any other hazard that may result in emergency
Unconrmed report of reemerging diseases, e.g., bird u, SARS
2. Human resource requirements for responding to the code:
Concerned directors or designates of the following ofces should be on
standby:
Material Management Division
Finance Service
Administrative Service
Procurement and Logistics Service
National Epidemiology Center
National Center for Health Promotion
Media Relations Unit
National Center for Disease Prevention and Control
National Center for Health Facilities and Development
Bureau of Quarantine & International Health Surveillance
Bureau of Food and Drug
CODE BLUE
1. Conditions for adopting Code Blue
Any condition mentioned in Code White plus any of the two below:
Mobilization of DOH resources is needed (manpower, materials, etc.)
30-50% health facilities in the area affected or damaged.
No capability of the LGU and/or lack of resources of the region to respond to
the affected area.
Magnitude of the disaster based on geographic coverage and number of
affected population (more than 30%).
Any Mass Casualty Incident (MCI) with 50-100 casualties (mortalities plus
injuries) irrespective of color code.
High case fatality rate for epidemic or conrmed/documented report of re-
emerging diseases (SARS, human to human Avian u).
2. Human resource requirements for responding to the code:
Director or designate to be present at the respective ofces:
Material Management Division
Finance Service
Administrative Service
Procurement and Logistics Service
National Epidemiology Center
National Center for Health Promotion
Media Relations Unit
National Center for Disease Prevention and Control
National Center for Health Facilities and Development
Bureau of Quarantine & International Health Surveillance
Bureau of Food and Drug
3. Other requirements:
Activate the following ofces:
Material Management Division
Ensure availability of staff to prepare all medicines and supplies needed.
Ensure that the medicines and supplies be transferred to the affected area via
NDCC arrangement or other means.
Ensure the presence of the inspection team (DOH and BFAD Teams).
Finance Service
All unit heads must be available to facilitate release of funds.
Petty cash must be in place.
Facilitate travel arrangements and other requirements in case of local or inter-
national teams to be sent.
Administrative Service
Should ensure availability of vehicles with drivers, gasoline/diesel, etc.
Should ensure the provision of electricity/ generator in all services responding
to the emergency/disaster at the Central Ofce.
Should ensure availability of other communication lines specially PABX.
Security Force to institute measures and stricter rules at the DOH Compound.
Assist MMD in the preparation of medicines and supplies and transfer of these
to airports, etc.
Facilitate arrangement with the airport for the travel of medical teams.
National Epidemiology Center
Ready surveillance and outbreak investigation team and experts to be de-
ployed as needed.
Procurement Division
Should ensure the availability of list of qualied & responsible pharmaceutical
companies and other suppliers for emergency procurement of drugs and
medicines.
Should facilitate procurement of emergency drugs/supplies as needed.
National Center for Health Promotion (NCHP)
Should ensure their availability to assist and provide technical assistance to
HEMS and Regional Ofces in the conceptualization and development of
behavioral messages and IEC materials.
Should assist Regional Ofces in the conduct of health education activities.
Assist in documentation of events.
115
116
Media Relations Unit (MRU)
Anticipate any untoward media reports and recommend necessary response.
Prepare press releases and/or press statement.
Recommend and organize press conference and other media blitz like radio
and television appearances.
Coordinate with HEMS/NCDPC and other ofces for technical inputs.
National Center for Disease Prevention and Control (NCDPC)
All Program Managers with concerns in disaster should be available for their
technical support, such as those for communicable disease, environmental,
nutrition, sanitation, psychosocial concerns, etc.
Provide treatment protocol as necessary.
Standby experts to be mobilized to affected area.
National Center for Health Facilities Development
Technical support for hospitals should be readily available especially for infra-
structure concerns.
There should be protocols in the movement of blood requirements for emer-
gencies especially for Mass Casualty Incidents. Blood intended for elective
cases can be realigned for the use of victims.
Provide technical support, especially for hospital management.
Bureau of Food and Drug
Ensure the presence of the inspection team to issue certicate of clearance for
drugs and medicines.
Facilitate requirements and certication for donated medicines, etc.
Bureau of Quarantine and International Health Surveillance
Will only be activated in the presence of cases of reemerging diseases such
as SARS and Avian Flu which needs international surveillance in all ports
of entry and other emergencies related to incoming and outgoing transporta-
tions.
All ofces/bureaus to have regular coordination with DOH-HEMS.
1. Conditions for adopting Code Red:
Any natural, man-made, technological or societal disaster where all of the
fol lowing are present:
Declaration of disaster in the affected area.
100 or more casualties in one area.
Health personnel in the region not capable of handling entire operation.
Mobilization of health sector needed.
Mobilization of key ofces of Department of Health.
Uncontrolled human to human transmission of SARS/avian u in any region.
2. Human Resource requirements for responding to the Code:
All services should ensure the availability of staff for 24 hours to address all requests
for technical as well as other logistical support.
3. Other requirements
Each ofce 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 ofce for
technical and management support.
All directors or designates mentioned above to report 24/7 to operations until
Code Red is lifted.
Other ofces/units shall be on call or required to report to the Operations Center
as identied or needed by the Crisis Committee.
Guidelines in implementing the Code
The Central Code Alert shall be declared by the Secretary of Health upon the rec-
ommendation and evaluation of the Director of HEMS for natural and man-made
emergencies with national implications; and for epidemics and reemerging diseases
by the directors of NEC and NCDPC.
This will be disseminated through a Department Memorandum. HEMS OpCen may
call through a telephone brigade all ofces concerned. This will also be followed
in lifting the code alert.
117
118
SECTION 6.1B
Integrated Code Alert System for the Health Sector
as per A.O. 2008-0024
CODE
ALERT
LEVEL
HEMS CENTRAL
OFFICE HOSPITAL
CENTER FOR HEALTH
DEVELOPMENT
CODE
ALERT
LEVEL
HEMS CENTRAL
OFFICE HOSPITAL
CENTER FOR HEALTH
DEVELOPMENT
Continuation of Integrated Code Alert System for the Health Sector
119
120
HEMS CENTRAL
OFFICE HOSPITAL
CENTER FOR HEALTH
DEVELOPMENT
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT
LEVEL
CODE
ALERT
LEVEL
HEMS CENTRAL
OFFICE HOSPITAL
Continuation of Integrated Code Alert System for the Health Sector
CENTER FOR HEALTH
DEVELOPMENT
121
122
CODE
ALERT
LEVEL
HEMS CENTRAL
OFFICE HOSPITAL
CENTER FOR HEALTH
DEVELOPMENT
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT
LEVEL
HEMS CENTRAL
OFFICE HOSPITAL
CENTER FOR HEALTH
DEVELOPMENT
Continuation of Integrated Code Alert System for the Health Sector
123
124
CODE
ALERT
LEVEL
HEMS CENTRAL
OFFICE HOSPITAL
CENTER FOR HEALTH
DEVELOPMENT
Continuation of Integrated Code Alert System for the Health Sector
CODE
ALERT
LEVEL
HEMS CENTRAL
OFFICE HOSPITAL
CENTER FOR HEALTH
DEVELOPMENT
Continuation of Integrated Code Alert System for the Health Sector
125
126
SECTION 6.2
Alert Signals
1. PUBLIC STORMS
WHAT ARE THE DIFFERENT PUBLIC STORM WARNING SIGNALS,
THEIR MEANINGS AND THE THINGS TO BE DONE?
MEANING
A Tropical Cyclone will affect the
locality.
Winds of 30-60 KPH may be expected
in at least 36 hours or intermittent
rains maybe expected within 36
hours*.
Disaster preparedness plan is acti-
vated to alert status.
A Moderate Tropical Cyclone will
affect the locality.
Winds of more than 60 up to 100
KPH may be expected in at least 24
hours*.
Disaster preparedness agencies/
organizations are in action to alert
their communities.
A Strong Tropical Cyclone will affect
the locality.
Winds of more than 100 up to 185
KPH may be expected in at least 18
hours*.
Disaster preparedness agencies/
organizations are in action with
appropriate response to actual
emergency.
A Very Intense Typhoon will affect
the locality.
Winds of more than 185 KPH may be
expected in at least 12 hours*.
The National Disaster Coordinating
Council and other disaster re-
sponse organizations are now fully
responding to emergencies and
in full readiness to immediately
respond to possible calamity.
WHAT TO DO
Listen to the radio for more information
about the weather disturbance.
Check the capacity of the house to
withstand strong winds and strengthen
the house if necessary.
The people are advised to listen to
the latest severe weather bulletin
issued by PAGASA every six
hours. In the meantime, business may
be carried out as usual except when
ood occurs.
Special attention should be given to
the latest position, the direction
and speed of movement and the in
tensity of the storm as it may inten
sify and move towards the locality.
The general public, especially people
travelling by sea and air, are cautioned
to avoid unnecessary risks.
Secure properties before the signal is
upgraded.
Board up windows or put storm shut
ters in place and securely fasten them.
Stay at home.
Keep your radio on and listen to the
latest news about the typhoon.
Everybody is advised to stay indoors.
People are advised to stay in strong
buildings.
Evacuate from low-lying areas.
Stay away from coastal areas and
river banks.
Watch out for the passage of the
Eye wall and the Eye of the Ty
phoon.
Stay in a safe house or evacuation
centers!!!
The situation is potentially very de
structive to the community.
All travels and outdoor activities
should be cancelled.
In the overall, damage to affected
communities can be very heavy.
PUBLIC STORM
WARNING
SIGNAL # 1
SIGNAL # 2
SIGNAL # 3
SIGNAL # 4
* Times are valid only the rst time the signal number is raised.
DESCRIPTION
Scarcely Perceptible - Perceptible to people under favorable circumstances. Delicately bal-
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
in containers oscillates noticeably.
Weak - Felt by many people indoors especially in upper oors of buildings. Vibration is felt like
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
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-
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 lled 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.
Motorists feel like driving with at 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 nd it difcult to stand in
upper oors. 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, sh 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 nd it difcult to stand even outdoors. Many well-built
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-
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-
slides and liquefaction, large-scale subsidence and uplifting of land forms and many ground
ssures are observed. Changes in river courses and destructive seiches in large lakes occur.
Many trees are toppled, broken and uprooted.
2. EARTHQUAKES
PHIVOLCS EARTHQUAKE INTENSITY SCALE
INTEN-
SITY
SCALE
I
II
IV
III
X
IX
VIII
VII
VI
V
127
128
INTERPRETATION/RECOMMENDATION
No eruption in foreseeable future.
Entry in the 6-km radius Permanent Danger
Zone (PDZ) is not advised because phreatic
explosions and ash puffs may occur without
precursors.
No eruption imminent.
Activity may be hydrothermal, magmatic or
tectonic in origin.
No entry in the 6-km radius PDZ.
Unrest probably of magmatic origin; could
eventually lead to eruption.
6-km radius Danger Zone may be extended to 7
km in the sector where the crater rim is low.
RICHTER MAGNITUDE SCALE
Magnitude
Scale Description
1 Earthquake with M below 1 are only detectable when an ultra sensitive seismometer is
operated under favorable conditions.
2 Most earthquakes with M below 3 are the hardly perceptible shocks and are not felt.
They are only recorded by seismographs of nearby stations.
3 Earthquake with M 3 to 4 are the very feeble shocks and only felt near the epicenter.
4 Earthquakes with M 4 to 5 are the feeble shocks where damages are not usually reported.
5 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 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.
I
II
III
IV
V
VI
Earthquake with M 7 to 8 are the major earthquakes and can cause considerable dam-
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
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
observations became available.
VII
X I
VIII
3.1 MAYON VOLCANO ALERT LEVELS
MAIN CRITERIA
Quiet.
All monitored parameters within
background levels.
Low level unrest.
Slight increase in seismicity.
Slight increase in SO2 gas output above
the background level.
Very faint glow of the crater may occur
but no conclusive evidence of mag-
ma ascent.
Phreatic explosion or ash puffs may
occur.
Moderate unrest.
Low to moderate level of seismic
activity.
Episodes of harmonic tremor.
Increasing SO
2
ux.
3. VOLCANIC ERUPTIONS
ALERT
LEVEL

129
INTERPRETATION/RECOMMENDATION
Magma is close to the crater.
If trend is one of increasing unrest, eruption is
possible within weeks.
Extension of Danger Zone in the sector where
the crater rim is low will be considered.
Hazardous eruption is possible within days.
Extension of Danger zone to 8 km or more in
the sector where the crater rim is low will be
recommended.
MAIN CRITERIA
Faint/intermittent crater glow.
Swelling of edice may be detected.
Conrmed reports of decrease in
ow of wells and springs during
rainy season.
Relatively high unrest.
Volcanic quakes and tremor may be
come more frequent.
Further increase in SO2 ux.
Occurrence of rockfalls in summit area.
Vigorous steaming/sustained crater glow.
Persistent swelling of edice.
Intense unrest.
Persistent tremor, many low frequen-
cy-type earthquakes.
SO
2
emission level may show sustained
increase or abrupt decrease.
Intense crater glow. Incandescent lava
fragments in the summit area.
ALERT
LEVEL

Continuation of 3.1 MAYON VOLCANO ALERT LEVELS
Pyroclastic ows may sweep down along gul-
lies and channels, especially along those
fronting the low part(s) of the crater rim.
Additional danger areas may be identied as
eruption progresses.
Danger to aircraft, by way of ash cloud encoun-
ter, depending on height of eruption column
and/or wind drift.
INTERPRETATION
No eruption in foreseeable future.
Magmatic, tectonic, or hydrothermal distur-
bance; no eruption imminent.
Probable magma intrusion; could eventually
lead to an eruption.
Increasing likelihood of an eruption, possibly
explosive, probably within days to weeks.
Magma close to or at the earths surface.
Hazardous explosive eruption likely, possibly
within hours or days.
Hazardous eruption ongoing.
Occurrence of pyroclastic ows, tall
eruption columns and extensive
ashfall.
CRITERIA
Background, quiet.
Low level seismic, fumarolic, other
unrest.
Moderate level of seismic, other unrest
with positive evidence for involve-
ment of magma.
Relatively high and increasing unrest,
including numerous low frequency
volcanic earthquakes, accelerating
ground deformation, increasing fu-
marolic activity.
Intense unrest, including harmonic
tremor and/or many long-period
(i.e., low frequency) earthquakes
and/or dome growth and/or small
explosions.

ALERT
LEVEL
3.2 BULUSAN VOLCANO ALERT SIGNALS
130
INTERPRETATION
INTERPRETATION
No eruption in foreseeable future.
Magmatic, tectonic or hydrothermal distur-
bance; no eruption imminent.
A) Probable magmatic intrusion; could eventu-
ally lead to an eruption.
B) If trend shows further decline, volcano may
soon go to level 1.
MAIN CRITERIA
Hazardous eruption in progress.
Hazards in valleys and downwind.
CRITERIA
Background, quiet.
Low level seismicity, fumarolic, other
activity.
Low to moderate level of seismicity,
persistence of local but unfelt earth
quakes. Ground deformation
measurements above baseline levels.
Increased water and/or ground probe
hole temperatures, increased bub-
bling at Crater Lake.
ALERT
LEVEL
ALERT
LEVEL

(ABNOR-
3.3 TAAL VOLCANO ALERT SIGNAL
Continuation of 3.2 BULUSAN VOLCANO ALERT LEVELS
A) If trend is one of increasing unrest, erup-
tion is possible within days to weeks.
B) If trend is one of decreasing unrest, vol-
cano may soon go to level 2.
Hazardous explosive eruption is possible
within days.
Hazardous eruption in progress. Extreme
hazards to communities west of the vol-
cano and ashfalls on downwind sectors.
Relatively high unrest manifested by
seismic swarms including increas-
ing occurrence of low frequency
earthquakes and/or harmonic tremor
(some events felt). Sudden or
increasing changes in temperature or
bubbling activity or radon gas emis-
sion or Crater Lake pH. Bulging of
the edice and ssuring may accom-
pany seismicity.
Intense unrest, continuing seismic
swarms, including harmonic tremor
and/or low frequency earthquakes
which are usually felt, profuse steam-
ing along existing and perhaps new
vents and ssures.
Base surges accompanied by eruption
columns or lava fountaining or lava
ows.
3
(CRITICAL)
4
(ERUPTION
IMMINENT)
5
131
4. HURRICANES
BAROMETRIC BAROMETRIC STORM
PRESSURE WIND SPEED SURGE DAMAGE POTENTIAL 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 (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 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 6-8 ft Considerable damage to vegetation; some trees blown
in (965-980 (83-95 kt or down. Major damage to exposed mobile homes. down. Major damage to exposed mobile homes. (83-95 kt or (83-95 kt or Moderate
mb) 154-177 km/hr) damage to houses. Considerable damage to damage to houses. Considerable damage to piers; marinas
ooded. Small craft in unprotected an ooded. Small craft in unprotected anchorages torn from
moorings. Evacuation from some shoreline residences and moorings. Evacuation from some shoreline residences and
low-lying areas required. low-lying areas required.

27.91-28.50 111-130 mph 9-12 ft Large trees blown down. Mobile homes destroyed. Ex- 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 tensive damage to small buildings. Poorly constructed (96-113 kt or (96-113 kt or
mb) 178-209 km/hr) signs blown down. Serious coastal ooding; larger signs blown down. Serious coastal ooding; larger
structures near coast damaged by battering waves and structures near coast damaged by battering waves and
oating debris. oating debris.

27.17-27.91 131-155 mph 13-18 ft All signs blown down. Complete destruction of mobile 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 homes. Extreme structural damage. Major damage to (114-135 kt or (114-135 kt or lower
mb) 210-249 km/hr) oors of structures due to ooding and battering oors of structures due to ooding and battering by waves
and oating debris. Major erosion of beaches. and oating debris. Major erosion of beaches.

< 27.17 in > 155 mph > 18 ft Catastrophic building failures. Devastating damage to roofs > 18 ft Catastrophic building failures. Devastating damage to roofs
(920 mb) (135 kt or 249 of buildings. Small buildings overturned or blown away. of buildings. Small buildings overturned or blown away.
km/hr) km/hr)
132
5. LAHAR
ALERT SIGNAL INTERPRETATION ALERT SIGNAL INTERPRETATION
LEVEL
Alert I Get ready People residing near the river channels and low lying areas Alert I Get ready People residing near the river channels and low lying areas
- Get ready - Get ready
- Tune in to their national/local radio station for further announce- - Tune in to their national/local radio station for further announce-
ment ment
Alert II Get Set Residents in the endangered areas Alert II Get Set Residents in the endangered areas
- Secure their houses and pack basic item and belonging - Secure their houses and pack basic item and belonging
- Prepare to leave to higher grounds/safer places or to the predesig- - Prepare to leave to higher grounds/safer places or to the predesig-
nated evacuation center nated evacuation center
Alert III Go People in the endangered areas Alert III Go People in the endangered areas
- Leave their homes - Leave their homes
- Proceed to safer places, higher grounds, designated pick-up - Proceed to safer places, higher grounds, designated pick-up
points for evacuation to designated evacuation centers. points for evacuation to designated evacuation centers.
Source: Department of Health Health Emergency Management Staff. A compilation on Natural Hazards
Accessedom Philippine Athmospheric, Geophysical and Astronomical Services Administrastion Website
http://www.pagasa.dost.gov.ph/wb
133
SECTION 7
RAPID HEALTH ASSESSMENT/
ASSESSMENT FOR RECOVERY
Rapid Health Assessment is the collection of subjective and objective information to
measure damage and identify those basic needs of the affected population that require
immediate response within 24 hours.
1. To determine the magnitude of the emergency.
2. To dene the specic health needs of the affected population.
3. To establish priorities and objectives for action.
4. To identify existing and potential public health problems.
5. To evaluate the capacity of the local response, including resources and logistics.
6. To determine external resource needs for priority actions.
7. To set up the basis for a health information system.
The assessment involves the collection of two key categories of information:
Classication of the victims
Classication of damage to infrastructure and/or interruption of services

Classication 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 classied 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)
Classication of Damages in Emergency Situations
The following are the physical elements that require assessment by the health
134
sector after a disaster:
o Integrity of infrastructure
o Capacity of service delivery
o Access to services
o Essential supplies water, energy
o Capacity for distribution of essential health supplies
For each facility or service in the affected area, the assessment grades function ac-
cording to a predened 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 ve 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 specic 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 identied in
the assessment:
1. Priority Relief Needs
Assistance in search and rescue (not a DOH role, except when requested for
in special circumstances)
First aid
Acute medical and surgical care
Care of the displaced and vulnerable
Security of water supply
Assistance in provision of shelter, warmth and clothing
2. Secondary Relief Needs
The health sector acts to improve the capabilities of services where decien-
cies are indicated. This is accomplished by: (a) increasing stocks of materials
and supplies; (b) developing auxiliary power sources, and providing supplies
of fuel, and acquiring additional repair equipment, and (c) recruiting and brief-
ing personnel, volunteers, retired professionals, and other similar workers.
Control of communicable disease
Mental Health and Psychosocial services
135
3. Management of Logistics, Transport, Communications
4. Epidemiological Surveillance
Morbidity number of illnesses priorities include trauma, diarrha , ARI,
measles, notiable diseases
Mortality number of dead
Laboratory support
Water quality
Nutrition
Vectors
5. Public Information and Community Participation
6. Monitoring, Evaluation and Reporting
7. Rehabilitation and Reconstruction (for internal disasters)
Replacement and repair
Restocking
Review of emergency plan, local policy and administrative procedures
Overall development policy and planning review
Retraining technical and administrative
Recommended Tools
The Hospital should accomplish and submit appropriate Rapid Health Assessment
Forms Prototype; for an MCI, for an outbreak and for a natural disaster within 24 hours
upon the occurrence of the event using the appropriate forms of HEMS.
Corresponding Health Situation Updates for Natural Disasters, MCI and Outbreak are
submitted twice a week for the rst two weeks and once a week thereafter until termina-
tion of response activities. The forms are in the section on Information Management.
Rapid Assessment Surveys (RAS) Rapid Assessment Surveys (RAS)
Aim
Decide on the rst priority to: Decide on the rst priority to:
1. Prevent or reduce the adverse health consequences of the health 1. Prevent or reduce the adverse health consequences of the health
emergency. emergency.
2. Optimize the decision-making process associated with management of 2. Optimize the decision-making process associated with management of
the relief effort. the relief effort.
3. Avoid the so-called second disaster which is a result of arrival on the 3. Avoid the so-called second disaster which is a result of arrival on the
disaster scene of outdated or inappropriate drugs, medical and disaster scene of outdated or inappropriate drugs, medical and
surgical teams without proper support, and relief programs that do surgical teams without proper support, and relief programs that do
not address local needs. not address local needs.
Time Time
Conducted during the rst 24 hours of the disaster. Conducted during the rst 24 hours of the disaster.
136
Process
Keep in mind the Keep It Simple and Short (KISS) principle. This helps
lessen the burden of the eld workers.
Content
1. Presence/nature of disaster (all hazards)
2. Emergency or disaster
3. Impact of disaster: magnitude and lifelines
Area affected by the disaster - location and size
Impact on human lives
o Number of population/individuals/families affected
o Number of deaths and injured
o Types of injuries and illnesses
o Characteristic and condition of the affected population
Damage to Facilities/ Services / Material Resources
o Emergency medical, health, nutritional, water and sanitation
situation.
o Infrastructure and critical facilities; homes and commercial
buildings.
o Economic resources, and social organization
Level of continuing or emerging threats (natural/human caused);
vulnerability of the population to continuing or expanding impacts
of the disaster over the coming weeks and months.
Level of response
o By affected area/community/internal capacities to cope with
situation
o Needed from outside the community
- Central Ofce
- Private voluntary organizations, nongovernment organiza-
tion, International organizations and donor countries
Basic Key Questions Required Within 24 Hours of the Event
1. Is there an emergency or not? (If so, indicate type, date, time and place
of emergency, magnitude and size of affected area and population.)
2. What is the main health problem?
3. What health facilities or services have been or may be affected?
4. What is the existing response capacity (actions taken by the local author-
ities, by DOH HEMS)?
5. What decisions need to be made?
6. What information is needed to make these decisions?

Assessment during the recovery phase is part of the Damage Assessment and Needs
Analysis (DANA), a process that is usually undertaken by a multidisciplinary team. While
Continuation of Rapid Assessment Survey
137
the Health Sector is not responsible for the overall process, it contributes actively to the
process with its own assessment (HEMS, June 2007).
The concept of DANA is complex for it covers the rst 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 identication of damage to infrastructure, material resources and services. Sec-
ondary damage assessment, on the other hand, is concerned with the impact of the
primary damage on the economic, social and cultural life of survivors. Since sustainable
livelihood security is the goal of both recovery and sustainable development, the as-
sessment is concerned with three kinds of losses or disruption loss of livelihood, loss
of social cohesion, and loss of cultural identity. (HEMS, June 2007)
These losses can create new vulnerability to future disasters or make existing vulnera-
bility worse. Failure to recover or partial recovery makes it more likely that people will be
more vulnerable to the next stressful situation. The assessment at this stage is known
as secondary vulnerability assessment.
The secondary damage assessment and secondary vulnerability assessment provide
the information base for the recovery planning.
The sources of information are:
Response Operations
Post-Incident Evaluations
Development Programs
Special Teams
Previous Disasters
The assessment and analysis of information for this phase supports the development of
the hospital recovery program which contributes to an overall strategy of the Community
or the Hospital Catchment Area recovery program (Carter, 1991). The latter include:
Government aspects

Government aspects 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

Community Community
Re-establishment of Social Services System
Long-term rehabilitation of communities and individuals
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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 eld management and hospital
reception.
DEFINITIONS
Mass Casualty Incident is an event resulting in a number of victims large enough to
disrupt the normal course of emergency and health care services. The event affects
several victims which could be as few as three or as many as several hundreds. Manag-
ing the victims, however, entails resources greater than those of the initial responders.
Mass Casualty Management is the handling of victims of a mass casualty incident, Mass Casualty Management Mass Casualty Management
aimed at minimizing loss of lives and disabilities. There is a need to initiate fast, timely,
coordinated and adequate response to reduce morbidity, mortality and disability among
the victims. The management of the incident spans from the disaster or impact site (pre-
hospital care) to the transport of the last victim to the emergency room of the receiving
SEARCH
RESCUE
FIRST AID
COMMAND
POST
TRIAGE
STABILIZATION
EVACUATION
RESCUE CHAIN -- MULTI-SECTORAL
PRE-HOSPITAL ORGANIZATION HOSPITAL ORGANIZATION
IMPACT ZONE
Trafc Control
Regulation
of Evacuation
Establishing a Mass Casualty Management System
Source: Sixth Inter-regional Course in Public Health and Emergency Management in Asia and the Pacic (PHEMAP), WHO
(WPRO, SEARO) and ADPC, 2006.
Figure S8.1. Rescue Chain in a Mass Casualty Management System
or A&ED
hospital. It is directed at prompt and efcient bringing back of disrupted emergency and
health care services to routine operation. The rst ve minutes response will determine
the response for the next ve hours.
Mass Casualty Management System refers to groups of units, organizations, sectors
and agencies which work jointly through institutionalized procedures to minimize dis-
abilities and loss of lives in a mass casualty event through the efcient use of all existing
resources.

139
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 eld care, and contin-
ues up to the transfer of victims to the appropriate health care facility for denitive care.
1. Scoop and Run
Most common
Does not require specic technical ability from rescuers
Justied for small numbers occurring near a hospital
May just transfer the problem to the hospital
2. Classical Approach
First responders are trained in basic triage and eld care
Disregards the receiving hospitals from the eld
Quickly results in chaos
3. Mass Casualty Management System Approach
Most sophisticated approach; includes:
o Pre-established procedures for:
- Resource mobilization
- Field management
- Hospital reception
o Training of various levels of responders
o Incorporation of links between eld and health care facilities
o Command Post
o Multisectoral response
Dependent on the availability of large amounts of human and material
resources
1. Preparation for Mass Casualty Management
Pre-planning and training are critical.
Guidelines and procedures are established.
Incident Command should be implemented early.
First ve minutes will determine the next ve hours.
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2. Conditions to anticipate and address in developing a Mass Casualty
Management System (MCMS):
Limited human resources
Limited material resources facility, transport, communication
Poor communication
o Topography
o Isolation
Political environment
In the development of a Mass Casualty Management System appropriate for the setting
and consistent with available resources, an understanding of the MCMS components is
essential. For upgrading the system in a step-wise manner, assessments through drills
and/or actual emergency events will provide valuable insights and lessons.
As shown in Figure S8.2, a Mass Casualty Management System entails sequence of
activities at various levels of responses:
1. Pre-hospital
a. Mass casualty incident site
Search and rescue
First triage
b. Collection Point for unstable MCI
c. Advance Medical Post (AMP)
Tag - Second triage (entrance to AMP)
Treat
Transport - Third triage
2. Evacuation Site or Temporary Shelter
From the Advance Medical Post, the following victims are placed in evacuation
sites or temporary shelters:
Uninjured victims who have no relatives/place to go
Victims who need shelter, not treatment
3. Hospital
a. Field Hospital will be established if there is no hospital around or the hospital
is too far from the impact site
b. Fourth triage at the Emergency Room
c. Denitive treatment
4. Emergency Medical Service (EMS)
These are the medical services rendered from the impact site to the Emergency
Room of the hospital; these are centered on evaluation, care and stabilization of
victims at the impact site, and transporting them to the nearest appropriate health
care facility.
I. Field Organization (On-site/Pre-hospital)
Field organization encompasses procedures used to organize the disaster area to
facilitate the management of victims. Its components are the following.

A. Alerting Process
The alerting process is the sequence of activities implemented to achieve the
efcient mobilization of adequate resources. It aims to:
Conrm the initial warning.
Evaluate the extent of problems.
Ensure that appropriate resources are informed and mobilized.
Dispatch Center
Core of the alerting process (Operations Center)
Functions
o Receives all warning messages (radio/ phone)
o Mobilizes a small assessment team from police, re or ambulance
services
Types of alert
o Pre-conrmation alert
o Conrmation report from the eld
o Post-conrmation alert
Figure S8.2. Role of the Hospital in the Mass Casualty Management System (MCMS)
Mass Casualty Incident
Mass Casualty Management
EMERGENCY MEDICAL SERVICE (EMS)
Advance Medical Post
Collection
Point
(for
unstable
MCI)
2nd
TRIAGE
Treatment
3rd
TRIAGE
Transport
Source: Banatin & Go, 2007
Impact Site
1st
TRIAGE
Search &
Rescue
Hospital
4th
TRIAGE
Emergency
Room
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142
B. Initial Assessment
Initial assessment should obtain the following information:
Precise location of the event
Time and type of event
Estimated number of casualties
Added potential risk
Exposed population
Resources needed
This involves the deployment of an On-scene Response Team composed of
individuals skilled in assessment, triage, treatment and surveillance . When
human resources are limited, one individual may perform multiple tasks

C. Pre-identication of Field Areas
The identication of eld areas for various purposes prior to dispatch and opera-
tions will allow various incoming resources to reach their intended places rapidly
and efciently. This is the rst 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 identied:
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 Ofcer)
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 re ghting.
Contain hazardous materials.
Evacuate exposed population.
2. Preventive Actions: Establish eld areas.
Primary : Impact Zone/Ground Zero
- Strictly restricted to professional rescuers who are adequately
equipped, such as HAZMAT teams, WMD teams, etc.
- Known in WMD as Hot Zone
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 ofcials and serves as buffer zone to keep
onlookers out of danger - approximately 50-100 meters from warm zone
and approximately positioned depending on the wind direction.
- Known in WMD as Cold Zone
3. Minimum Personal Protective Equipment (PPE) for any medical responder
who is in contact with a patient: gloves, goggles, mask
4. For suspicion of Weapons of Mass Destruction incidents, medical responders
are allowed only at cold zone with proper protective clothing. Only those with
appropriate protective clothing and with proper training will be allowed entry
into the hot and warm zone.
Personnel
Fire services
Specialized units
Hazardous Materials and Explosives (bio-nuclear and radioactive material)
Experts, etc
Airport manager
Chemical plant expert

Security Measures
Non-interference of external elements; Crowd/Trafc Control
Contribute to safety:
o Protect workers from external inuence additional stress.
o Ensure free ow of victims and resources.
o Protect general public from risk exposure.
- Ensured by police ofcer/special units/security force of airport/build
ing/hospital/establishment, etc.
E. Command Post (CP) or Incident Command Post (ICP)
This is a multisectoral control unit tasked to:
Coordinate sectors involved in eld/ scene management
Linked with backup system: provide information and mobilization of resources
Supervise victim management
A requisite for the unit to be effective is the Radio Communication Network, which
serves as a coordination/communication hub of people who do not work routinely
(pre-hospital setting).
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144
Personnel
High-ranking ofcer (government police, re, health, defense)
o Plant manager/airport manager/chief security, etc.
o Fire ofcer/police ofcer skilled in Incident Command System/Mass
Casualty Management
o Highest representative of the Department of Health, or Local Health Ofce
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 ofcer 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 Ofce as designated by the local executive depending on
the extent of the disaster. Serves as the liaison ofcer 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.
Identied by name/position, coordinator/commander.
May depend on the type of incident.
Must be familiar with each others roles during previous meetings/drills/simu-
lation exercises (policy).
Core group cooperates with volunteer organizations.
Method
Communication/coordination hub of the pre-hospital organization.
By constant reassessment, Command Post will identify needs to increase/
decrease resources:
o Organize timely rotation of rescue workers exposed to stressful or
exhausting conditions in close coordination with backup system.
o Ensure adequate supply of equipment/ manpower.
o Ensure welfare/comfort of rescue workers.
o Provide information to backup system, other ofcials and trimedia
through an Information Ofcer.
o Release as soon as situation allows emergency (E) staff and
reestablish normal operations.
o Determine termination of eld operations.
F. Management of Victims
1. Search and Rescue (MCI)/Search and Recover (MDM)
Locate victims.
Remove victims from unsafe locations collecting area.
Assess victims status (On-site Triage).
Provide rst aid, if necessary (No CPR on-site in a Mass Casualty
Incident).
Transfer injured victims to Advance Medical Post
Transfer of dead victims by MDM group
May, in special situations, require medical personnel (trained) to stabilize/
resuscitate/amputate (trapped) victim before extrication.
This activity will be handled only by skilled teams, such as those coming
from the Bureau of Fire, Coast Guard, 501 Engineering Brigade, CSSR, 505
Fighter Wing, etc. In situations where there might be a need for on-site
assistance of medical personnel to commence stabilization of the patients
dur ing evacuation or extrication of victims, only DOH personnel with training
in Search and Rescue should involve themselves (especially in high-risk
situations like collapsed buildings or in mountainous areas), except in
exceptional situations and with the company of trained rescuers.
The Department of Health is not into Search and Rescue except in the condi-
tion described earlier.
2. Field Care
Pre-established capabilities/inventory: Pre-planning
Integrated community plan: Practiced with policy support
Golden Hour Principle
Trimodal Distribution of Death in Trauma (Advanced Trauma Life Support
or ATLS)
1st Peak: within seconds to minutes
2nd Peak: golden hour versus golden 24 hours
3rd Peak: days to weeks/months
Recent progress in pre-hospital emergency/disaster medicine: Establish Ad-
vance Medical Post with specially skilled/trained disaster eld medical
teams.
Good triage/stabilization capacity
Specically trained/upskilled medical teams
Good (radio) communications between the eld scene and medical facility
Dont transfer chaos in the scene to the hospital.
2a. Triage

Denition: French word meaning to sort; is a system used to identify
treatment priorities in a multiple-victim situation.
Basis: Urgency (victims status)
Survival (chance or likelihood)
Care resource availability and capability
Objective: Quick identication for immediate stabilization, life-saving
measures and surgery.
START System
Meaning: Simple Triage and Rapid Treatment
Most commonly used by rst responders.
Assessment focuses in three areas: respiration, pulse rate and quality,
and mental status. (RPM)
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Table S8.1 shows the levels of triage in the eld and in the hospital, location of conduct,
and categories used.
Table S8.1. Triage Levels by Period, Location and Categories
Color Tagging
The basic colors used for triage include: red for rst priority cases; yellow for second
priority cases; green for third priority cases; blue for fourth priority cases; and black/
white for last priority cases.

In the Philippines, the prescribed tag is the ribbon for practical reasons.
Categories
Red Transferred as soon as possible to tertiary facilities in an equipped ambulance
with medical escort
Yellow After evacuation of Red, without life threatening problem
Green Walking wounded to Admitting Section/Outpatient Department
Blue To be returned for Re-triage
Black and White To Morgue, Forensic Services, Public Health and psychosocial
interventions to relatives/kin
Determining Priority for Case Management
Patient classication is based on the severity of the injury and need of Emergency Medi-
cal Service and evacuation.
Table S8.2. Use of Color Tag for Prioritization of Care
Priority for In-Hospital Care (Retriaging in the Hospital)
RED Immediate: Priority One (Life-threatening Conditions)
The condition is life-threatening and the patient requires immediate attention and
transport. The following conditions should be present for a Mass Casualty Incident
(MCI) victim to be classied Priority One:

a. Obstruction or damage to airway.
b. Disturbance of breathing respiration above 30/min.
c. Disturbance in circulation capillary rell greater than 2 seconds or carotid pulse
weak , irregular or absent, radial pulse absent.
d. Does not follow commands or altered level of consciousness.
e. Need for life-saving measures (BLS and ATLS) and urgent hospital admission.
f. Victims whose injuries demand denitive treatment in the hospital but which treat
ment may be delayed without prejudice to ultimate recovery.
YELLOW Urgent: Priority Two
Patient has passed primary survey, but with major system injury, may delay transport
to one hour. Any one of the following conditions could place a victim into a Priority
Two category:
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148
a. Needs to be treated within one hour; otherwise they will become unstable.
b. Severe burns; burns involving hands, feet or face (not including the respiratory
tract); burns complicated by major soft tissue trauma.
c. Hospital admission is required.
d. Moderate blood loss; back injuries; head injuries with a normal level of conscious-
ness.
GREEN Delayed: Priority Three
An injury exists but treatment can be delayed for four to six hours. Generally, any-
one who can walk (walking wounded) to a designated area for treatment will be a
Priority Three. The following injuries are examples:
a. Minor injuries not threatened by airway, breathing and circulatory instability.
b. Minor fractures, minor soft tissue injuries, minor burns.
c. May or may not be admitted.
BLUE Near Dead: Priority Four
Victims who are clinically dead. Those tagged blue in the eld are to be returned
for re-triaging when time and physical conditions of area allow, e.g., collapsed
structure, etc.
BLACK and WHITE Dead: Last Priority
a. Patient is dead.
b. Those who die while awaiting treatment, and those in cardiac arrest following
trauma.
For Moslem communities, white tag will be used for dead Moslems.

2b. First Aid
Personnel: Volunteers, re, police, staff, special units, EMT and Medical Personnel
Location
On-site, before moving victim
At collecting point/area in an unstable environment
Green Area of Advance Medical Post
Ambulance in transit to facility

Action: Primarily to transfer with consideration of the RPM order of priority.
2c. Advance Medical Post

Purpose: Reduce loss of life and limb: Save as many as possible in the context of
existing and available resources/situation (e.g., Field Hospital).

Location
50-100 meters from Impact Zone (walking distance)
Direct access to Evacuation Road/Command Post
Clear Radio Communication Zone and SAFE (Upwind)
Role
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/EMTs/nurses/aiders, etc.

2d. Field Hospital (FH)
Tent/building/open/mobile
Established if there is no hospital around or the hospital is too far from the
Impact site.
2e. Evacuation Site or Temporary Shelter
From the Advance Medical Post, these victims are placed in evacuation sites:
o Victims who need shelter, not treatment.
o Uninjured victims who have no relatives or place to go.
3. Evacuation
3a. Transfer Organization
This consists of procedures undertaken to ensure that victims of a mass casualty
situation are safely, quickly and efciently transferred by appropriate vehicles
to the appropriate and prepared facility.
Preparation for Evacuation
Single Reception Facility
Multiple Reception Facilities
o Type of vehicle required
o Type of escort required
o Destination
Preparation for Transport
Transport Ofcer should be responsible for:
Assessing patients status, vital signs, ventilation/hemostasis.
Checking security of equipment and accessories.
Ensuring efciency of immobilization measures.
Ensuring triage tags: secure/clearly visible.

Evacuation Procedures:
Principles
Not to overwhelm care facility.
Avoid spontaneous evacuation of unstable patients.
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150
Rules
Victim is in most possible stable condition.
Victim is adequately supported by appropriate equipment during transfer and
transport
Receiving facility is correctly informed and ready.
Best possible vehicle and escort are available.
3b. Victim Flow
Based on the Noria Principle used during World War I, Battle of Chemin
de Dames, Verdun, France. (Noria is the Spanish word for the Arabic water
wheel)
Simulates that of a conveyor belt ow where the victims are relayed from rst
aid to the most sophisticated care level shown in Figure S8.3.
Figure S8.3. Victim Flow: Conveyor Belt Management Diagram
Impact
Zone
Collecting
Point
Triage
AMP
Triage
3-T
Tag
Treat
and
Transfer
Evacua-
tion
TRANS-
FER
HOSPITAL
Treatment
Victim Flow
Transport Resource Flow
3c. Ambulance Trafc Control

Radio Links
Transport Ofcer at AMP
Hospital Admission and Emergency Department/Emergency Room
Command Post
Ambulance Headquarters
Ambulance Driver takes orders from Transport Ofcer

3d. Road Control

Police ofcers are in charge of Crowd and Trafc Control.

3e. Evacuation of Non-acute Victims
Use available mass transport.
As much as possible, transport to primary care center.
Field Organization Checklist
Situation Assessment
Report to Central Level
Work Areas Pre-identication
Safety
Primary Area Impact Zone
Secondary Area units: Command Post,/Advance Medical Post/
Evacuation/Transfer
Radio Communications
Crowd and Trafc Control
Search and Rescue
Triage and Stabilization
Controlled Evacuation
II. Hospital Organization
A. Hospital Disaster Plan
Hospital Mass Casualty Management (MCM) Plan
Dissemination and regular drills among the hospital staff and multisectoral
groups
B. Activation of Hospital MCM Plan
Alerting Process
Dispatch/Opcen/Unqualied Observer
Emergency Room/Admission & Emergency Department (ER/A&ED)
Operator to activate System Recall
Mobilization

Hospital Scene Response Team
Hospital Staff
o Hospital Senior Management Staff
o Reinforcment Staff
- Internal: ER/A&ED staff leaves, replacement
- Centripetal Mobilization: Avoid burnout
o Coordination: other sectors
- Police
- Red Cross/NGO/Paramedics/Volunteers
- Radio Groups
Hospital Command Post
o Clearance of receiving facility: beds and designated areas
- Care Facility Capacity and Capability Rating
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C. Management of Victims
1. Reception of Victims
Location: Accessible/suitable/sufcient
Equipped/manned
*Chaotic scene overwhelms care facility.
Personnel: Triage ofcer (4th triage) Conrms Evacuation Triage; may
recategorize patients
Links with eld, especially Command Post.
2. Hospital Treatment Area
Red Treatment Area: Follow Trauma Flow Chart.
Yellow Treatment Area: Monitored/reassessed/stabilization maintained/re-
categorized Red area
Green Treatment Area: Holding area walking wounded
Hopeless Victim Area: Supportive Care
Bodies Morgue/mortuary
Activate Mental Health Team
3. Hospital Denitive Treatment Units

4. Secondary Evacuation
When hospital facility is overwhelmed
Highly specialized care neurosurgery
Domestic and overseas evacuation
Hospital Command Post requests: district/regional level
D. Support Requirements
Various departments are mobilized in support of patient care. As highlighted in
the Integrated Code Alert System, this is done by alert status:

Code WHITE
Emergency Department, Surgery (Operating Room), Pharmacy, Laboratory
and Radiology to:
- Ensure that emergency medicines (especially for trauma needs) are
made available at the emergency room.
- Review and increase medicines and supplies in the operating rooms to
meet sudden requirements.
- Ensure that other needs such as X-ray plates, laboratory requirements,
etc. are made available and not required to be purchased by victims.
- Ensure and monitor use of personal protective equipment (PPE) for all
health personnel.
Personnel Department - Prepare for mobilization of additional staff.
Finance Department - Ensure availability of funds in cases of emergency
purchases and the like.
Logistics Department - Coordinate with possible suppliers for additional
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 Ofcer, Liaison Ofcer, (to coordinate
with other agencies), and Public Information Ofcer (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 identication.
Security Team - In anticipation of possible inux or patients, relatives,
responders, police, press, etc., should ensure smooth ow of trafc 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 hospitals 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 eld hospital, closure and/or quarantine of the
hospital.
Special conditions such as emergencies related to Weapons of Mass Destruc
tion entail modication of responses appropriate to the hazard identied, e.g.
chemical, radiological, etc.
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154
Requirements from DOH Hospitals in MCM
1. Upgrading of hospital capability that shall include the ability to handle
trauma victims, burn patients, poisoning cases, etc.
2. Ensuring the readiness of the Emergency Rooms in terms of equipment,
manpower and systems to answer to Mass Casualty Incident especially for
general hospitals.
3. Availability of sufcient emergency medical kits containing equipment and
supplies for treating a minimum of 10 serious casualties. The number
should increase depending on the capability of the hospitals. A responding
team should have the capability for treating a minimum of 3-5 serious
patients.
4. Ready availability at all times of at least one ambulance for emergencies/
disasters equipped with all the necessary emergency supplies and equip
ment including communication equipment to establish coordination.
5. Activating Hospital Emergency Plan, observation of the Code Alert Sys
tems and Hospital Emergency Incident Command System (HEICS) in such
situations.
-- AO 155. Section VII B Responsibility of all DOH Hospitals
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 ve domains,
namely: Search and Recovery; Identication 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 ve domains men-
tioned.
Figure S9.1. MDM Functional Structure
Management of the Dead, the Missing, and the Bereaved (DOH)
Search and
Recovery
DND AFP/PNP
BFP-SRU
PCG
DILG
PNRC
LGU Leagues
Identication
of the Dead
NBI/PNP-CL
Forensic
Experts
Academe
LGU Leagues
Final
Arrangement
DILG
LGU Leagues
Mortuary
Cemetery
Religious
Organizations
Handling
the Missing
DSWD
DILG
PNRC
NBI
PNP
LGU Leagues
Assistance to
Bereaved
Families
DSWD
DOH, PNRC
DILG
Insurance
Companies/
Commission
Social Security
Groups
LGU Leagues
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156
The activities related to the management of the dead and the missing persons are the
responsibility of the DOH, the Armed Forces of the Philippines (AFP)/Philippine National
Police (PNP), National Bureau of Investigation (NBI), Department of the Interior and Lo-
cal Government (DILG) and Department of Social Welfare and Development (DSWD).
The functions of search and recovery, identication of the dead, nal arrangement,
handling the missing, and assistance to bereaved families have to be coordinated and
harmonized at various sites at all levels, from the national, regional and local levels.
1. All efforts shall be exerted for proper retrieval, identication 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 identied, 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, unidentied
bodies shall be placed in individual niches or trenches, which is a basic human
right of the surviving family members.
NB: Section IV. Denition 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)
unidentied 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 identication and disposition.

OPERATIONAL FRAMEWORK
1. A coordinated body shall be established under the National Disaster Coordinat-
ing Council (NDCC) primarily for the management of the dead, the missing, and
the bereaved families during an emergency or disaster, to be led by the Depart-
ment of Health.
2. Recovery/Retrieval Operation will commence simultaneously with the Search and
Rescue Operation and will end upon the declaration of the NDCC as per recom-
mendation of the Local Disaster Coordinating Council.
3. In any event of disaster, the Local Health Ofcer of the concerned local govern-
ment unit (LGU) shall lead/coordinate the activities in the management of the
dead, the missing and the bereaved families.
4. If two (2) or more municipalities/provinces are involved, the concerned Provincial
Health Ofcer shall lead in the MDM.
5. If two (2) or more provinces are involved, the concerned Regional Health Director
shall lead in the MDM.
6. In providing assistance to the bereaved, the Social Welfare Ofce of the con-
cerned LGU shall be primarily in charge, to be supported by other concerned
agencies.
7. In every agency at all levels, the MDM shall be incorporated as a component of
the agencys Disaster Management Program.
MDM OPERATIONAL GUIDELINES AND PROCEDURES
A. Search and Recovery Operation
Dead Body Recovery shall be done spontaneously and simultaneously, led by the
Armed Forces of the Philippines of the Department of National Defense (AFP-DND)
and supported by the following agencies and groups: the Philippine National Police
(PNP), Search and Rescue Unit of the Bureau of Fire Protection (BFP-SRU),
Philippine Coast Guard (PCG), Philippine National Red Cross (PNRC), Private
Rescue Personnel, Local Rescue Unit and Civilian Group Volunteers. For the
National Capital Region (NCR), the Search and Recovery Operation shall be led
by the PNP supported by other agencies.
In the event of disaster, the initial site commander shall be the Chief of Police (COP)
who shall turn over the responsibility to AFP upon the arrival of the AFP task group
except for that in NCR.
1. The Search and Rescue Operations Commander shall establish and dissemi-
nate a unied 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 identied collection point or
storage area which are preferably refrigerated, for examination or proper
identication.
3. The Local Health Ofce shall look after the health conditions and needs of the
responders and volunteers. In the event that the Local Health Ofce 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 ofce shall coordinate all
processes related to the management of corpses, including the retrieval, han-
dling, transport and disposition of body parts and dead bodies.
B. Identication of the Dead Operation
1. The LGU shall request the NBI and/or PNP Crime Laboratory for disaster
vic tim identication.
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.
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158
3. In case of a mass fatality incident caused by natural disasters, the NBI shall
primarily be in charge of identication 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 identication of the dead. The PNP shall
coordinate with the NBI and other related experts.
5. The Medico-Legal Ofcers of the NBI and/or PNP shall issue a Certicate of
Identication for all examined/processed and identied bodies.
6. The NBI and/or PNP shall provide the Local Health Ofcer an ofcial list of
identied and unidentied disaster victims.
7. The Local Health Ofcer shall issue a Death Certicate based on the Certi-
cate of Identication 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 identied and unidentied 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 ofce recommendations.
11. The Local Health Ofce 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 identication
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 identication of the bodies and
body parts.
14. The NBI and/or the PNP may request the ngerprints, dental and medical
records of the missing/dead in the custody of other government agencies
(GSIS, SSS, or other ofces) for the purpose of identifying dead bodies only.
15. The Interpol Identication System for the Antemortem (Dead/Missing Persons
Form) and Postmortem (Dead Bodies Identication 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 scientic identication 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 Identication (DVI).
C. Final Arrangement for the Dead
1. Legitimate claimants shall be responsible for the ultimate disposal of identied
cadavers.
2. The respective embassies of identied dead foreigners shall be informed and
the repatriation of their bodies shall be their responsibility.
3. The LGU shall be responsible for the nal disposition of the unidentied bodies.
4. The unidentied bodies shall be buried in the collective or individual graves,
marked with their unique case numbers.
5. Cremation of unidentied bodies will not be allowed.
6. The LGU shall consult the community and religious leaders of the disaster site
regarding the nal disposition of the unidentied bodies.
7. Religious and ethnic considerations shall be considered in the nal disposition
of bodies.
8. Exhumation of unidentied remains shall be done in the presence of local
health ofcials.
9. Necessary decontamination or disinfection of the dis-interment areas must be
done.
10. All body parts and corpses that remain unidentied after examinations shall be
buried immediately according to the prescribed procedures.
11. No embalming procedures for identied dead bodies shall be done without
permission from the nearest of kin of the dead (bereaved).
12. The Local Health Ofce should take the responsibility of maintaining the sani-
tary retrieval and disposal of body parts and dead bodies.
13. All identied body parts and corpses shall be turned over to the rightful/legiti-
mate claimant accordingly.
14. Burial of bodies in mass graves or the use of mass cremation/burning shall be
avoided in all circumstances.
15. All unidentied bodies and body parts shall be turned over to the LGU for nal
disposition after thorough postmortem examinations have been nished.
16. MDM related to infectious diseases and Biological, Chemical, Radiological,
Nuclear, and Explosives Emergencies (BCRNE) shall be done in accordance
with the existing DOH guidelines/procedures.
D. Management of the Missing Persons Operation
1. Provincial/City/Municipal Social Welfare Ofce (P/C/MSWDO) shall:
a. Establish the Social Welfare Inquiry Desks for data generation/information
management of missing persons and the surviving families;
b. Manage information regarding the Identication of Retrieved Bodies/Body
Parts using the Interpol identication System;
c. Validate and process documents of the missing persons for the issuance of
the Certicate of Presumptive Death; and
d. Submit to the Local Chief Executive (LCE) processed and validated docu-
ments.
2. The LGU shall submit to the NBI and/or PNP an updated list of missing and
dead persons.
3. The DOH, PNRC and DSWD shall provide technical and resource augmenta-
tion/assistance for the medical, psychological and physiological needs of the
families of the missing persons.
4. The NDCC through the Ofce of Civil Defense (OCD) as per the recommenda-
tion of the LGU shall issue Certicates of Missing Persons Believed to Be
Dead During Disaster.
E. Management of the Bereaved Families
1. P/C/MSWDO is the lead agency in the overall management of the bereaved
families.
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2. The DSWD shall provide technical and resource augmentation/assistance to
the P/C/MSWDO on the overall management of the bereaved families.
3. The DSWD, PNRC and NGOs shall provide technical and resource augmeta-
tion/assistance to P/C/MSWDO for the physiological needs of the bereaved
in terms of : Food Assistance; Financial Assistance; Livelihood Assistance;
Clothing Assistance; Shelter Assistance; Management of the Orphans; and
Food/Cash for Work.
4. The DSWD, PNRC and NGOs shall provide technical and resource augmen-
tation/assistance to P/C/MSWDO for the social needs of the bereaved in
terms of: Family/Peer Support System; Social Welfare Inquiry Desk/Informa-
tion Center; Educational Assistance; and Legal Needs.
5. The DSWD, PNRC and NGOs shall provide technical and resource augmen-
tation/assistance to P/C/MSWDO for the psychological needs of the bereaved
in terms of: Mental Health and Psychosocial Support approaches such as
Psychosocial First Aid.
6. The DOH and PNRC shall provide the technical and resource augmentation/
assistance for the medical and psychological needs of the families of the
missing persons, and provide a support system from among volunteers for the
families of the missing persons, respectively.
7. The DOH shall provide services for Mental Health Management.
F. Reporting Protocol
1. The LGUs concerned shall submit to the NDCC-OCD, through the DOH, an
initial report on the MDM containing the background of the disaster, initial nd
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 condentiality of
reports.
5. NDCC-OCD shall be the repository of all information/reports, which could be
shared and/or accessed by concerned agencies.
G. Communication
1. In time of disasters, the established communication networks within the NDCC
member agencies shall be used in the dissemination of information and other
updates at all levels.
2. The NDCC shall be designated as the clearinghouse for information dissemi-
nation.
3. The NDCC-OCD, DOH, National Telecommunication Commission (NTC), and
the Movie Television Review and Classication Board (MTRCB) shall coordi-
nate/collaborate in drawing the guidelines for the proper coverage of MDM
activities.
4. The Local Health Ofce shall conduct Information, Education and Communica-
tion (IEC) services to the public on proper sanitation and hygiene practices,
emphasizing that, in general, the presence of exposed corpses poses no
threat of epidemics.
H. Information Management
1. All information obtained about the dead/missing person and from relatives
shall be held condential.
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 condentiality of
reports.
6. The issuance of the Certicate 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 Certicate of Missing Person Believed to Be Dead.
I. Logistics Management
1. All foreign donations (food and non-food) intended for disaster relief shall be
free from any customs taxes and duties.
2. There shall be established norms and guidelines in receiving/accepting and
managing donations for disasters from DSWD relief goods and cash; DOH
medicines and cash; and NDCC checks and cash (fully receipted)
3. All concerned agencies shall formulate a logistics management system to
include the preparation of a list of logistics needed on MDM for submission to
NDCC/DOH.
4. All agencies shall have a stockpile good for 200 victims and that would last for
at least three (3) days of operations (for replenishment by the NDCC).
5. NDCC shall invest in cold storage for the dead bodies.
7. The LGUs shall include in their Disaster Management Plan all possible logisti-
cal arrangements such as burial sites, etc.
J. Monitoring and Evaluation
1. The Local Health Ofce shall monitor the entire MDM operation.
2. The Local Health Ofcer 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).
The roles and responsibilities of DOH in general include:
1. Serves as lead agency in the Management of the Dead and the Missing Persons
During Disaster.
2. Leads the Health Sector in the formulation of policies, protocols, guidelines, and
standards related to MDM.
3. Gathers, clears, and releases information regarding mortalities together with
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162
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 conrmation of the dead brought to the hospital (4th triage)
3. Identication of the dead (dress and personal materials, etc.)
4. Provision of technical assistance in terms of expertise and laboratory services in
the identication 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.

SECTION 10
Public Health Roles of the Hospital
in Emergency Management
The hospital plays crucial roles in emergency management. It is the receiving end of
victims and it can be a responding agency to any type of emergency or disaster at in the
disaster site. It is well-known for its life-saving roles during emergencies.
The role of the hospital as a receiving health care facility has public health implications
(ADPC, WHO/WPRO, 2006) and it is expected to function as follows:
1. Provides not only curative but preventive services as well.
2. Contributes to the diagnosis, prevention and control of diseases.
3. Signals early warning of communicable diseases.
4. Hosts public health reference laboratories.
5. Serves as a resource center for public heath education.
6. Provides Psychosocial and Mental Health Services.
7. Undertakes Management of Mass Dead brought to hospitals.
8. Acts as center for research.
A. PROVIDES CURATIVE SERVICES DURING EMERGENCIES
1. Treats trauma injuries with infections.
2. Treats communicable diseases resulting from outbreaks.
3. Provides treatment to victims belonging to vulnerable segments of the population
(children, pregnant women, elderly, disabled, etc.)
4. Provides therapeutic nutrition to victims with malnutrition.
5. Provides intervention to direct and indirect victims with organic psychological
afictions due to trauma.
6. Provides drugs and medicines for treatment.
B. PROVIDES DISEASE-PREVENTIVE SERVICES
1. Provides immunizations for vaccine-preventable diseases.
2. Maintains cold chain management.
3. Provides chemo-prophylaxis to the exposed/contacts of highly communicable
diseases.
4. Provides safe water to prevent water-borne diseases.
5. Provides isolation rooms in the hospital for communicable diseases.
6. Provides necessary PPEs to care providers.
7. Provides treatment protocols.
8. Conducts health education.
C. SIGNALS WARNING FOR COMMUNICABLE DISEASES
1. Conducts disease surveillance among the victims and the health workers/re
sponders.
2. Conducts advocacy and early warning activities regarding impending outbreak of
communicable diseases based on surveillance results.
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164
3. Develops and disseminates IEC materials in the form of health advisories, key
health messages, etc.
D. HOST TO PUBLIC HEALTH LABORATORIES
1. Provides laboratory services such as water analysis, culture and sensitivity of
disease pathogens, etc.
2. Provides diagnostic laboratory examinations.
3. Provides blood banking laboratory services.
4. Provides facility to store blood and blood products.
E. RESOURCE CENTER FOR HEALTH EDUCATION
1. Available resource persons for health education initiatives.
2. Source of materials for health education and promotion activities.
F. MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT SYSTEMS
Develops and/or adapts the hospital minimum responses to mental health and psy-
chosocial support services arbitrarily categorized into:
1. Designation of mental facilities
2. Establishment and activation of referral systems
3. Identication, training and mobilization of health workers including local indig-
enous traditional health care providers
4. Provision of treatment protocols
5. Provision of reporting and assessment forms
6. Provision of selected psychotropic drugs
7. Provision of information on availability of mental health services
G. MANAGEMENT OF DEAD BODIES
1. Health Sector Action
2. Health Considerations in Cases of Mass Fatalities
3. Practical Approach to a Multiple Fatality Accident (12 points)
Initial concerns
Personnel
Handling of the bodies at the scene
Evidence and property
Removal and transport of remains
Temporary mortuary facility
Examination of remains
Preservation of body
Dealing with claimants
Death certication and release of bodies
Disposal of the dead
Other concerns
H. CENTER FOR RESEARCH
1. Rich materials for research purposes in terms of cases and patients
2. Abundant data/information for research studies
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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.
Mental Health and Psychosocial Support (MHPSS) is a composite term used to de-
scribe any type of local or outside support that aims to protect or promote psychosocial
well-being and/or prevent or treat mental disorder.
These close-related terms reect different, yet complementary approaches. Agencies
outside the health sector tend to speak of supporting psychosocial well-being. People
in the health sector tend to speak of mental health but have also used the terms psy-
chosocial rehabilitation and psychosocial treatment to describe non-biological interven-
tions for people with mental disorders. (IASC, 2007)
The Health Emergency Management Staff is in the process of reformulating guidelines
on Mental Health in collaboration with the Department of Social Welfare and Develop-
ment, the agency earlier responsible for providing psychosocial support through Criti-
cal Incident Stress Debrieng (CISD). The guidelines will now follow the Inter-Agency
Guidelines on Mental Health and Psychosocial Support in Emergency Settings 2007 of
the Inter-Agency Standing Committee (IASC).
The IASC guidelines center on six core principles, namely:
1. Human rights and equity
2. Participation
3. Do no harm
4. Building on available resources and capacities
5. Integrated support systems
6. Multi-layered supports:
a. Basic services and security
b. Community and family supports
c. Focused, non-specialized supports
d. Specialized services
Health service is one of the four areas in the Core Mental Health and Psychosocial
Supports. The other three are Community Mobilization and Support, Education, and Dis-
166
semination of Information. For health, the minimum response covers ve points, namely:
1. Include specic psychological and social considerations in the provision of gen-
eral health care.
2. Provide access to care for people with severe mental disorders.
3. Protect and care for people with severe mental disorders and other mental and
neurological disabilities living in institutions.
4. Learn about and, where appropriate, collaborate with local, indigenous and tradi-
tional health systems.
5. Minimize harm related to alcohol and substance use.
Given this context, the DOH-HEMS/DSWD Technical Working Group agreed to a set of
health service minimum responses, i.e., essential high-priority responses that should be
implemented as soon as possible in an emergency.
AREAS FOR HOSPITAL ACTION
With the above IASC framework, the HEMS coordinator, in consultation with the psy-
chiatrist, psychologist and social worker, needs to draw the hospital minimum responses
in mental health and psychosocial support services to cover internal and external emer-
gencies.
As shown in Table S11.1, the countrys 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:
Philippines Minimum MHPSS Responses Philippines Minimum MHPSS Responses
1. Designate mental facilities at strategic loca- 1. Designate mental facilities at strategic loca-
tions in the area.
2. Establish access to mental hospital networks 2. Establish access to mental hospital networks
(government and private).
3. Establish referral system. 3. Establish referral system.
4. Identify/tap personnel trained on Psychiatric 4. Identify/tap personnel trained on Psychiatric
Emergencies.
5. Mobilize health workers trained in identica- 5. Mobilize health workers trained in identica-
tion and management of alcohol and other
substance use substance use (AOSU).
6. Provide treatment protocols. 6. Provide treatment protocols.
7. Provide screening procedure/guidelines incor- 7. Provide screening procedure/guidelines incor-
porated in Treatment Protocols.
8. Provide reporting forms and assessment 8. Provide reporting forms and assessment
tools.
9. Utilize existing monitoring/assessment tools 9. Utilize existing monitoring/assessment tools
for alcohol and other substance use (AOSU)
in emergency settings.
Hospital Minimum
MHPSS Responses
Adapt Develop Remarks Adapt Develop Remarks Adapt Develop Remarks
Table S11.1. Checklist of Minimum Mental Health and Psychosocial Services
SOCIAL CONSIDERATIONS
The social considerations in the rst 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-
gency health care is provided by international staff, who may approach
Philippines Minimum MHPSS Responses
10. Include selected/limited psychotropic drugs 10. Include selected/limited psychotropic drugs
in a separate E kit based on previous in a separate E kit based on previous
reports and identied need with necessary reports and identied need with necessary
precautions/guidelines on its use. precautions/guidelines on its use.
11. Identify and designate MHPSS workers in- 11. Identify and designate MHPSS workers in-
cluding psychiatrists to be included in the cluding psychiatrists to be included in the
DOH emergency response team. DOH emergency response team.
12. Submit list of response teams to HEMS- 12. Submit list of response teams to HEMS-
OpCen for proper stafng, scheduling of de- OpCen for proper stafng, scheduling of de-
ployment. ployment.
13. Ensure proper orientation and supervision of 13. Ensure proper orientation and supervision of
traditional health care providers, traditional health care providers,
14. Mobilize local indigenous traditional health 14. Mobilize local indigenous traditional health
care providers. care providers.
15. Provide area in health facilities and on-site for 15. Provide area in health facilities and on-site for
mental health consultations and management. mental health consultations and management.
16. Provide information on the availability of men- 16. Provide information on the availability of men-
tal health services/facilities, e.g., distribution tal health services/facilities, e.g., distribution
of IEC materials and basic mental health edu- of IEC materials and basic mental health edu-
cational activities. cational activities.
17. Ensure adequate stock pile of resources for 17. Ensure adequate stock pile of resources for
basic biological needs. basic biological needs.
18. Mobilize hospital network to take over psychi- 18. Mobilize hospital network to take over psychi-
atric facility/local MH facility operations or for atric facility/local MH facility operations or for
referral/distribution of patients to their respec- referral/distribution of patients to their respec-
tive hospitals. tive hospitals.
19. Activate collaborative services. 19. Activate collaborative services.
20. Activate referral system. 20. Activate referral system.
Continuation of Checklist of Minimum Mental Health and Psychosocial Services
Hospital Minimum
MHPSS Responses
Adapt Develop Remarks
167
168
medicine differently)
o Privacy (as much as possible, e.g., put a curtain around the consultation
areas)
o Condentiality 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.
A. A half-day to one-day orientation for health staff on the psychological components of
emergency health care may include the following contents:
Psycho-education and general information
o Importance of treating survivors with respect to protect their dignity.
o Basic information on what is known about mental health and psychosocial
impact of emergencies, including understanding of local psychosocial re-
sponses to an emergency.
o Avoiding inappropriate pathologizing/medicalization (i.e., distinguishing
non-pathological distress from mental disorders requiring clinical treatment
and/or referral).
o Knowledge of available mental health care in the area to enable appropri-
ate referral for people with severe mental disorders.
o Knowledge of locally available social supports and protection mechanisms
in the community to enable appropriate referrals.
Communicating to patients, giving clear and accurate information on their health
status and on relevant services, such as family tracing. Communicating in a
supportive manner include:
o Active listening
o How to deliver bad news in a supportive manner
o How to deal with very angry, very anxious, suicidal, psychotic or withdrawn
patients
o How to respond to sharing of extremely private and emotional events such
as sexual violence
How to support problem management and empowerment by helping people
clarify their problems, brainstorming together on ways of coping, identifying
choices, and evaluating the value and consequences of choices.
Basic stress management techniques, including local (traditional) relaxation tech-
niques.
Non-pharmacological management and referral of medically unexplained somatic
complaints, after exclusion of physical causes.
B. Make available psychological support for survivors of extreme stressors (also
known as traumatic stressors).
Most individuals experiencing acute mental distress following exposure to extremely
stressful events are best supported without medication. All aid workers, and espe-
cially health workers, should be able to provide very basic psychological rst aid
(PFA). PFA is often mistakenly seen as a clinical or emergency psychiatric interven-
tion. Rather, it is a description of a humane, supportive response to a fellow human
being who is suffering and who may need support. PFA is very different from
psychological debrieng in that it does not necessarily involve a discussion of the
event that caused the distress. PFA covers:
Protecting from further harm. (In rare situations, very distressed persons may
take decisions that put them at further risk of harm.) Where appropriate, inform
distressed survivors of their right to refuse to discuss the events with other aid
workers or with journalists.
Providing the opportunity for survivors to talk about events but without pressure.
Respect the wish not to talk and avoid pushing for more information than the
person may be ready to give.
Listening patiently in an accepting and non-judgmental manner.
Conveying genuine compassions.
Identifying basic practical needs and ensuring that these are met.
Asking for peoples concerns and trying to address these.
Discouraging negative ways of coping, (specically, use of alcohol and other sub-
stances), explaining that people in severe distress are at much higher risk of
developing substance use problems.
Encouraging participation in normal daily routines (if possible) and use of positive
means of coping (e.g., culturally appropriate relaxation methods.
Accessing helpful cultural and spiritual supports.
Encouraging, but not forcing, the company of one or more family members or
friends.
As appropriate, offering the possibility to return for further support.
As appropriate, referring to locally available support mechanisms (e.g., rituals,
festivals, discussion groups) or to trained clinicians.
- In a minority of cases, when severe acute distress limits basic functioning,
clinical treatment will probably be needed. If possible, refer the patient to a
clinician trained and supervised in helping people with mental disorders.
- In most cases, acute distress will decrease naturally over time, without out
side intervention. However, in a minority of cases, a chronic mood or anxi-
ety disorder (including severe post-traumatic stress disorder) will develop. If
the disorder is severe, it should be treated by a trained clinician as part of
the minimum emergency response. If the disorder is not severe (e.g.,
person is able to function and tolerate suffering), the person should
receive appropriate care, i.e., from trained and clinically supervised health
workers such as social workers and counselors attached to health services.
Moreover, there is increasing inter-agency consensus that psychosocial concerns in-
volve all sectors of humanitarian work, because the manner in which aid is implemented
(e.g., with/without concern for peoples dignity) affects psychological well-being. Mor-
tality rates are affected not only by vaccination campaigns and health care but also by
actions in the water and sanitation, nutrition, food security and shelter sectors. Similarly,
psychosocial well-being is affected when shelters are overcrowded and sanitation facili-
ties put women at risk of sexual violence.
In most emergency situations, signicant numbers of people exhibit sufcient resilience
to participate in relief and reconstruction efforts. Many key mental health and psychoso-
cial supports come from affected communities themselves than from outside agencies.
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170
From the earliest phase of an emergency, local people should be involved to the greatest
extent possible in the assessment, design, implementation, monitoring and evaluation of
assistance.
The Hospital HEMS Coordinator considers the following concerns in support of hospital
staff including volunteers (HEMS, June 2007):
1. Recognition of the sources of stress for Health Emergency Workers
a. Health Emergency/Disaster Event Stressors
Personal injury
Personal loss
Traumatic stimuli gruesome sights/activities
b. Occupational Pressures
Time pressure
Work overload
Physical demands
Emotional demands
c. Organizational Pressures
Role conict
Role ambiguity
Confusing chain of command
Organizational conict
2. Identication of Health Emergency Workers at Greatest Risk for Severe Stress Symptoms
Those who directly experience or witness any of the following during or after the
disaster:
Life threatening danger or physical harm (especially to children)
Exposure to gruesome death, bodily injury, or dead or maimed bodies
Extreme environmental or human violence or destruction
Loss of home, valued possessions, neighborhood or community
Loss of communication with or support from close relations
Intense emotional demands (such as searching for possibly dying survivors or
interacting with bereaved family members)
Extreme fatigue, weather exposure, hunger, or sleep deprivation
Extended exposure to danger, loss, emotional/physical strain
Exposure to toxic contamination (such as gas or fumes, chemicals,
radioactivity)
Those with history of:
Exposure to other traumas (such as severe accidents, abuse, assault, com-
bat, rescue work)
Chronic medical illness or psychological disorders
Chronic poverty, homelessness, unemployment or discrimination
Recent or subsequent major life stressors or emotional strain (such as single
parenting)
3. Development of mechanisms (e.g., training, fast track administrative procedures,
staff rotation) to ensure that health workers have the following before, during and
after disaster work:
Health emergency preparedness before disaster work/assignment
Have a good training on disaster work.
Have a factual information on the disaster situation.
Have ample emergency and regular supply packed.
Have communication lines with family, superiors and authorities.
Have a personal/family emergency and contingency plan.
Have mutual aid system with neighbors.
Secure well-being of family.
Health emergency response at disaster work/assignment
Health worker
Make working conditions as comfortable as possible.
Try to get enough food, uids, 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/debrieng sessions.
Hospital Staff (HEMS/WHO/WPRO, 2nd edition)
Rotation of work assignments to allow time away from the daily routine
of disaster work for those in the eld.
Rest and recreation program for those in active duty.
Conduct of debrieng sessions regularly.
Provision by superiors and hospital for situations to give credit, ex-
press appreciation and recognition of their disaster workers at regular
intervals.
Provision of appropriate assistance to those who might require coun-
seling and/or specialist psychiatric attention.
Health emergency recovery after disaster work/assignment
Attend defusing/debrieng sessions.
Anticipate problems at home/at work.
Be aware of the effects of disaster to self.
If with children, help them understand work without frightening them.
Catch up on sleep, rest, relaxation, exercise.
Take time to introspect, learn, grow from experience.

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172
NEED FOR RESEARCH
At present, there is scarcity of scientic evidence regarding the kind of Mental Health
and Psychosocial Support that proves to be most effective in emergencies. Most re-
searches have been conducted months or years after the end of the acute emergency
phase. The survivors, communities and health workers will benet from appropriate
documentation and analysis of the experiences of practitioners in a hospital setting.
Mental
Mental confusion
Slowness of thought
Inability to make judg-
ments & decisions
Loss of objectivity in
evaluating own
function
Emotional
Depression
Hyper-excitability
Irritability
Excessive rage
reactions
Anxiety
Physical
Exhaustion
Loss of energy
Gastrointestinal
disturbances
Sleep disorders
Behavioral
Feeling of excessive
fatigue
Hyperactivity
Inability to express
self
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
workers effectiveness and capability. Its symptoms consist of:
173
SECTION 12
Networking and Coordination
Administrative Order No. 168 s. 2004 contains the following provisions.
In Section V-C: Policy Statements on Support Systems:
2. Resource pooling/sharing of resources (including manpower and materials) among
the various stockholders in the health sector shall be institutionalized.
In Section V-F: Networking and Collaboration:
1. Response to emergencies and disasters is not a monopoly of any institution. Hence
there should be an active desire to coordinate with all agencies, other government
agencies, nongovernment organizations, private organizations and also international
organizations.
2. Collaboration with the Health Sector responding to emergencies and disasters will
ensure a more comprehensive, integrated and coordinated response to maximization of
resources. Hence, a system for coordination/collaboration should be developed.
1. Networking is an exchange of information or services among individuals, groups
or institutions. It is a purposive engagement of individuals and groups in a proc-
ess of collaboration to achieve common goal. (HEMS, June 2007)
2. Coordination is an ongoing process. The nature of the relationship depends on
what is acceptable to the participating agencies. No single model can be
provided. It is important to forge linkages not only during emergencies, but
also more importantly before the disaster.
Coordination ensures: (HEMS, June 2007)
Information sharing
Working together with a common goal
Avoidance of overlapping of services
Regular communication of relevant data
Networking enables the health facility to:
1. Coordinate and guide the activities of the members of the response teams.
2. Maximize resource utilization and minimize waste of resources.
3. Facilitate referrals of cases from one facility to another.
4. Facilitate transmission and receipt of information and instructions.
174
Coordination enables the health facility to:
1. Understand each others operations, roles and responsibilities.
2. Integrate views, capabilities and options.
3. Ensure cooperation.
4. Determine the strategic direction.
5. Maximize resources.
6. Achieve synergy.
Coordination of the action taken in response operations is very important. Good co-
ordination ensures that resource organizations are utilized to the best effect, therefore
avoiding gaps or duplication in operational tasks.
In a broader context, networking aims to exchange information and services to broaden
resources and thus achieve goals while supporting others to achieve theirs (HEMS,
June 2007). Similarly, coordination also involves information sharing and working to-
gether with a common goal to avoid overlapping/duplication of tasks and facilitate the
maximization of resource utilization.
Specically, networking and coordination enable the health facility to:
1. Improve efciency, effectiveness and speed of response.
2. Provide a framework for strategic decisions.
3. Unify the strategic approach.
4. Reduce gaps and duplication in services.
5. Ensure appropriate division of responsibilities.
PRECONDITIONS TO COORDINATION
To establish good working relationship with other groups or entities, consider the
following:
1. Have all agencies commit to a common goal.
2. Develop clear, detailed group goals and a mission statement from the start of the
project or engagement.
3. Dene the parameters of coordination.
4. Enlist and maintain the support of top-level management with decision-making
authority.
5. Identify role/s of own organization and in relation to other participating organiza-
tions.
6. Identify priorities of the whole group. Recognize that each agency has a differ-
ent set of priorities to take into consideration, but maintain a set of equal
importance for each agency on the team.
7. Identify points of complementation, integration and collaboration.
REQUIREMENTS AND TECHNIQUES FOR COORDINATION
Requirements:
Perceived need for coordination
Mutual understanding and respect
Agreed parameters and responsibilities
Common vocabulary and concepts
Figure S12.1. The Spectrum of Coordination Activities
Information
Sharing
(What is at
hand)
Points of
Integration
(Strategies,
etc.)
Points of
Collabora-
tion
Collaborative
Planning
and
Programming
Points of Comple- Points of Comple-
mentation
(Avoid
duplication)
Least difcult Most difcult
The degree of coordination possible will depend on the circumstances
Coordination techniques:
Use a neutral facilitator.
Build consensus before meetings/proposals.
Document agreements and arrangements with memoranda of understanding.
Identify strengths and capabilities before dividing work and responsibilities.
Respect organizational mandates.
Establish and maintain effective communications.
Take nal decisions in plenary.
Include partners and beneciaries.
Provide mechanisms for timely action, especially during crises.
Ensure responsibilities for follow-up and follow-through on decisions.
Provide personal and organizational incentives to coordinate.
Make use of the news media to strengthen coordination.
Possible Information-sharing activities:
Provide rosters, points of contacts, and alternative means of communication.
Initiate, maintain, and share early warning systems and information.
Clarify general roles and responsibilities.
Identify the specic resources each organization brings to the emergency.
Potential shared resources and divisible work:
Identify the affected population and jointly assess local capacity and needs.
Identify gaps and overlaps in assistance.
Agree on standards of assistance and services.
Collaborate in preparation of appeals.
Negotiate as a group for access and resources.
Conduct common training.

Networking is a continuum of three stages namely :

1. Stakeholders analysis
Clear statement of the mission or objectives of the agenda or activities being
planned.
List of individuals and groups who may share the agenda and its vision.
Identication of possible stakeholders from the list who will provide the
needed support.
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176
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.
2. During Health Emergency/Disaster Response
Activate emergency response teams.
Provide medical care/assistance to victims during evacuation operations.
Initiate and coordinate evacuation operations.
Monitor occurrence of epidemics in evacuation centers and undertake the
necessary measures to control and prevent spread of diseases.
Provide warning to the public on occurrence of epidemics.
Conduct daily inspection on the state of sanitation in the evacuation center.
Submit periodic reports to the council.
3. Post Health Emergency/Disaster Recovery
Provide psychological debrieng to victims and bereaved families.
Continue to provide direct service and/or technical assistance on sanitation.
Submit after operation reports to the council.
NETWORKS/ORGANIZATIONS AND RESPONSIBILITIES:
NETWORKING WITH THE HEALTH SECTOR
Networking in the Catchment Area (DOH-SDP, 2000a)
Networking for the hospital is imperative. Every hospital integrates its hospital health
emergency preparedness, response and rehabilitation plan with those of community dis-
aster management agencies for better inter-operability during emergencies or disasters.
This is critically important in disaster notication 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., re 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 identied hazards
commonly occurring in the community (e.g., typhoons, landslide, volcanic eruptions,
etc.). These include the pre-identication of expert personnel (e.g., poison control) and
special supplies (e.g., antidotes) which may not readily be available in a particular dis-
aster situation, and the formulation of appropriate procedures to ensure rapid access to
these resources. For consideration in the plans are acquisition of additional shelter, food
and water.
Below is a list of partners and agencies who are members of the network in the different
catchment areas of hospitals.

DOH Hospitals and Ofces
Philippine Hospital Association (Local Counterpart)
Philippine Medical Association (Local Counterpart)
Specialty Groups (Local Counterpart)
Philippine National Red Cross (Local Counterpart)
Respective Local Chief Executives
Respective Disaster Coordinating Councils and member agencies
- Local Health Counterparts (PHO, MHO, CHO) and LGU Hospitals
Department of the Interior and Local Government
-Bureau of Fire Protection (Local Counterpart)
-Philippine National Police (Local Counterpart)
Department of National Defense
-Armed Forces of the Philippines
-Philippine Navy
-Philippine Army
-Philippine Air Force
Department of Transportation and Communication
- Philippine Coast Guard
Local Emergency Medical Services groups
Academe/Universities
Local Private Hospitals
Pharmaceutical Companies
Local Laboratories
Local Ambulance Service Providers
Local Funeral Parlor and Morgue
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178
Local Transportation Group/Trucking Services
Local Business Sector Group
Local Nongovernment Agencies
International Organizations with local counterparts
Local Private Organizations and Civic Organizations
Community (Community/Barangay Leaders, Church, Youth)
Local Volunteers
Local Blood Bank
Local TV/Radio stations/Press

Cluster Approach
A recent development in networking and coordination is the institutionalization of the
Cluster Approach in the Philippine Disaster Management System. The Cluster Approach
aims to ensure a more coherent and effective response by mobilizing groups of agen-
cies, organizations and NGOs to respond in a strategic manner in support of the exist-
ing government coordination structure and emergency response mechanism.
The cluster lead at National Level is DOH-HEMS with the Center for Health Develop-
ment at the regional level for four clusters: Nutrition; Water, Sanitation and Hygiene
(WASH); Health, and Psychosocial Services.
Roles and Responsibilities
Inclusion of humanitarian partners in the cluster taking stock of their mandates
and program priorities
Establishment and maintenance of appropriate humanitarian coordination
mechanisms
Attention to priority cross-cutting issues
Needs assessment and analysis
Emergency Preparedness
Planning and strategy development
Application of standards
Monitoring and reporting
Advocacy and resource mobilization
Training and capacity building
The regional counterpart of the members of the three (3) clusters at the national level
can be tapped by the hospital. These include among others:
Nutrition Cluster
CHD-HEMS as Government Lead Agency in the region
United Nations Childrens 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
Save the Children
Accion Contra El Hambre
Water, Sanitation and Hygiene (WASH) Cluster
CHD-HEMS as Government Lead Agency in the region
United Nations Childrens Fund as the IASC Country Team Counterpart/Co-Lead
DOH-National Center for Disease Prevention and Control
Department of Public Works and Highways
Department of the Interior and Local Government
OXFAM Great Britain-Philippines
World Health Organization
Philippine Center for Water and Sanitation/International Training Network
Foundation
Plan International
Manila Water Company, Inc.
Health Cluster
CHD-HEMS as Government Lead Agency in the region
World Health Organization as the IASC Country Team Counterpart/Co-Lead
DOH-National Center for Disease Prevention and Control
DOH-National Epidemiology Center
DOH-National Center for Health Promotion
Department of Social Welfare and Development
United Nations Childrens Fund
United Nations Population Fund
International Federation Red Crescent
Philippine National Red Cross
Plan International
Save the Children
Handicap International
International Organization for Migration
For providing mental health and psychosocial support to direct and in direct victims,
as well as responders, during emergencies and disasters, the CHD is responsible in
coordinating with DSWD and other GOs and NGOs.
Hospital Networking and Referral System (DOH-SDP, 2000a)
The hospital network is a sharing arrangement among several hospitals of different
levels and specialties in a given area to work together. It is aimed at managing medi-
cal emergencies more efciently. The hospital network can readily be mobilized during
disaster operations. This implies that the hospital develops its external disaster plan in
conjunction with other emergency facilities in the community. For example, there may be
a pre-arranged memorandum of agreement with hospitals outside the immediate area
should hospital capacity be exceeded. Hospitals, both private and government, need to
work as a network irrespective of specialty and capability. With a clear system of refer-
rals, pre-planned and pre-arranged to tertiary medical centers and special units of gov-
ernment and private institutions (e.g., burn, spinal, pediatric trauma centers), continuous
appropriate patient care is assured.
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180
One example is the Hospital Zoning System in Metro Manila, where DOH Metro Ma-
nila-retained hospitals were divided into eight zones. Each zone has a lead hospital and
support hospitals. This hospital zoning system identies easily the specic hospital to
request support from and mobilize its resources for the appropriate emergency condi-
tion.
At the policy level, Section VIII of Administrative Order FAE 007 s. 1998: Policies and
Guidelines on the Transfer and Referral of Patients Between DOH Metro Manila Hospi-
tals addresses the situation that during MCI, the prescribed usual rules and procedures
on Emergency Referrals were unsuitable.
At the implementation level, the development of the Metro Manila Hospital Network can
provide lessons to hospitals.
With a clear system of referrals, pre-planned and pre-arranged to tertiary medical cent-
ers and special units of government and private institutions (e.g., burn, spinal, pediatric
trauma centers), continuous appropriate patient care is assured.
Metro Manila Hospital Network
One example of a hospital network arrangement is that of the hospitals in
Metro Manila. The arrangement is based on the rated capability of a hos-
pital using the following criteria: (1) presence of specialty experts, existing
training program and of available personnel in the emergency room capable
at all times of handling specic sub-specialty problems; and (2) available
equipment, therapeutics and communication facilities, infrastructure and
service performance. .
The hospital capability ratings serve as a guide for networking activities in
the different phases of health emergency management.
RATED 1 means that the hospital is capable of accepting all cases of this
specialty. A hospital Rated 1 is an end-hospital that will not refuse patients
unless the situation makes admission extremely difcult or impossible.
RATED 2 means that the hospital is capable of handling sub-specialty
cases but has some limitations such as bed capacity, equipment, etc. and
cannot be expected to offer denitive care. It may also mean there are not
enough full-time consultants or residents available on a 24-hour basis or
that there is no training program and therefore no front-line personnel in
this specialty.
RATED 3 means the hospital is incapable of handling cases of this sub-
specialty beyond giving primary care and resuscitation.
Per catchment area, a lead hospital (Rated 1) for the identied sub-special-
ty and its support hospitals were identied. A two-way referral system be-
tween the lead hospital and other hospitals in the network was established.
SECTION 13
Human Resource Development
Human Resource Development (HRD) consists of organized learning activities arranged
within an organization to improve performance and/or personal growth for the purpose
of improving the job, the individual and/or the organization. A comprehensive process, it
covers training and development, career development, and organizational development
as well.
The goal of HRD is to improve the performance of organizations by maximizing the ef-
ciency 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 reected 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
identication, 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
tness of personnel shall be maintained through drills/simulation exercises,
stress management, debrieng 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 identied 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.
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182
7. An inventory of the available human resources based on their expertise should
be developed at each level.
Administrative Order No. 155 s. 2004: Management of Mass Casualty Incidents
Section V: General Guidelines provides that:
D. Training sessions and drills relative to MCI shall be institutionalized and organ-
ized annually in all DOH Hospitals and Centers for Health Development to con-
tinually upgrade levels of knowledge and maintain a state of readiness. All
physicians, nurses and other emergency responders shall be required to under-
go MCM training.
Section VI: Implementing Guidelines of the same Administrative Order further
provides:
2. Capability Building
a. Basic Life Support (BLS) training shall be mandatory for all health personnel.
b. Advance Cardiac Life Support (ACLS) and Pediatric Cardiac Life Support
(PCLS) shall be a requirement for all medical personnel assigned in the
Emergency Rooms.
c. All Response Teams shall have additional training in Emergency Medical
Technicians 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 Ofcer.
Training Process
The development of appropriate, effective and efcient training programs is a ve-step
training process that includes: Training Needs Assessment, Preparation of a Training
Design, Development of Instruction Methodology, Conduct of Training, and Validation of
Training. The activities and outputs of each step are in Table S13.1.
Table S13.1. Training
STEPS
1. Training Needs
Assessment (TNA)
2. Design training
3. Develop instruc-
tion/methodology
4. Conduct instruc-
tion/methodology
5. Validate training
ACTIVITIES
Analyze the job.
List the task perform-
ances, task conditions
and standards.
List the training needs
and their priorities.
Design training to suit
the results of job analy-
sis.
Dene and arrange
the training objectives
and assessment in
logical sequence within
the framework of train-
ing design.
Choose the instructional
methods and media.
Compile the course pro-
gram and content .
Trail and amend the in-
struction content and
methods.
Conduct the course.
Administer the test.
Monitor the progress of
the course.
Apply remedial meas-
ures to problems met.
Identify the problem
areas from Steps 4 and
5 by analyzing:
- effectiveness
- appropriateness
- efciency
Modify or update the
training as necessary.
OUTPUTS
List of task performances,
conditions, and standards
Schedule of training &
priorities
Sequenced set of train-
ing objectives and tests
A program of instruction
which has been
successfully trailed
Trainees who have
achieved course objec-
tives
Course modied as
necessary
Validated and success-
ful conduct of training
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184
Functional Core Competencies
The HEMS coordinator can be guided by the results of the Training Needs Assessment
(TNA) conducted for the identied six groups of trainees namely: Health Emergency
Managers, Leaders, Responders, OpCen Staff, Trainers, and General Public. The func-
tional competency requirements and required training courses for each group are shown
in Table S13.2.

Table S13.2. Table S13.2. Competency Requirements and Required Training Course/Package by Roles
Position
Roles/Functions
1. Health Emergency
Managers
- Leader
- Policymaking,
budget, etc
- Standard formulation
- Capability building
- Advocacy
- Coordination/collabo -
ration
- Management of
event
- Monitoring & evalua-
tion (M/E)
2. Leaders (Chief of
Hospital)
- Decision-makers
- Resource mobilizers
- Communicators
- Advocators
- Program director/supervisor
3. Responders
a. Pre-hospital
- Responds to emer-
gencies (Patient
management)
- Decontamination
- Triage
- Ambulance care
(patient management)
Competency Requirement
(Functional)
Technical writing for policy devel-
opment
Policy development planning
Knowledge & skills in standard
formulation
Training needs analysis
Analytical thinking
Evidence-based analysis
Negotiation
Public information
Social marketing
Public speaking
Power communication
Coordination/collaboration skills
Decision-making
Conict management
Leadership training
Training in M/E
Organizational management
Basic HEM
Information technology (IT)
Basic HEM
Crisis & Consequence Manage-
ment
Mass Casualty Incident & Inci -
dent Command System (MCI &
ICS)
Rapid assessment skills
Basic knowledge on hospital
system; Basic Life Support
(BLS), Standard First Aid; Medi-
cal First Responder (MFR)
Emergency Medical Technician
(EMT)
Advanced Cardiac Life Support
(ACLS)
Mass Casualty Incident (MCI)
Health Emergency Management
Decontamination skills
Incident Command System (ICS)
skills
Ambulance trafc control
Radio communication
Sound knowledge of access
routes to health care facilities
Networking/coordination
Safe driving skills
Required Training
Course/ Package
Hospital Emergency Aware-
ness and Response Train-
ing (HEART)
Leadership Training espe-
cially in decision-making
Management Training
Policymaking, Planning,
Budgeting, Standard
Formulation, TNA,
Evaluation
Power and Risk communi-
cation
Coordination Skills
Crises and Consequence
Management
MCI and ICS
Personnel Management
Logistics Management
Orientation on Basic HEM
HEART
Basic Life Support (BLS),
Standard First Aid;
Medical First Responder
(MFR)
Emergency Medical Techni-
cian (EMT)
Advanced Cardiac Life
Support (ACLS)
Advanced Trauma Life
Support (ATLS)
Mass Casualty Incident ,
Incident Command System
& Weapons of Mass De -
struction (MCI-ICS-WMD)
Basic Health Emergency
Management
(HEM)

Continuation of Competency Requirements and Required Training Course/Package by Roles Continuation of Continuation of
Position
Roles/Functions
Hospital
- Decontamination/isolation
- Patient management/triage
- Specic case management
o Burns
o Weapons of Mass
Desruction (WMD)
o Radiological, Biological
& Chemical (RBC)
o Poisoning
4.Trainers
- Training needs assess-
ment (TNA)
- Training design
- Actual conduct of training
- Development of evaluation
tool
- Evaluation of training
- Development of module
5. OpCen Staff
- Monitoring of events
- Coordination
- Data Management
Competency Requirement
(Functional)
Knowledge and skills in:
Basic Life Support & Standard
First Aid
Advanced Cardiac Life Support
(ACLS)
Advanced Trauma Life Support
(ATLS)
Triage
Mass Casualty Incident , Inci-
dent Command System &
Weapons of Mass Destruction
(MCI ICS- WMD)
Specic case management
Presentation skills
Communication skills
TNA skills
Training design skills
Knowledge of DOH System/
Health Sector
Knowledge of HEMS Policies,
guidelines, procedures in moni-
toring
Skills in tri-media monitoring
Skills in map reading, hazard
mapping, etc.
In addition to the above:
Knowledge of the network and Knowledge of Knowledge of
contact persons
Communication skills
Negotiation skills
Skills in decision making
Knowledge in all HEMS reporting
forms and templates
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
Required Training
Course/ Package
Basic Life Support (BLS),
Standard First Aid;
Medical First Responder
(MFR)
Emergency Medical
Technician (EMT)
Advanced Cardiac Life
Support (ACLS)
Advanced Trauma Life
Support (ATLS)
Mass Casualty Incident ,
Incident Command System
& Weapons of Mass De -
struction (MCI-ICS-WMD)
Radiological, Biological &
Chemical (RBC) Courses
Basic Health Emergency
Management (HEM)
Basic Training of Trainers
(TOT)
Organization of the DOH
and the Health Sector
Health Emergency Manage-
ment (HEM) Basic
Public Health and Emer-
gency Management in Asia
and the Pacic (PHEMAP)
Basic courses in computer
including use of Internet
Networking and Coordina-
tion
Basic Epidemiology
Data Management
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186

Hospitals
The HEMS Coordinator needs to classify the different hospital staff by their function in
health emergency to determine the appropriate training courses for them. The recom-
mended courses include the requirements from A.O. 155 for Mass Casualty Manage-
ment, stated below.
1. BLS training shall be mandatory for all health personnel.
2. Advance Cardiac Life Support (ACLS) and Pediatric Cardiac Life Support
(PCLS) shall be a requirement for all medical personnel assigned in the
Emergency Rooms.
3. All Response Teams shall have additional training in Emergency Medical Techni-
cians Course Basic and Mass Casualty Management.
Specially designated hospitals should have training on their areas of expertise. Below is
a list of such hospitals and their corresponding training requirement:
1. Hospital Poison Control Centers - Toxicology Training, Chemical Terrorism
2. Trauma Centers
3. Infectious Disease Hospitals Biological terrorism, emerging and re-emerging
diseases (SARS, Avian Flu, etc.)
Competency Requirement
(Functional)
Knowledge of available re-

sources in DOH
Knowledge on the steps in
mobilizing human (e.g., medi-
cal teams, etc.) and material
resources to the affected com-
munity
Knowledge and skills in MCI/
ICS
Knowledge of available IECs
especially for emergencies
Skills in media handling
Administrative Functions such
as:
- Maintaining database of con-
tact persons, experts, facilities,
logistics, etc.
- Filing, recording of important
documents
- Updasting les
Performing other functions
assigned
Skills in BLS/ First Aid/ EMT
Knowledge and skills on the fol-
lowing:
- Basic HEM (Awareness)
- BLS
- First Aid
- 4Ws & 1H (Who, Where,
When, Why and How)
Required Training
Course/ Package
Logistics Mobilization
Mass Casualty Incident and Inci-
dent Command System
Risk Communication
Basic Communication Technology
(Radio, Map Reading, GIS, etc.)
Basic HEM Training 2-day course
(training module to be developed)
Position
Roles/Functions
- Logistics Mobilization

- Risk Communication
- Others
6. Other Hospital Personnel
- Initial responder
- First aider
- Health education &
promotion
- Reporting
Continuation of Competency Requirements and Required Training Course/Package by Roles Continuation of Continuation of
4. Burn Centers
5. Hospitals with Radio-nuclear Management Capability Radiological Terrorism
6. Hospitals with Chemical Management Capability Chemical Terrorism
Similarly, designated referral hospital laboratory should have training on their areas of
laboratory capability.
Apart from the training which hospital staff should have, they can serve as technical
resource persons and/or trainers. As part of the Hospital Emergency Preparedness, Re-
sponse and Recovery (HEPRR) Plan, the hospital can provide technical assistance on
Basic Life Support, Basic First Aid, and Basic Health Emergency Management (HEM) to
the community within their catchment area.
CAREER DEVELOPMENT
A holistic approach in initiating and nurturing staff in health emergencies is crucial to
human resource development. Upgrading of competencies through training should be
mapped out in the context of a long-term perspective that of a career path of the hos-
pital staff, an area that needs to be dened and enhanced.
Health Human Resource Management
Beyond knowledge and skills, psychosocial support for the staff deserves closer at-
tention, given the pressures inherent in the work including the 24-hour shifts, the quick
decision-making process, and need to balance with equally important demands of their
respective families.
Considering the nature of the work where speed and timeliness are of the essence, spe-
cic concerns such as safety, incentives, compensation, and other workers benets 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 benets 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/ofce 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 renement 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.
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188
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 identied at the different levels of health facilities.
PURPOSE
The purpose of this section is to provide an overview of logistics management system
and to provide guidelines for the hospitals to be able to perform their logistic man-
agement functions during emergencies and disasters.
DEFINITION
1. Logistics management has been described as the procurement and delivery of
the right supplies, in the right quantities, in the right order, in good condition
(proper packing and not expired), at the right place, at the right time (HEMS, June
2007).
Getting the appropriate emergency resources to the right place at the right time in
the most efcient means possible is a primary concern. These resources include
drugs, medicines, supplies, equipment and materials needed in response to
emergencies and disasters.
2. Logistics management is the process of planning, preparing, implementing and
evaluating all logistics functions in the provision of assistance, as well as its place
in carrying out emergency management operations.
LOGISTICS MANAGEMENT PROCESS
A. Planning
Annual Procurement Plan (APP)
The APP containing a list of all drugs/medicines, supplies, equipment and
materials to be procured for the coming year shall be prepared and submitted
by the HEMS Coordinator and signed by the Chief of Hospital at least one
quarter prior to the start of the succeeding calendar year. Any procurement
not included in the APP will not be approved and processed.
The HEMS Coordinator of the hospital should be involved during logistics
planning for emergency requirement.
In the preparation of the APP, the HEMS Coordinator of the hospital will have
to consider the following:
- Inventory of available stocks including the expiry date of drugs, medicines,
supplies and materials including equipment.
- Utilization of the past years.
- Postmortem analysis of disasters specically 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
specications and appropriateness to emergency conditions, indicating the
following:
- Dosage
- Size
- Volume
- Preparation
- Ingredients
- Required packaging
- Appropriate storage and transport (e.g., cold chain management)
- Necessary supplies for administration (e.g., vaccines need syringes, needles,
and special puncture-proof container for containment prior to waste treatment
and disposal).
- It is very important that only drugs and medicines in the latest PNDF will be
considered.
Supplemental Annual Procurement Plan
In the event of additional needs or during emergency procurement, a supplemen-
tal APP will have to be prepared and submitted.
B. Procurement
The hospital can procure emergency drugs/medicines and supplies. However, if the
hospital can make arrangements with pharmaceutical companies and other suppli-
ers during emergencies there might be no need to procure large amount of drugs
and medicines.
Procurement shall follow the pertinent government rules and regulations and other
DOH policies relative to procurement.
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190
Purchase request for the whole year must be submitted to the procuring entity every
rst quarter of the year (or the hospital may have a different schedule) with the
following supporting documents:
Annual Procurement Plan/Supplemental Annual Procurement Plan
Certicate of Clearance (medicines, drugs, medical supplies and equipment)
Certicate of Availability of Fund
In the event that supplies and materials are not available locally or the hospitals
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 sufce. The request shall be supported by a report on the
emergency.
C. Storage/Warehousing
There are various options for storage during preparedness, response and rehabilita-
tion phase.
Preparedness
Look at various storage/warehouse areas in and outside the hospital. Ideal storage
areas may include warehouses and other suitable buildings where storage manage-
ment procedures already exist during pre-disaster phase.
Emergency/Response Phase
When ideal storage is not available, especially during emergency or response
phase, available space in the eld can be utilized. There are ways to innovate/
modify the minimum requirement for storage. These may include among others:
Lockable transport container that can be left near the site or stricken areas
Temporary storage for stocks in transit
The following are some guidelines to be observed to ensure proper storage and to
minimize wastage of drugs/medicines, compact food, medical supplies and reagents:
Store foods in a dry, well-ventilated area free from insects and rodents.
Boxes, bags and containers must not be placed directly on oor. Use pallets
or boards underneath piles.
Keep items at least 40 cm away from the wall and do not stock them too high.
Replace damaged boxes, bags and containers.
Pile boxes, bags and containers two by two crosswise to permit ventilation.
Observe First in-First Out principle and dispose of food supplies at least one
(1) year, and medicines at least six (6) months, before the expiry date.
Vaccines should be stored at the cold storage with a temperature of 2-8
degrees centigrade.
Do not store food and vaccine together in one cold storage.
Keep the medicines away from sunlight.
It is necessary to categorize and record what might be termed as logistic tools to
address needs for disaster situations. Commodities which are likely to be needed
may include among others:
Operational support items (e.g., fuel, oil lamps/lanterns, ashlight, means of
communication)
Relief commodities (e.g., food, shelter materials, clothing)
Medical necessities (e.g., drugs, water purication accessories)
Items likely to be required for recovery programs (e.g., building materials)
D. Distribution and Delivery
The HEMS Coordinator can request their own supply for use in the emergency room
or for the use of the response teams in responding to the site. They have to make
their own listings for these, considering that they should be able to handle at least
5 red victims during response. Majority of the needs of the hospitals are for trauma
management, so this should be considered.
The resources are distributed to the concerned department/unit.
In the event of augmentation from CHD, emergency drugs, medicines, supplies
(including BP Compact Food) shall be provided to the Response Teams so they can
respond immediately during emergencies in their areas.
E. Monitoring and Reporting
To ensure that essential items are always available, incoming supplies, supplies dis-
tributed, and stock levels should be closely monitored. It is important to:
Record the end destination for items in the stock records.
Monitor that they are being used appropriately.
Provide reliable reports.
The Hospital Supply Ofcer 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 rst 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
There shall be no donation for purposes of emergencies and disaster situations,
whether from international or local sources, unless a formal acceptance for the
purpose is issued by the Secretary of Health or his designated representative.
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192
B. Acceptance
Infant formula, breastmilk substitutes, feeding bottles, articial nipples and teats
shall not be items for donation. No acceptance for donation shall be issued for
any of these items.
Acceptance of donation in foodstuffs for purposes of emergency and disaster
situations should be made for foodstuffs that have a shelf life of at least three (3)
months from the time of arrival to the Philippines.
Acceptance of donation in drugs/medicines for purposes of emergency and dis-
aster situations should comply with the following minimum criteria:
Shelf life of at least twelve (12) months from the time of arrival to the Philip-
pines.
Labeling with English translation or in a language that is understood by Philip-
pine health professionals.
Packaging that complies to international shipping regulations accompanied by
a detailed packing list
Weight per carton does not exceed 50 kilograms.
Exclusive packaging with regards to other supplies.
Documentary proof of compliance to applicable quality standards.
Documentary proof that the items were obtained from reliable sources.
C. Distribution
The DOH shall distribute the donated items to emergency and disaster affected
areas. The distribution of such items for election purposes shall not be allowed
nor the repackaging thereof in consideration of elective or appointive government
ofcials.
A. Health Emergency Preparedness Phase
During this phase, the Logistic Management System shall be developed.
Proper coordination and arrangement must be established between the HEMS
Coordinators, Logistics and Supply Ofcer, Budget Ofcer and the warehouse
management.
Proper protocols and procedures likewise should be established to ensure faster
accessibility to the drugs and medical supplies as needed.
Logistics and Supply Ofcers should have data of available suppliers in the event
of an emergency procurement; they can also establish special arrangements or
go into an MOA (MOA) with established and credible suppliers.
Sufcient logistical capacity must be in place for the ambulance needs as well as
for emergency room requirements.
Ensure plans are in place.
B. Health Emergency Response Phase
Rapid Assessment, specically on logistics needs, must be conducted. Vulner-
ability of logistics components (i.e., commodities, transport vehicles of various
kinds, supply systems and routes) must be considered and addressed.

193
The Logistics Ofcer should take charge in supplying all the needed logistical
requirements needed by the responders.
The Finance Ofcer should ensure available nances and shall be responsible for
sourcing out from other budgets.
The Hospital Liaison Ofcer should be able to network with other hospitals to
identify sources.
C. Health Emergency Recovery and Reconstruction Phase
Conduct evaluation.
Update inventory of resources.
Review and update systems and plans.
Replenish utilized resources.
Hospitals should have a supply stock for two weeks to one to three months based
on hazards in their region. DOH Central Ofce will be called only for augmentation
purposes.
HOSPITAL LOGISTICS
The hospital should be in constant state of readiness to respond to any health emer-
gency/disaster in terms of logistics for patient care and for safety of workers, both at the
disaster site and in the hospital.
Necessary supplies and equipment must be ready for immediate distribution to appro-
priate locations in the hospital: (a) Emergency Room (e.g., stretchers and wheelchairs
to the receiving area); (b) X-ray; (c) Laboratory ; (d) Blood Bank; (e) Operating Rooms;
(f) Intensive Care Units; (g) Special Units Burn, Toxicology, etc.
The essential medical facilities and support for disaster operations to on-scene and
in-hospital response teams should be in place, regularly monitored and regularly main-
tained. This includes: (a) ambulance facilities that enable the Scene Response Teams to
conduct rescue operations at the site of the disaster (see Section 4.1); (b) transport and
communication facilities; and (c) standby power generators. Apart from the supplies and
equipment for patient care, the personal protective equipment (PPE) for workers is an
utmost necessity.
The hospital, particularly in disaster-prone areas, has to develop logistic management
procedures to support the organizational shift in times of emergencies and disaster.
Prior arrangements have to be made, such as opening of credit lines with suppliers of
critical supplies to ensure continuous supply of medicines and other consumables, and
with maintenance service providers to ensure prompt repair and/or temporary replace-
ment of critical medical equipment that break down during disasters.
One major area to consider is the procurement, transport and storage of biological sup-
plies such as blood, plasma or vaccines.
Stockpiling of Equipment and Supplies at Hospital Level
Normally all hospitals have a system of procurement and stockpiling drugs, medicines
and supplies usually for 2-3 months. In health emergency management, there is no
194
need for the hospital to maintain stocks of drugs, medicines, supplies, equipment and
materials, as long as these can be procured locally. However, arrangement and agree-
ments with local suppliers must be in place.
In case these logistics are not available locally, stockpiling is suggested but has to be
monitored regularly to prevent the expiration of drugs and supplies to pass unnoticed.
The needs to be met may vary depending on the demand and previous experience.
The categories of logistics may include:
a. Emergency Kit for the responders
b. Emergency stocks of reagents
c. Emergency drugs, and medical supplies for the emergency room
d. Power generators
e. HEMS Trauma Kit (rst responder medical supplies)
f. Others (e.g., things which are most frequently requested and needed)
Inventories should be regularly reviewed and updated. Periodic tests must be carried
out to ensure that the equipment are always in good working condition.
It is important to record the end distribution destination for items in the stock records,
to monitor that they are being used appropriately and to provide reliable reports.
Supplies that are not usually readily available locally can be requested from the DOH
Central Ofce. 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.

195
SECTION 15
Information Management
A.O. 168 s. 2004 Section V-C: Policy Statements on Support Systems provides:
4. A system for managing information during emergencies shall be developed and
institutionalized for the health sector to ensure that appropriate, timely and rel-
evant information are disseminated to the target stakeholders. Furthermore, ow
of information and proper way of documentation should be established.
5. A communication system should be developed at all levels to improve monitor-
ing and response to emergencies and disasters.
Information Management, an iterative process of data collection, information sharing
and utilization, is carried out to support decisions and activities during pre-disaster,
emergency/disaster and post-disaster phases of health emergency management. (De la
Pea, 2007)
.
The tasks for a Management of Information System are the following:
1. Set policy, goals and objectives (to address identied information needs), prepare
guidelines.
2. Develop methodologies, procedures, indicators, etc.
3. Issue guidelines and identify training needs.
4. Collect data and information.
5. Filter the data.
6. Analyze the data.
7. Disseminate information about managing risks to:
Guide decision-makers.
Inform the public.
Inform research.
Obtain feedback.
The Information Management Manual for Coordinating and Monitoring Health Emergen-
cy and Disaster Response, Volume I, 2007 identies the roles and information needs of
eight key players in health emergency management at the national level; the hospital is
the fth 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/
196
reporting forms and their timing/frequency for DOH-HEMS. (The forms are presented
towards the last part of this manual.)
Reporting form
Form 1. Hears Field Report
Annex
Form 2. Materials Utilization Report
Form 2-1. Inventory Checklist
Annex
Form 3-A. Rapid Health Assessment
Annex
Form 3-B. Rapid Health Assessment
(MCI) Annex
Form 3-C. Rapid Health Assessment
(Outbreak) Annex
Form 5. List of Casualties Annex
Form 5 -1. Patient List from Field Medi-
cal Commander Annex
Form 5-2. Mass Casualty Medical Case
Record Annex
Form 6-1. Post Mission Report Annex
Form 6. HEMS Coordinators Final Re-
port Annex
Timing/Frequency
Within 24 hours of occurrence of event
One month after the event or as needed
Daily for rst two weeks, as necessary
thereafter
Within 24 hours of occurrence/aware-
ness of event
Within 24 hours of occurrence/awareness
of event
Within 24 hours of occurrence/awareness
of event
Daily for rst two weeks, as necessary
thereafter
Daily for rst two weeks, as necessary
thereafter
Prompt accomplishment
Within 24 hours of completion of mission
Within one week after termination of re-
sponse
Table S15.1. Data Collection Tools
Data and information have three dimensions of quality in information, namely:
1. Time dimension refers to timeliness (ready when needed), currency (up-to-
date), and frequency (available as often as needed) of the data or information
being managed.
2. Form dimension refers to clarity (easy to understand), level of detail (de-
tailed vs. summary report), and order (sequence of data presentation) in
which the data or information is presented in the reports.
3. Content dimension refers to the accuracy (free from error), relevance
(an swer the needs of the user), and completeness (free of omissions) of the
data or information.
197
The Hospital HEMS Coordinator shall ensure the quality of data and information follow-
ing these guidelines:
1. All data and information providers shall exercise due diligence in verifying ac-
curacy of their reports. Doubtful data or information shall be veried with reliable
sources within the network of agencies involved in emergency and disaster man-
agement.
2. Data collection forms and reporting templates shall be prepared and submitted
within the prescribed deadline and frequency.
3. The persons responsible for lling out the data collection forms and preparing
the reports shall ensure that the latest data and information are provided.
4. Prescribed forms shall be lled out as completely as possible. Templates may be
modied but the general format shall be followed and the minimum data/informa-
tion asked for shall be provided. For data elds requiring descriptive information
(e.g., Brief Description of Event), the person preparing the report shall provide as
much relevant details as possible.
5. As much as possible, all forms and reports shall be typewritten or computer-gen-
erated. Otherwise, they shall be written legibly and in black ink.
Data 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 signicance what
needs to be done in response to the information.
The reporting forms are submitted to DOH-HEMS, specically OpCen, as prescribed.
The utilization of information is incumbent upon the ofces and personnel to whom it is
disseminated. The following actions may be considered in planning and implementing
appropriate health emergency response by the Hospital HEMS coordinator.
1. Resource Matching allocation of personnel and resources to identied tasks
2. Preliminary Deployment responding using available resources
3. Activation of Support Services and Request for Outside Assistance when the
required response cannot be addressed by immediately available resources, but
which may be available from other organizations through existing planning ar-
rangements
4. Logistics Support considering:
Length of self-sufciency of affected area
Need to bring a small stock of high-usage items
Replenishment of consumables
Provision of operational equipment
Repair of operational equipment
5. Prognosis forecasting the potential for additional assistance or resources re-
quired for the following hours or days as appropriate
198
Hard copies of the accomplished forms shall be organized and stored into related les
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.
199
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 inuenced 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 Ps or elements of Successful Health
Emergency Management. This element advocates for behavior change towards prepar-
edness and response to health emergency and disaster.
A.O. 168 s. 2004 Section V-C: Policy Statement on Support Systems states:
3. Media management and public information shall be made readily accessible in
such situations. As such, there shall be a designated spokesperson in all health
facilities and institutions to respond to inquiries related to health emergencies.
Such person should be trained and be readily available, accessible to the media
Health Promotion as dened 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 afrms the earlier denition of the Ottawa Charter of Health
Promotion in 1986, where it is implied that Health Promotion works through concrete
and effective community action in setting priorities, making decisions, planning strate-
gies and implementing them to achieve better health.
Advocacy is the organization of information for the purpose of persuading, convincing
and motivating the target audience towards a specic idea or behavior. It changes the
social climate within which changes in the behavior of people about their own lives
takes place.
Health Promotion in Health Emergency and Management is educating and promot-
ing for a change in lifestyle among the common people that will lead to the prevention of
health emergencies and disasters.
200
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 Mitigation advocacy Mitigation advocacy
occurring. Responsive advocacy activities include the actual provision of emergency
response like evacuation and rescue services. Recovery advocacy activities are longer-
term efforts to assist or rebuild the affected community. This is the rehabilitation period
after the disaster which will also bring its post-disaster hazards like psychological trau-
ma and diseases.
PROCESS
1. How to Conduct Health Promotion
1.1. Develop a Health Promotion Plan.
The development of a Health Promotion Plan on Health Emergency and Man-
agement is one of the tasks in the Health Emergency Management Coordinators
roles and responsibilities Takes the lead in public information and awareness
concerning disasters and emergencies. There are three major steps in the
development of a Health Promotion Plan. These are: (1) Conduct of Diagnosis
deals with the assessment of the different situations affecting the behavior and
lifestyle of the people; (2) Development of Intervention Strategies determining
the strategies that will be done in order to achieve the desired behavior change;
and (3) Development of Evaluation Tools and Parameters assessment of the
effect of the health promotion intervention.
1.1.1. Conduct of Diagnosis
a. Social Diagnosis process of determining peoples perception of their
own needs, quality of life, and aspirations for the common good, through
broad participation and the application of multiple information-gathering
activities designed to expand understanding of the community. Methods
that can be used for Social Diagnosis are: community fora, focus groups,
surveys, interviews, etc.
b. Epidemiological Diagnosis data gathering of important statistical data
related to health emergency and disaster. This step determines the health
issues associated with quality of life, in particular, specic health problems
and non-health factors related to poor quality of life. Epidemiological data
include vital statistics, years of potential loss, disability, disease preva-
lence and incidence, morbidity and mortality.
c. Behavioral and Environmental Diagnosis assessment of the present
behavior of the target audience and the environmental factors that affect
their risk. It also includes non-behavioral causes (personal and environ-
mental factors) that contribute to health problems, but controlled by behav-
ior. Behaviors identied should be scaled to their importance and change-
ability.
Environmental Diagnosis is a parallel analysis of factors in the social and
physical environment other than specic actions that could be linked to
behaviors.

d. Educational and Organizational Diagnosis assessment of the causes
of health behaviors which were identied in (c) Behavioral Diagnosis.
Three kinds of causes are identied:
1. Predisposing factors any characteristics of a person or population
that motivate the individual/s prior to the occurrence of that behavior.
These include values, cultures, beliefs and attitudes of the person or
population.
2. Enabling factors characteristics of the environment that facilitate Enabling factors Enabling factors
action and any skill or resource required to attain a specic behavior,
including the knowledge, skills and resources of the population and
environment.
3. Reinforcing factors rewards or punishments following or anticipated Reinforcing factors Reinforcing factors
as a consequence of a behavior, which serve to strengthen the motiva-
tion of behavior.
e. Administrative and Policy Diagnosis the assessment of resources,
budget development and allocation, development of an implementation
time table, organization or personnel within the programs, coordination
of the program with all other departments, and institutional organization
within the community.
Administrative diagnosis analysis of the policies, resources and circum- Administrative diagnosis Administrative diagnosis
stances prevailing, and of organizational situations that could hinder or
facilitate the development of the health programs.
Policy Diagnosis assessment of the capability of the program goals and
objectives in relation to those of the organization and its administration.
1.1.2. Development of Intervention Strategies
Following the recommendations of the Ottawa Charter, the strategies
should focus on the ve areas of health promotion in order to:
1. Develop personal skills personal and social development of the tar- Develop personal skills Develop personal skills
get audience by providing information, education and enhancing skills
related to health emergency and disaster management.
2. Build health public policy putting health emergency and disaster Build health public policy Build health public policy
management on the agenda of policymakers in all sectors and at all
levels.
3. Create supportive environment - establishing network and alliance
building among partner agencies.
201
202
4. Reorient health service greater attention to health research as well
as changes in professional education and training. This must lead to a
change in attitude and organization of health services, refocusing on
the total needs of the individual as a whole person.
5. Strengthen community action empowerment of communities, their
ownership of the projects, and activities geared towards prevention of
health emergency and disaster.
1.1.3. Development of Evaluation Tools and Parameters
This can be done through records review, survey, focus group discus-
sion and other evaluation methods. The health promotion program can be
evaluated at one or more of three levels:
Process Evaluation evaluates the process by which the program is being
implemented; assesses the planned strategies/activities versus the strate-
gies/activities actually implemented.
Impact Evaluation measures the program effectiveness in terms of inter-
mediate objectives and changes in predisposing, enabling and reinforcing
factors. It measures the attainment of the Behavioral and Environmental
Diagnosis and Educational Diagnosis.
Outcome Evaluation measures change in terms of overall objectives
and changes in health and social benets or the quality of life. This form of
evaluation takes a very long time to get results. It may take years before
an accrual change in the quality of life is seen.
1.2. Implement the Health Promotion Plan refers to the execution of the
strategies and activities of the plan
1.3. Evaluate the effects of the Health Promotion Plan refers to the Process,
Impact and Outcome Evaluation
2. How to Conduct Advocacy
2.1. Build oneself as an advocate. Learn to imbibe the qualities of an advocate,
which include the following:
Objectivity degree of condence or suspicion you have in the system, and
your belief in the potential of positive change
Independence uninuenced and informed judgment
Sensitivity and understanding interest and empathy
Persistence and patience determined and secure enough in your position to
weather storms, deal with setbacks, and maintain energy over time.
Knowledge and judgment understanding what to ask for and whom to ask,
and be able to exercise judgment about what is reasonable, and what is not
Assertiveness rmness with politeness; having a good working relationship
with others without letting them not control you
Ethics and respect for others having respect for the privacy and con-
dentiality of others, and respect for the basic rules of ethical conduct, to be
effective and to maintain credibility
2.2. Develop the Advocacy Plan.
2.2.1. Assess the problem What is the issue, idea or behavior that needs persua-
sion, convincing and motivation of the target audience? Form an advocacy
team.
2.2.2. Gather information and form solutions Conduct literature review or other
similar situations from other organizations, communities or institutions.
2.2.3. Choose your strategies There are different strategies or tools that can be
used. Advocacy strategies include:
1. Policy reform
2. Organized community response
3. Dispute resolution
Advocacy tools that can be used are:
1. Big bang presentation of information during national events. Big bang Big bang
Examples:
Basic Life Support Demonstration at the different malls during the obser-
vation of the National Disaster Consciousness Month
Conduct of National Convention on Disaster Management by the Health
Sector in the Philippines during the celebration of the Health Emergency
Week
2. Little bang small events can become excellent venues for presenting Little bang Little bang
your advocacy arguments.
Example: Announcements during ag ceremony or community assemblies
3. Big visit visits by leaders and decision-makers in your areas. Example: Big visit Big visit
Personal appearance of the Secretary of Health or other executives at any
community event
4. Inside man key people in an organization can do advocacy with leaders
and decision-makers with whom they have routine access and you do not.
Example: Making use of the gate keepers
5. Letter a letter to a leader and decision-makers can provide a good Letter Letter
means to present your arguments and allow the other side time to think
out their response.
Example: Issuance of Department Memorandum on the Observance of
the National Disaster Consciousness Month
6. Quiet meeting sometimes it is more effective to talk with the person Quiet meeting Quiet meeting
alone.
7. Technical journal concerns the need to make certain ideas respectable Technical journal Technical journal
in professional circles before pushing them with government ofcials.
2.3. Implement the plan actual implementation of the strategies and tools
conceptualized.
203
204
2.4. Evaluate the plan carry out the identied assessment tools and proce-
dures.
Following is an example of a health promotion and advocacy plan.
HEALTH EDUCATION AND PROMOTION PLAN
I. DIAGNOSIS
A. Social Diagnosis
The World Bank study entitled Natural Disaster Risk Management in the Philip-
pines: Enhancing Poverty Alleviation Through Disaster Reduction, published in
2004, reported that the countrys 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 countrys GNP.
A study on the Impact of disaster-related mortality on gross domestic product in
the WHO African Region by Kirigia, Sambo, Aldis and Mwabu found that:
o Disaster-related deaths have a statistically signicant negative effect on GDP
per capita.
o A unit increase in disaster mortality was found to decrease GDP per capita by
US$0.01828, which is the economic burden of a single disaster-related death.
o The annual GDP lost by the Region has been estimated at US$9,713.
o The undiscounted lifetime GDP lost through the death of 539,597 people was
estimated at US$242,819.
Indirect and secondary disaster impacts lead to a greater economic burden of
disease and thus lead to a poor quality of life among the Filipinos, especially
those mostly affected.
B. Epidemiological Diagnosis
Of the 124,566 total population in Real, Infanta and Nakar,Quezon affected by
typhoon Yoyong and Winnie:
o !9,211 families and 94, 060 persons were affected.
o 530 were injured, 623 dead and 338 missing.
o Leading causes of morbidity ARI, wounds of all kinds, diarrhea, UTI.
o Leading cause of mortality drowning.
C. Behavioral and Environmental Diagnosis
Behavioral Diagnosis
Act only when disaster strikes.
Does not practice health emergency and disaster-preventive measures.
Note: No existing study has been done on the behavior of the people and
health emergency-concerned staff regarding health emergency and disaster
preparedness.
Environmental Diagnosis
The Philippines forms part of the prominent volcanic chain known as the ring
of re.
The country experiences, on average, 887 earthquakes every year.
Out of 220 dormant volcanoes, 22 are potentially alive.
The Philippines also lies within the Pacic typhoon belt, an area renowned
for hydrometeorological hazards.
According to the Philippine Atmospheric and Geophysical Services Adminis-
tration, the average tropical cyclone occurrence in the Philippines is 19 to 21
per year, of which two are super typhoons.
D. Educational and Organizational Diagnosis
Educational Diagnosis
(Note: No study on the knowledge and attitude of the people and the health
emergency staff at all levels)
1. Predisposing Factors
Inadequate knowledge on the facts and concepts of health emergency
among the community
Inadequate knowledge on what to do when health emergency and disaster
occurs among the community
Passive attitude towards prevention of disasters
Attachments of people to personal property
2. Enabling Factors
Inadequate IEC campaign materials
Available health emergency trained personnel at the regional level
3. Reinforcing Factors
Presence of gate keepers in the community

Organizational Diagnosis
Existing health emergency management staff
Presence of health emergency and disaster preparedness network
E. Administrative and Policy Diagnosis
Presence of legal mandate P.D. 1566: Strengthening the Philippine Disaster
Control Capability and Establishing the Program on Community Disaster Prepar-
edness
Existing policies on health emergency management at the DOH:
o A.O. 168 National Policy on Health Emergencies and Disasters
o A.O. 155 Implementing Guidelines for Managing Mass Casualty Inci-
dents During Emergencies and Disasters
205
206
II. INTERVENTION
Areas of Health
Promotion
Build health
public policy
Develop
personal skills
Reorient
health services
Strengthen
community
action
Create supportive
environment
Strategies
Advocacy
Capability
Building
IEC Campaign
Community
development
Networking and
alliance building
Activities
1. Review existing policies on
health emergency management.
2. Draft local ordinance on health
emergency management
3. Advocacy forum on health
emergency management
4. Awarding of Best Practices
5. Development of HEMS video
presentation
1. Conduct mandated trainings on
health emergency management
among regional staff.
2. Send health emergency
management staff to appropriate
trainings on health emergency.
3. KAP survey among the com-
munity, health workers and
managers on health emergency
management.
4. Health Promotion Needs as-
sessment on health emergency
1. Conceptualization, develop-
ment, pretesting, production and
distribution of IEC materials and
collaterals
2. Celebration of HEMs event
3. Establishment of HEMS re-
source center
1. Development of guidelines on
the organization of local emer-
gency brigade
1. Conceptualization of HEMS
webpage
2. Establishment of health emer-
gency SMS network
Evaluation Indicators
% existing policies re-
viewed and recommended
for amendment
% local ordinances passed
at the local board
% realized among pledges
of commitment made
Regional Ofce/LGUs with
best practices recognized
Level of reach
% of regional staff trained
on health emergency man-
dated training
% health emergency
management staff sent to
training
KAP on health emergency
evaluated
Health promotion needs
identied and analyzed
% distribution reached
Level of reach
Level of reach
Functional HEMS resource
center
% functional local emer-
gency brigade
HEMS webpage online
and updated
Health emergency SMS
network functional
III. EVALUATION
Year-end survey on Health Emergency among the community, health workers and
health managers.
207
SECTION 16B
Risk Communication and Media Management
INTRODUCTION
The publics yearning to learn about health, the increasing trend toward health behavior
change, and the advances in information technology all contribute to the likely attain-
ment of a health-informed public. Communication strategies are often done through
mass distribution of information, education and communication (IEC) materials and
media releases. But health providers should not only focus on health behavior in normal
situations but also on communicating health risk messages. Risk communication is an
area of communication strategies that is rarely practiced. It is imperative that health
workers develop the habit of communicating health risks before the event, during the
response and after the disaster. (Covello &Allen, 1988)
WHAT IS RISK COMMUNICATION?
Risk Communication is the purposeful exchange of information about the existence,
nature, and form severity or acceptability of health risks between policymakers, health
care providers and the public/media aimed at changing behavior and inducing action to
minimize/reduce risks.
It is an ongoing process involving potentially affected audiences and various stake-
holders to come to a common understanding about the hazards, the risks, their accept-
ability, and actions needed to reduce the risks considering risk management strategies.
It is the process of bringing together various stakeholders to come to a common under-
standing about the risks, their acceptability and actions needed to reduce risks.
Four Kinds of Risk Communication (Sandman, P.and Lanard, J.)
1. High hazard, low outrage
Situation: When the lack of outrage increases the hazard. In this situation, the
hazard is high; however, the outrage or the response/reaction of the people is
very low so there is a behavior of complacency.
Health Emergency Managers communicator role: Make the population con-
scious of the hazard to level off the hazard and outrage.
2. Medium hazard, medium outrage
Situation: When outrage and hazard need to be linked. The level of hazard and
the reaction of the public are of the same intensity.
Health Emergency Managers communicator role: Take advantage of the situ-
ation to develop communication and behavioral strategies.
3. Low hazard, high outrage
Situation: When outrage is the problem. The outrage is largely of the audience,
but the actual hazard is low. In this situation, the public has overreacted to the
hazard which is at its manageable level or of minimal consideration. The reaction
of the public is manifested in their attitude and their behavior.
208
Health Emergency Managers communicator role: Calm the public and inform
them of the real hazard scenario.
4. High hazard, high outrage
Situation: Crisis occurs when hazard is high but outrage is even higher.
Health Emergency Managers communicator role: Help the public bear its fear
and misery while avoiding reassurance.
What Is the Purpose of Risk Communication?
It is the fundamental right of the population to access information about the risks
they face.
Organizations are seen to be more legitimate and effective when they are trans-
parent and open with information.
The risk is shared by the organization and the population.
Risk Communication serves as an avenue for information and education to the
communities, health personnel and decision-makers. It gives a better chance to
explain risks to the population more effectively.
Populations can make better choices when they are better informed.
The emergency information can stimulate behavior change.
It prevents misallocation and wasting of resources.
It can decrease illness, injuries and deaths.
How Do We Explain Risks?
Find out what information people want and in what form.
Anticipate and respond to peoples concerns about their personal risk.
Take care to give adequate background when explaining risk numbers.
Acknowledge uncertainty.
The steps are:
1. Identify risks to be addressed.
Identify risks of the hazard using the risk management pro-
cess. Refer to the Health Emergency Preparedness Plans.
Determine the knowledge and the behavior(s) to be learned
and adopted to prevent the risk(s). These will be the basis
for the development of the communication plan.
Example:
Hazard: Disease Outbreak, Measles
Risk: Death
Knowledge:
Prevention of measles
Signs and symptoms of measles
Measures to prevent complications from measles
Home management of measles
Behavior:
Bring eligible children for measles immunization.
Bring children with early signs and symptoms of measles to health
workers.
Proper care and management of measles.
2. Develop a communication strategy.
Identify communication strategy based on the identied risk(s). Strategies should
focus on the prevention and/or management of the identied risk(s).
Examples:
1. Development of IEC materials
2. Media mix campaign
3. Design a Risk Communication Plan.
The communication plan should contain the following:
Target group To whom the Risk Communication will be addressed or the
recipient of the message. One important target group could be the people
responsible for creating risk situations through human activities. Target
audience can be grouped according to the following classications:
Social refers to the age, gender, educational status, religion and eth-
nicity of the target group.
Example: Productive age group or 15-44 years old, mothers, Muslims,
Aetas
Economic refers to the economic status of the target group. Exam-
ple: Below poverty line, underpriveleged
Political refers to the political afliation of the target group. Example:
Mayors, businessmen, farmers
Message Informs the target group
- what is happening (eg., to know the dangers they are exposed to)
- what it means to them (potential impacts to understand the risk)
- what the target group can do (to know how to respond when the haz-
ard strikes and protect lives and minimize damage)
Risk Communication messages may contain information on the following:
The nature of the risk
- Characteristics and importance of the hazard concern
- Magnitude and severity of risk
- Urgency of the situation
- Probability of exposure to the hazard and its distribution
- Nature and size of the population at risk
The nature of the benets
- Actual or expected benets associated with each risk
- Who benets and in what ways
- Where the balance point is between risks and benets
- Total benet to all affected populations combined
Risk management options
- Actions taken to control or manage the risk
- Action individuals may take to reduce personal risk
209
210
- Justication for choosing a specic risk management option
- Effectiveness and benets of a specic option
- Cost of managing the risk, and who pays for it
- Risks that remain after a risk management option is implemented
Source Who will be the sender of the message.
Communication channel Medium through which the message will be conveyed.
The use of media mix is highly recommended to achieve the maximum intended
result. The types of media commonly used are:
Print Newspapers, magazines
Broadcast Radio, TV
Electronic Internet, SMS, MMS
Folk Street play
Other channels of communication are:
Interpersonal communication
Group communication
Telecommunication (including cable TV)
Printed IEC materials (posters, brochures, yers, billboards, etc.)
Special events
Showcases and exhibits
Intended results Expected impact of the Risk Communication; change in the Intended results Intended results
knowledge and behavior of the target group as inuenced by the Risk Communi-
cation.
The intended result leads to the expected outcome which is either the prevention
or reduction of the risk(s), although this may take a longer period of time to be
measured.
4. Pre-testing
Check or verify the content, design and mode of communication for appropriateness
as perceived by the target group. Conduct the pretest with a group that matches the
characteristics of the intended audience. The most common methods used in pre-
testing are Focus Group Discussion and Survey.
5. Program implementation
Execution of the communication strategies identied.
6. Program evaluation and impact assessment
Program evaluation refers to the process evaluation or assessment of what strate-
gies/activities had been implemented as against the plan.
Impact assessment refers to the change in the knowledge and behavior of the target
group/audience.
Figure S16B.1 presents a ow chart summing up the entire process of communicating
health risks (Dr. Sulaiman Che Rus).
Figure S16B.1. Flow Chart: Steps in Communicating Health Risk (Dr. Sulaiman
Che Rus)
START
Identify and prioritize issues
Analyze communication situation
Set communicataion objectives
Analyze and select audience
Design, develop and pretest
Redesign
Accept
Communicate Message
No Yes
Evaluate
OK
End
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212
REMEMBER!!!
Seven Cardinal Rules of Risk Communication
1. Accept and involve the public as a partner.
Your goal is to produce an informed public, not to defuse public concerns or
replace actions.
2. Plan carefully and evaluate your efforts.
Different goals, audiences, and media require different actions.
3. Listen to the publics specic concerns.
People often care more about trust, credibility, competence, fairness, and
empathy than about statistics and details.
4. Be honest, frank, and open.
Trust and credibility are difcult to obtain; once lost, they are almost impossi-
ble to regain.
5. Work with other credible sources.
Conicts and disagreements among organizations make communication with
the public much more difcult.
6. Meet the needs of the media.
The media are usually more interested in politics than risk, simplicity than
complexity, danger than safety.
7. Speak clearly and with compassion.
Never let your efforts prevent your acknowledging the tragedy of an illness,
injury, or death. People can understand risk information, but they may still not
agree with you; some people will not be satised.
MEDIA MANAGEMENT
Role of Media During Risk Communication
Media plays a very important role in Risk Communication and handling media is very
crucial in health emergency management. Understanding them is one of the signicant
tasks of a health emergency manager.
Handling Media
1. Familiarize yourself with what media wants.
Know what kind of information media wants.
Consider that media runs after information to sell their story and in return
merit needed ratings for their newspaper and radio or TV station.
2. Be prepared for what media will ask.
Make available for media consumption information on the nature, effect and
other vital facts about the risk.
Consider that information should be brief and concise so that it will not create
misinformation. Below are some of the important data/information that media
wants:
a. Casualties
Number killed or injured
Number who escaped
Nature of the injuries received
Care given to the injured
Disposition of the dead
Prominence of anyone who was killed, injured or escaped
How escape was handicapped or cut off
b. Property Damage
Estimated value of loss
Description kind of building, etc.
Importance of the property, e.g., business operations, historic value, etc.
Other property threatened
Insurance protection
Previous emergencies in the area
c. Causes
Testimony of participants
Testimony of witnesses
Testimony of key responders
How emergency was discovered
Who sounded the alarm
Who summoned aid
Previous indications of danger
d. Rescue and Relief
The number engaged in rescue and relief operations
Any prominent persons in the relief crew
Equipment used
Handicaps to rescue
How the emergency was prevented from spreading
How property was saved
Acts of heroism
e. Descriptions of the Crisis or Disaster
Spread of the emergency
Blasts and explosions
Crimes or violence
Attempts at escape or rescue
Duration
Collapse of structures
Extent of spill
f. Accompanying Incidents
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214
Number of spectators spectator attitudes and crowd control
Unusual happenings
Anxiety, stress of families, survivors, etc.
g. Legal Actions
Inquests, coroners reports
Police follow-up
Insurance company actions
Professional negligence, or inaction
Suits stemming from the incident
3. Decide when to release information.
When to release information:
If people are at risk, do not wait.
Inform people concerned of any risk you are investigating and why.
If it seems likely that media (or others) may release information, release it
yourself.
Fill in information gaps for the media.
If preliminary results show a problem, release them and explain the tentative-
ness of the data.
If the information will not make sense without other relevant information, wait
to release it all at once.
Advise community on interim actions while waiting to conrm data.
If you dont trust your data, dont release it.
Consider:-
- Although the agency is vulnerable to criticism, one may be more vulner-
able if information is held on to.
- The alarm caused by early release will be less than the alarm that can be
compounded by resentment and hostility if information is held on to.
4. Choose how to release information.
Information can be released through:
1. Press release follow the following basic press release structure:
Summarize the content: In a press statement today, the Mayor called
on.
Quote the source: A public health emergency can only be avoided by,
the Secretary said.
Link the quote to an important event that is public knowledge: The state-
ment was made referring to the recent outbreak of measles where 10
children died
Acknowledge controversy but show that this is the best course of action:
Despite overwhelming resistance to,the action is needed because
Tell the public what to do: In support of this, the public is asked to For
more information call
2. Press Statement it should contain the following:
Opening remarks.
State the action.
Link it to an event.
State other supporters of the action.
Inform people of their role.
3. Press conference
HOW TO PREPARE FOR A PRESS CONFERENCE:
A. Before a Press Conference
1. Prepare (update) media directory.
2. Select a location which is accessible to media.
3. Make sure there are no other (newsworthy) events happening at
the time of your event/press conference.
4. Issue a press conference advisory.
Date
Topic or agenda
Time
Location
Contact information
5. Follow up calls after issuing advisory.
6. In the event of other breaking news, try to reschedule your event
or reach out to journalists on a one-on-one basis to generate a few
stories.
7. Prepare logistics needed. The ideal set-up includes a podium (or
table) and microphone(s) for the speakers.
8. For indoor press conferences, leave space for TV cameras at the
back of the room.
9. Provide for sign-in table where media can register their name and
contact information.
10. Prepare simple signage, e.g., banner behind the speakers. Name
plates for speakers may also be necessary.
11. Prepare press kit to hand out to media during the press conference.
Press release containing key information presented at the press
conference
Fact sheets or background information (including graphs, charts,
photos, etc.)
Copies of prepared statements
Brief background information and photo of speakers
12. Prepare speakers or spokespersons for the event.
13. Decide the order of speakers. Ideally, no more than three speakers
per forum.
14. Develop a brief statement (under 10 minutes is a good rule-of-
thumb) or provide spokespersons talking points and Questions
and Answers (Q&As).
15. Include quotable phrases or soundbites in the prepared
statement(s).
16. Prepare visual aids (e.g., easily seen from any point in the press areas).
17. Anticipate questions and prepare clear, brief answers.
18. Schedule a rehearsal.
19. Prepare visual aids (e.g., easily seen from any point in the press areas).
215
216
20. Anticipate questions and prepare clear, brief answers.
B. During the Press Conference
1. Arrive at least an hour before the event to give time to attend to any
last-minute matters.
2. Assign staff to greet media guests as they arrive and direct them to
the sign-in table.
3. Start on time even if few people are in attendance.
4. Review with the moderator the tasks. Moderator shall have been
prepared before the event.
o Moderator welcomes the media and briey explains why the
press conference has been called. Also, acknowledge VIPs
(speakers).
o Moderator may summarize key messages and opens the ses-
sion to questions. The Q & A portion should last no more than 30
minutes.
o Moderator may ask the reporter to identify himself/herself and
the name of their organization before asking a question.
o Moderator designates the appropriate speaker to answer the
question (in case there is more than one speaker).
o Moderator should not let the press conference drag on or zzle
out. He/she should step in and formally conclude the proceed-
ings.
5. Consider that:
o In science journalism, off-the-record, not-for-attribution, no-publi-
cation news conferences are neither unknown nor totally without
merit.
o An ideal press conference should last no more than one hour.
o TV reporters may still want to get speaker aside for some on-
cam comments after the conclusion of the press conference.
C. After the Press Conference
1. Consider sending thank you notes to the VIPs who attended.
2. Distribute press kits to key media who were unable to attend.
3. Monitor the press for coverage.
217
SECTION 16C
Risk Communication in the Hospital
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.
During an emergency/disaster, the hospital may be overwhelmed by more members of
the media than by actual disaster victims. The presence of these individuals can impair
the performance of an already stressed hospital staff if not handled properly.
The right of the public to know must strike a balance with the right of the patient to
privacy and quality medical care which media should understand and consider. Doctors
must have a conducive working atmosphere and enough working space in treating his/
her critically ill patient without having to worry about someone seemingly looking over
his/her shoulders.
The activities in the Emergency Room are so critical and urgent that any form of distrac-
tion or interruption may impact on the delivery of efcient and timely patient care.
On the other hand, the hospital recognizes that news releases from media can assist
in providing information to the families of victims who are looking for their loved ones.
Authorities can be contacted to activate the Emergency Broadcast System which dis-
seminates information on very short notice to a large number of people. Media provides
a mechanism for coordination with other stakeholders.
This familiar scenario during an emergency/disaster highlights the issues confronting
the hospitals during a disaster. The hospital takes a broader perspective in its health
promotion and advocacy role focused on the risk communication element prior to, dur-
ing and after an emergency. The sections on Health Promotion and Advocacy and Risk
Communication will serve as a guide to the HEMS Coordinator and other hospital emer-
gency managers in the formulation of plans and protocols.

A media management protocol may include the following actions as examples.
Identication/designation of a Public Information Ofcer.
Description of roles and functions.
Training for a Public Information Ofcer.
Preparation of guidelines on what information to look for and what information to
share with the Press.
Pre-designation of Press Room/Area.
Preparation of a schedule for press releases guided by the urgency of the informa-
218
tion that needs to be shared.
Clearance from the Incident Commander to release critical information.
While a protocol species the conduct of the duties of the designated Public Informa-
tion Ofcer, 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 ofcer and they
should direct any member of the media to the designated public relations/press area in
order to have consistency in the information given out by the hospital.)
An equally important aspect of the Risk Communication Plan is on health promotion
and advocacy for behavior that will reduce risks for the patients, health workers and the
general public. The hospital is a highly vulnerable area given the supplies and equip-
ment used in the provision of services. Risks from internal emergencies and those from
external emergencies have to be addressed with messages for staff, for neighboring
hospitals and operation partners (such as ambulances, police), for victims/patients and
respective families and friends, and for communities in the catchment area. The hos-
pital may refer to the HEMS. November 2007, Key Health Messages for Emergencies:
Philippines.
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 efcient-
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 rst ve minutes response determines the response for the next ve hours.
Immediate response starts with on-site or eld management where activities include:
scene assessment; setting up of a command post; alerting process; eld organization;
triaging of victims; establishment of command, control, coordination and communica-
tion; search and rescue; and eld care. There will be evacuation or transport of victims
from the impact site to the appropriate receiving health care facilities for denitive 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 conne 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, nancial or human resources amidst
a jeopardized circumstance. This health system needs to address the variety of health
needs of this conned population during disasters.
A. Organizational Component
1. Incident Command System - command, control, and coordination spearheaded
by the CHD Director
2. Organized operational and management support teams
a. Health Operation Team
219
220
b. Planning Team
c. Logistics/Supply Team
d. Administrative Team
Functions:
Operationalize health care delivery in the evacuation site, including man-
ning the clinic/hospital at the evacuation center if necessary.
Perform medical management/treatment at the center based on the devel -
oped treatment protocols and health program protocols.
Deliver direct health services (immunization, services, therapeutic nutrition,
etc.)
Provide water and environmental sanitation services.
Take charge of setting up a surveillance system for outbreak prevention.
- Early detection
- Monitoring of cases
- Case denition
- Community surveillance
- Effective treatment
- Rapid response
Conduct health education and promotion at the center.
Provide psychosocial support services to both direct and indirect victims as
well as responders.
Manage the logistics, supplies, equipment and other logistical needs at the
center.
B. Organized Health Operation
Health Operation Team Composition:
a. Medical Team
b. Water, Sanitation and Hygiene (WASH) Team
c. Food and Nutrition Team
d. Surveillance Team
e. Psychosocial Team
f. Health Education Team
C. Health Service Delivery
1. Disease Prevention Services
a. Prevention of communicable diseases such as:
Food and water-borne diseases
Vaccine-preventable diseases
Communicable diseases with epidemic potential
Respiratory diseases
b. Disease prevention services
Disease surveillance
Water and sanitation services
Food and nutrition services
Environmental sanitation
Immunization services
Case segregation at the evacuation center
221
2. Disease Control Services
a. Early case detection based on disease surveillance report, and laboratory
results
b. Proper and appropriate treatment of cases based on the developed treat-
ment protocols and health program treatment protocols
c. Provision of appropriate drugs, medicines and food
Figure S17.1. Strategy for Controlling Communicable Diseases
Control of
Communicable
Diseases
Primary
Prevention
Secondary Secondar Secondar
Prevention
Secondary
Prevention
Tertiary
Prevention
3. Referral System
Levels of Health Care Services:
a. Community-based
Health education
Community surveillance
Environmental sanitation
Feeding programs
b. Primary Health Care Services
Out-patient clinic with daytime operation or 24-hour operation
Mobile hospital if necessary
Laboratory
Medical rst aid
Treatment/management/stabilization of selected diseases (e.g.,
rehydration, etc.)
c. Hospital Care Services
Referral system
Established network of hospitals
Coordinated ambulance services
D. Health Care Structures
1. Health care facilities in the evacuation site in the form of:
Out-patient clinic with daytime operation
Clinic or hospital with 24-hour operation
222
Rehydration center
Feeding center for the malnourished children
2. Established Operation Center
3. Warehouse for storage of resources
E. Provision of nancial and logistical needs
1. Needed medical equipment and supplies
2. Drugs and medicines
3. Transport vehicles
4. Communication equipment
5. Reporting forms
6. Financial support
F. Systems developed
1. Early Warning and Alert System
2. Damage Assessment and Needs Analysis/Rapid Health Assessment
3. Emergency Operations Center
4. Mass Casualty Management
5. Management of Mass Dead and Missing
6. Public Health Services
7. Mental Health and Psychosocial Support
8. Coordination and Networking
9. Human Resource Development
10. Logistic Management
11. Health Promotion and Advocacy/ Risk Communication in Public Information
and Media Management
12. Information Management
13. Evaluation
!4. Research

223
SECTION 18
Evaluation
Once nalized and approved, the hospitals 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 reect changes in staff,
technicians, material resources, etc., which have taken place since the plan was pre-
pared.
An overall evaluation of the entire process of health emergency management in the
hospital is closely interlinked with the competencies of the users of the plan, meaning
the Crisis and Consequence Management Committee, HEMS coordinators, and the
hospital staff. Continuous improvement of the hospital and its health emergency man-
agement process through an evidence-based approach is fundamental to its function.
This can be derived from an analysis of the post-incident evaluations (actual experi-
ences) and evaluation exercises (hypothetical situations).
Post-incident evaluations (PIE) are conducted during the debrieng of the deployed
teams and at the end of the response phase. The debrieng may be done immediately
at the conclusion of the event. The evaluation at the end of the response phase is often
done in a structured meeting of all participants, which includes a review of events fol-
lowing a timeline, analysis of strengths and weaknesses, and drawing up proposed ac-
tion to improve/enhance the response work. Other documented sources of insights from
actual experiences are the Post-Mission and Final Reports of deployed teams.
The learning process usually centers on the following questions:
What worked well? Why did these work well?
What did not work well? Why not?
What are the insights from these experiences in the context of the event, as well
as past events?
What are the recommendations for future response work?
The results shall be included in the Hospital HEMS Coordinators Final Report (Form 6)
as lessons learned either as new lessons or validated ones based on previous expe-
riences. A critical review of such lessons should be undertaken for the lessons cannot
be said to be fully learned until the recommendations have been implemented and new
behaviors demonstrated through subsequent practice or experience. (WHO/WPRO,
2006)
Post-Incident Evaluation needs to have a comprehensive review of the health emer-
gency/disaster which will include the following aspects as modied from Carter (Carter,
1991):
Status of HEPRR plans and preparedness prior to the emergency/disaster
Communications
Early Warning and Alert system including origin(s), transmission and receipt,
processing dissemination, action taken (by sender, recipient), functioning of
warning systems
Emergency Operation Center, acquisition, receipt and handling of information,
224
display and assessment of disaster situation, decision-making, dissemination of
decisions and information
Activation of the Hospital Emergency Incident Command System and Emergency
Response Plan
Mobilization of Response Facilities/Units
Assignment of tasks to units/departments involved in the Response Operation
Operations for internal and external emergencies that carried out search and
rescue/search and recovery, casualty handling, initial relief measures, clearance
of vital routes/areas, evacuation, restoration of services, handling the mass dead
Mental Health and Psychosocial Support Services
Arrangements for emergency feeding, health, shelter, welfare
Assessment of Risk Communication in Promotion and Advocacy (e.g., Public
Information, Media Relations)
Provision of information for recovery programs
Human Resource Development concerns of staff (e.g., Training, Welfare, etc.)
External Assistance arrangements Central, Regional and International Donors,
Community
Any special factors raised by the nature and effects of the particular disaster
Research requirements revealed by the disaster
Where appropriate, the Post-Incident Evaluations can include brieng from technical
experts on future trends and developments to help achieve optimum utilization of post-
incident experiences.
A continuing evaluation of the viability of a hospitals HEPRR plans and of the training of
personnel, however, requires exercises of increasing complexity through the implemen-
tation of a comprehensive exercise program. Through exercises ranging from orienta-
tion exercises, drills, tabletop exercises to functional and full-scale exercises, hospital
personnel should be oriented on and familiarized with the plan.
The emphasis is on a comprehensive exercise program made up of progressively com-
plex exercises, each one building on the previous one, until the exercises are as close
to reality as possible (i.e., making use of scenarios commonly occurring in the hospitals
and communities) and, more importantly, until mastery is achieved.
A progressive program has several important characteristics:
Involves the efforts and participation of various entities departments, organiza-
tions or agencies. Through the involvement of multiple entities, the program
allows the involved organizations to test, not only their implementation of emer-
gency management procedures, but their coordination with each other in the
process as well.
Is carefully planned to achieve identied goals.
Is made up of a series of increasingly complex exercises.
In the progressive internal and external exercises, the role/function of each department/
unit in the hospital during the response and recovery phases is closely examined along
with their increasing commitment to work in order for the hospital to build/enhance a
coordinated, effective response.
The stepwise manner of organizing the exercises ensures that weaknesses are identi-
ed through simpler and less expensive exercises.
225
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 ve main types of activities in a comprehensive exercise program are (WHO/
WPRO, 2006):
Orientation seminars
Drills
Tabletop exercises
Functional exercises
Full-scale exercise
These activities build from simple to complex, from narrow to broad, from least expen-
sive to most costly to implement, from theoretical to realistic.
Focused on questions of coordination and assignment of responsibilities, orientation
exercises are informal discussions aimed at familiarizing participants with plans, roles
and procedures. These are considered the minimum requirement for validating a plan or
its sections or a facility under development.
Drills are exercises used to develop, evaluate and maintain skills in specic proce-
dures, such as alerting and notication. 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 identication of problem areas determines the success of its conduct.
An interactive process conducted under time constraints in the health facility (i.e., hospi-
tal) is the functional exercise. Designed to validate policies, roles and responsibilities,
and procedures of single or multiple emergency management functions or agencies, the
functional exercise requires more resources.
A full-scale exercise examines the operational capability of emergency response and
management systems. Used to evaluate a component of a total response system, this
type requires deployment of more human and material resources for its detailed plan-
ning and conduct.
It is suggested that exercises are conducted at least twice a year, such as during the
Disaster Consciousness Month of July. Some practical considerations are as follows:
1. Precautionary measures should be taken so as not to alarm the patients during
disaster preparedness drills.
2. Simulations are conducted preferably without announcements.
3. Prior to these exercises, training session may be conducted in a stepwise manner:
- Session for individual participants to learn their functions/tasks
- Separate rehearsals for each section or group of participants, particularly
those on evening shift
- Comprehensive rehearsal for entire hospital
226
4. Post-exercise assessments are conducted to improve the practical exercises and
the components of the HEPRR plans.
Tables S18.1 and S18.2 provide a quick guide for the hospital in the planning and con-
duct of a comprehensive exercise program. Table S18.1 shows the comparison of the
key characteristics of the ve types of exercises and Table S18.2 shows the reasons for
the conduct of the ve 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 ve types of exercises is given in Annex S18.1.)
Table S18.1. Table S18.1. Comparison of Key Activity Characteristics
Charac-
teristics
Orientation Drill Tabletop
Exercise
Functional
Exercise
Full-Scale
Exercise
Table S18.2. Reasons to Conduct Exercise Program Activities
Orientation Drill Tabletop
Exercise
Functional
Exercise
Full-Scale
Exercise
227
228
SECTION 19
Research and Development
A.O. 168 Section V-C:.Policy Statement on Support Systems states:
10. There should be a system for documentation of lessons learned from all
health emergency incidents.
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
signicance 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 bene-
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 identication of
new areas of concern where there is limited information and where studies have not
been conducted.
Research is useful to Health Emergency/Disaster Management in the following ways:
For input to decision-making, e.g., development or revision of policies, proce-
dures and tools
For monitoring and evaluation purposes, e.g., to test the functionality and effec-
tiveness of health emergency policies, operations and systems
As source of data for developing teaching materials
For sharing experiences locally and internationally, e.g., success stories, lessons
learned and best practices
Some sources of data or information for research activities are:
Success stories, lessons learned, and best practices brought about during the
health emergency/disaster management
Statistical data and reports gathered related to the disaster
229
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 efciency concerns
Client satisfaction
Differential value of the program across populations
The choice between descriptive and analytical studies is largely dependent on the state-
of-the art information for the particular intended study. Of interest to health emergency
managers are the different types of researches, such as policy research, operational
and methodological researches, and epidemiological researches on health conditions
related to disasters.
Fundamental to the institutionalization of the documentation process is the systematic
identication and validation of Best Practices. Hospitals in hazard-prone areas are liv-
ing Experience Resource Centers whose documentation and reection of experiences
need to be distilled and shared to improve health care in an emergency/disaster situ-
ation. The HEMS Coordinator needs to works closely with the Regional Research and
Development Coordinator for the organization of such centers and the systematization
of knowledge processing. An initial step is the system for documentation mandated in
the National Policy. Networking with academe in the catchment area will be a valuable
relationship to nurture toward this end.
Among the initiatives in the documentation process to date are the following publica-
tions:
1. Health Emergency Management Staff, Department of Health (2005). Responding
to Health Emergencies and Disasters: The Philippine Experience
2. Bi-annual Proceedings of the Health Emergency Management Convention (2001,
2003, 2005, 2007)
230
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233
Standard Operating Procedures
in Mass Casualty Incident
SOP I: INFORMATION AND DISPATCH
(OPCEN CENTRAL, CHD OPCEN, HOSPITAL OPCEN)
PROCEDURES STEPS
234
PROCEDURES STEPS
Continuation of SOP I, Information and Dispatch
235
SOP II: SITE SELECTION, SIGNAGES AND LOGISTICS
PROCEDURES STEPS
236
SOP III: HANDLING OF EQUIPMENT
ATTACHED TO THE PATIENT
PROCEDURES STEPS
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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, res, oods and explosions. The frequency and intensity of these hazards will
differ according to the buildings 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 coefcients appropriate to the place. The structure will be designed for the
highest-intensity earthquake expected during that period.
The construction materials used should be reinforced concrete or steel, depending on
the availability and cost of each. In all cases, the parts of the structure should be rein-
forced to attain a 180-minute resistance to re (RFA 180). The inner walls and partitions
should be RFA 120.
Stairwells should be located so as not to produce a torque effect on the structure when it
is subjected to horizontal forces.
The structure of the stairways should have the same resistance to re specied for the
structure of the building.
LOCATION WITHIN THE PROPERTY
The main faade of all the buildings of the hospital should face a public thoroughfare.
Another faade 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 reproof walls. In buildings four or more stories high, escape
routes of bedroom areas should be compartmentalized.
260
ESCAPE ROUTES
All doors should open in the direction of trafc 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 inrmary exits should be at least 1.2
meters wide.
Wards of 15 or more persons should have at least two exits, one at each end. Ward
exits should open directly onto hallways.
Hallways should be at least 1.5 meters wide. A hallway along which beds or stretchers
are moved should be at least 2.4 meters wide.
In buildings of two or more stories, ramps should be provided as part of the escape
route so that bed patients may be evacuated.
All doors opening into an escape route should be at least 1.1 meters wide.
SIGNS
The following signs should be put in place:
a. Signs indicating the escape routes
b. Signs indicating equipment
c. Building layout diagrams
Exit signs should be placed at all emergency exit doors providing access routes and
leading to stairways. These signs should be placed over the door at a height 2.25 me-
ters above the oor.
All signs should be lit as long as the building is occupied.
All buildings should contain diagrams showing the location of the various types of alarm
and reghting equipment. Such diagrams should be placed on each oor of the build-
ing in places where they are visible to building personnel.
All reghting equipment that can be used by the staff should have precise instructions
beside the equipment itself.
A diagram showing a persons location in relation to escapes routes should be installed
in each area.
FIRE DETECTION, ALARM AND CONTROL EQUIPMENT
Ionic-type, linear-operation re detection equipment should be installed at the rate of
one detector for every 50 m2 of oor space. The building should have an alarm center,
preferably in the basement.
The building should be equipped with ABC type portable extinguisher for every 200 m2
of oor space and at least one per oor. An extinguisher should never be more than 20
meters away.
261
SERVICES
Water supply
The re 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 systems distribution line should have a built-in automatic
extinguisher system with automatic sprinklers. There should be one sprinkler for
every 15 m2 of oor space.
Drains
The drainage system should be of the separator type; if there is no connection to the
public sewer system, a septic tank or seepage pit should be provided.
Contaminants and/or radioactive materials
If it is necessary to dispose of this type of contaminants or radioactive materials
within the perimeters of the hospital, an underground reinforced concrete tank should
be constructed as far away from the building as possible. The tank should be
covered by a layer of soil at least 2 meters thick.
Electric energy
The following points should be checked with respect to:
Hospitals electrical installations
1. Have available and up-to-date installation plans.
2. Check type of switchover to the emergency power plant.
If automatic, check to see that it is operating normally.
If not automatic, determine the procedure to be followed to transfer the
load.
If the switchover is normal, step-by-step instructions for transferring the
load should be available in an accessible place.
3. Check the length of time the emergency plants fuel reserves will last.
4. Check the equipment once a month.
5. Keep the fuel tank full.
6. Identify the equipment and installations that operate with the emergency plant.
Energy source
1. Request for a generator with at least 40 percent of the transformer capacity of
the hospital, if the hospital does not have an emergency plant. Know the
cycles (60 or 50 Hz) of the generator required, the type of connection to the
distribution line (delta or star), and the voltage of the hospitals system
Take the following steps:
Determine where the generator will be placed and how it will be connected.
Bear in mind noise and contamination problems.
262
Determine the fuel consumption of the generator to be installed per 24-
hour period.
Determine how fuel is to be supplied to the generator to keep it in opera
tion.
Have a diagram showing the distribution boxes that must be disconnected
in order for the generator to function correctly.
2. Know the source of electric supply for the X-ray equipment:
If it is connected to the main distribution box, it may be fed by either the
hospitals emergency plant, if one exists, or by the generator furnished for
the emergency.
If the X-ray equipment has its own feeder system, it will be necessary to
install a generator solely for that equipment; the generators capacity
should be that of the X-ray equipment. The rst three steps in installing
a generator (No. 1 above) should be considered.
3. Determine if a special system provides emergency service in operating rooms
and intensive care units. This system provides uninterrupted energy supply to
those areas. An emergency system refers to a direct current system and is an
alternative to the systems described above.
4. Check the batteries (charge and acid) at least once a week. Know exactly how
long the batteries will continue to hold the charge with all the equipment in
operation. Determine the source of power for charging the batteries in the
event of failure of the power distribution network.
5. Know the hospital substations transformer capacity.
Communication service
Have the hospitals 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 hospitals emergency plant (the hospitals 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 systems 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 generators consumption of fuel in a 24-hour period and the type of
fuel it uses.
3. Locate and identify all of the hospitals secondary telephone lines.
4. Locate all the loudspeakers of the hospitals 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
loudspeakers and the use of the switchboards should be alternated.
263
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 specic function to facilitate
evacuation of the building.

264
ANNEX S18.1
Five Types of Evaluation Exercises:
Characteristics and Guidelines
ORIENTATION SEMINAR
As the name suggests, an orientation seminar is an overview or introduction. Its pur-
pose is to familiarize participants with roles, plans, procedures or equipment. It can also
be used to resolve questions of coordination
Orientation Seminar Characteristics
265
Continuation of Orientation Seminar Characteristics
Guidelines in Conducting an Orientation Seminar
There are no cut-and-dried rules for an effective orientation; its purpose will determine
its format. Here are the general guidelines:
Be creative. You can use various discussion and presentation methods. Think of
interesting classes that you have attended in other subjects, and borrow the tech-
niques of good teachers and presenters. For example, you might call on people
one by one to give ideas, plan a panel discussion, hold a brainstorming session,
present case studies for problem solving, or give an illustrated lecture.
Get organized and plan ahead. Even though orientation seminars are less complex
than other activities, it is no time to wing it.
Be ready to facilitate a successful orientation seminar. Discourage long tirades, keep
exchanges crisp and to the point, focus on the subject at hand, and help everyone
feel good about being there.
DRILL
A drill is a coordinated, supervised exercise activity, normally used to test a single spe-
cic 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
266
Continuation of Drill Characteristics
Guidelines in Conducting a Drill
How a drill is conducted varies according to the type of drill ranging from simple oper-
ational procedures to more elaborate communication and command post drills. For ex-
ample, a command post drill would require participants to report to the drill site, where
a visual narrative would be displayed in the form of a mock emergency. Equipment,
such as vans, command boards, and other needed supplies would be made available.
Given the variety of functions that may be drilled, there is no set way to run a drill. How-
ever, some general guidelines in the conduct of drills are as follows:
Prepare. If operational procedures are to be tested, review them beforehand.
Review safety precautions.
Set the stage. It is always good to begin with a general brieng, which sets the
scene and reviews the drill purpose and objectives. Some designers like to set
the scene using lms, slides or videotapes.
Monitor the action. After a drill has been started, it will usually continue under
its own steam. If you nd that something you wanted to happen is not happening,
however, you might want to insert a message to trigger that action.
TABLETOP EXERCISE
A tabletop exercise AA is a facilitated analysis of an emergency situation in an informal,
stress-free environment. It is designed to elicit constructive discussion as participants
examine and resolve problems based on existing operational plans and identify where
those plans need to be rened. The success of the exercise is largely determined by
group participation in the identication of problem areas.
There is minimal attempt at simulation in a tabletop exercise. Equipment is not used,
resources are not deployed, and time pressures are not introduced.
267
Tabletop Exercises
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 organizations operational plan. It is a coordinated response to a situation in a time-
pressured, realistic simulation.
A functional exercise focuses on the coordination, integration, and interaction of an
organizations policies, procedures, roles and responsibilities before, during or after the
simulated event.
Functional Exercise Characteristics
268
Continuation of Tabletop Exercises
FULL-SCALE EXERCISE
A full-scale exercise simulates a real event as closely as possible. It is an exercise
designed to evaluate the operational capability of emergency management systems in a
highly stressful environment that simulates actual response conditions. To accomplish
this realism, it requires the mobilization and actual movement of emergency personnel,
equipment and resources. Ideally, the full-scale exercise should test and evaluate most
functions of the emergency management plan or operational plan.
A full-scale exercise differs from a drill in that it coordinates the actions of several enti-
ties, tests several emergency functions, and activates the EOC or other operating cen-
ter. Realism is achieved through:
On-scene actions and decisions from Policy Groups
Simulated victims
Rapid Detection, Reporting and Response requirements
Communication devices
Equipment deployment
Actual resource and personnel allocation
269
Full-Scale Exercise Characteristics
270
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272
Administrative Order No. 2007-0018: National
Policy on the Management of the Dead and
Missing Persons During Emergencies and
Disasters, 2007.
Banatin, C.A., 2005. Developing a National
Health Emergency Preparedness and Re-
sponse System. Responding to Health
Emergencies and Disasters: The Philippine
Experience. Department of Health-Health
Emergency Management Staff, World Health
Organization (Western Pacic Regional Of-
ce).
Carter, Nick W., 1991. Disaster Management:
A Disaster Managers Handbook. Manila:
Asian Development Bank.
Covello, Vincent and Frederick Allen, 1988.
Seven Cardinal Rules of Risk Communication.
Washington, D.C.: U.S. Environmental Protec-
tion Agency, Ofce of Policy Analysis.
Dela Pea, Jason, 2007. Information Manage-
ment Manual for Coordinating and Monitoring
Health Emergency and Disaster Response.
Department of Health-Health Emergency
Management Staff, World Health Organization
(Western Pacic Regional Ofce).
DOH-HEMS, 2005. Responding to Health
Emergencies and Disasters: The Philippine
Experience. Department of Health-Health
Emergency Management Staff. Philippines.
DOH-HEMS, 2007a. A Manual on Natu-
ral Hazards: A Compilation. Department of
Health-Health Emergency Management Staff.
DOH-HEMS, 2007b. Compilation of Legal
Mandates. Department of Health-Health
Emergency Management Staff.
DOH-HEMS, 2007c. Key Health Messages
for Emergencies: Philippines. Department of
Health-Health Emergency Management Staff,
United Nations Population Fund, Ministerio de
Asuntos Exteriores y de Cooperacion, Coop-
eracion Espaola, World Health Organization.
November 2007.
DOH-HEMS, WHO-WPRO, 2001. 1st National
Convention on Disaster Management by the
Health Sector in the Philippines. Department
of Health-Health Emergency Management
Staff, World Health Organization (Western
Pacic Regional Ofce). Quezon City, Philip-
pines. December 3-5, 2001.
DOH-HEMS, WHO-WPRO, 2003. 2nd National
Convention in Health Emergency Manage-
ment. Department of Health-Health Emergency
Management Staff, World Health Organization
(Western Pacic Regional Ofce). Manila, Phil-
ippines. December 3-5, 2003.
DOH-HEMS, WHO-WPRO, 2005. 3rd National
Convention in Health Emergency Management
(Theme: Global Threat, Local Action). Depart-
ment of Health-Health Emergency Manage-
ment Staff, World Health Organization (West-
ern Pacic Regional Ofce). December 5-7,
2005.
DOH-HEMS, WHO-WPRO. Pocket Emergency
Tool, 2nd Edition. Department of Health-Health
Emergency Management Staff, Emergency &
Humanitarian Action, World Health Organiza-
tion (Western Pacic Regional Ofce).
DOH-HEMS, WHO-WPRO, 2007a. Capac-
ity Assessment (Module 4). Public Health
and Emergency Management in Asia and the
Pacic: Reference Manual, 1st Edition. Depart-
ment of Health-Health Emergency Manage-
ment Staff, Emergency & Humanitarian Action,
World Health Organization (Western Pacic
Regional Ofce).
DOH-HEMS, WHO-WPRO, 2007b. Damage
Analysis and Needs Assessment (Module 6).
Public Health and Emergency Management in
Asia and the Pacic: Reference Manual, 1st
Edition. Department of Health-Health Emer-
gency Management Staff, Emergency & Hu-
manitarian Action, World Health Organization
(Western Pacic Regional Ofce).
DOH-HEMS, WHO-WPRO, 2007c. Networking
and Coordination (Module 10). Public Health
and Emergency Management in Asia and the
Pacic: Reference Manual, 1st Edition. Depart-
ment of Health-Health Emergency Manage-
ment Staff, Emergency & Humanitarian Action,
World Health Organization (Western Pacic
Regional Ofce). June 2007.
DOH-HEMS, WHO-WPRO, 2007d. Operations
Management/Logistics Management (Module
8c). Public Health and Emergency Manage-
ment in Asia and the Pacic: Reference Man-
ual, 1st Edition. Department of Health-Health
Emergency Management Staff, Emergency &
Humanitarian Action, World Health Organiza-
tion (Western Pacic Regional Ofce). June
2007.
273
REFERENCES
DOH-HEMS, WHO-WPRO, 2007e. Opera-
tions Management/Management of Mass Ca-
sualty (Module 8a). Public Health and Emer-
gency Management in Asia and the Pacic:
Reference Manual, 1st Edition. Department
of Health-Health Emergency Management
Staff, Emergency & Humanitarian Action,
World Health Organization (Western Pacic
Regional Ofce). June 2007.
DOH-HEMS, WHO-WPRO, 2007f. Policies,
Guidelines and Protocols (Module 2). Public
Health and Emergency Management in Asia
and the Pacic: Reference Manual, 1st Edi-
tion. Department of Health-Health Emergency
Management Staff, Emergency & Humantar-
ian Action, World Health Organization (West-
ern Pacic Regional Ofce). June 2007.
DOH-HEMS, WHO-WPRO, 2007g. Public
Health and Emergency Management in Asia
and the Pacic: Reference Manual, 1st Edi-
tion. Department of Health-Health Emergency
Management Staff, Emergency & Humanitar-
ian Action, World Health Organization (West-
ern Pacic Regional Ofce). June 2007.
DOH-HEMS, WHO-WPRO, 2007h. Public
Health Aspect of Disaster Management/Men-
tal Health (Module 7e). Public Health and
Emergency Management in Asia and the
Pacic: Reference Manual, 1st Edition. De-
partment of Health-Health Emergency Man-
agement Staff, Emergency & Humanitarian
Action, World Health Organization (Western
Pacic Regional Ofce). June 2007.
DOH-HEMS, WHO-WPRO, 2007i. Risk
Management (Module 3). Public Health and
Emergency Management in Asia and the
Pacic: Reference Manual, 1st Edition. De-
partment of Health-Health Emergency Man-
agement Staff, Emergency & Humanitarian
Action, World Health Organization (Western
Pacic Regional Ofce). June 2007.
DOH-HEMS, WHO-WPRO. Manual on
Treatment Protocols of Common Communi-
cable Diseases and Other Ailments During
Emergencies and Disasters. Department of
Health-Health Emergency Management Staff,
World Health Organization (Western Pacic
Regional Ofce).
DOH-SDP, 2000a. Guidelines on Health
Emergency Management for the Centers for
Health Development, 1st Edition. Department
of Health-Stop Death Program. July 2000.
DOH-SDP, 2000b. Guidelines on Hospital
Emergency Preparedness and Response
Planning, 1st Edition. Department of Health-
Stop Death Program. July 2007.
DOH-SDP, 2000c. Manual for the DOH Op-
erations Center, 1st Edition. Department of
Health-Stop Death Program. July 2000.
DND-OCD, 2004. The Philippine Disaster
Management System, 2nd Edition. Department
of National Defense-Ofce of the Civil Defense
Region VIII. March 2004. pp. 1-6, 17-24, 27-
29.
Go, Marilyn V., 2007. Easy Guide for Hospital
Emergency Preparedness, Response and Re-
covery Plan Development (Lecture). Depart-
ment of Health-Health Emergency Manage-
ment Staff.
IASC, 2007. Interagency Standing Committee
(IASC) Guidelines on Mental Health and
Psychosocial Support in Emergency Settings.
Geneva
Juango, Susana G. Training Needs Assess-
ment. Department of Health-Health Emergency
Management Staff Operations Center.
Pan American Health Organization, 1983.
Health Services Organization in the Event of
Disaster. Scientic Publication No. 443. Wash-
ington, DC: World Health Organization, Pan
American Health Organization.
Sandman, Peter and Jody Lanard (2004).
Managing Stakeholder Outrage: Corporate
Citizenship on the Dark Side..Keynote speech
given at the Annual International Corporate
Citizenship Conference. San Francisco, March
30, 2004. Websites: http://www.psandman.
com/articles/cma-1.htm and http://www.psand-
man.com/webpubs.htm
UNICEF, 2007. Cluster Planning. Inter-Agency
Contingency Planning Guidelines for Humani-
tarian Assistance. Draft for Consultation by the
Inter-agency Drafting Group (Megan Gilgan
and Rasmus Egendal, Co-chairpersons). June
22, 2007.
WHO, ADPC, 2006. Sixth Inter-regional Train-
ing Course on Public Health and Emergency
Management in Asia and the Pacic. Refer-
ence Material for Participant. World Health
Organization (Southeast Asia Regional Ofce,
Western Pacic Regional Ofce), Asian Disas-
ter Preparedness Center, Royal Government
of Norway. Bangkok. August 7-13, 2006.
WHO, ADPC, 2006a. 6th Inter-regional Train-
ing Course on Public Health and Emergency
Management in Asia and the Pacic. Com-
munity Risk Management, Policymaking,
Emergency Preparedness Programs (Modules
2, 2a and 2b). Reference Material for Partici-
pant. World Health Organization (Southeast
Asia Regional Ofce, Western Pacic Regional
Ofce), Asian Disaster Preparedness Center,
274
Royal Government of Norway. Bangkok. Au-
gust 7-13, 2006.
WHO, ADPC, 2006b. 6th Inter-regional Train-
ing Course on Public Health and Emergency
Management in Asia and the Pacic. Health
Assessments (Module 6a). Reference Mate-
rial for Participant. World Health Organization
(Southeast Asia Regional Ofce, Western
Pacic Regional Ofce), Asian Disaster
Preparedness Center, Royal Government of
Norway. Bangkok. August 7-18, 2006.
WHO, ADPC, 2006c. 6th Inter-regional Train-
ing Course on Public Health and Emergency
Management in Asia and the Pacic. Health
Care Facilities in Disaster (Chapter 10). Ref-
erence Material for Participant. World Health
Organization (Southeast Asia Regional Ofce,
Western Pacic Regional Ofce), Asian Disas-
ter Preparedness Center, Royal Government
of Norway. Bangkok. August 7-18, 2006.
WHO, ADPC, 2006d. 6th Inter-regional Train-
ing Course on Public Health and Emergency
Management in Asia and the Pacic. Mass
Casualty Management (Chapter 9). Refer-
ence Material for Participant. World Health
Organization (Southeast Asia Regional Ofce,
Western Pacic Regional Ofce), Asian Disas-
ter Preparedness Center, Royal Government
of Norway. Bangkok. August 7-18, 2006.
WHO, ADPC, 2006e. 6th Inter-regional Train-
ing Course on Public Health and Emergency
Management in Asia and the Pacic. Recov-
ery and Rehabilitation (Module 16). Reference
Material for Participant. World Health Organi-
zation (Southeast Asia Regional Ofce, West-
ern Pacic Regional Ofce), Asian Disaster
Preparedness Center, Royal Government of
Norway. Bangkok. August 7-18, 2006.
WHO-WPRO, 2005. Strategic Health Opera-
tions Centre: Systems Overview. Geneva:
World Health Organization (Western Pacic
Region Ofce). February 2005.
WHO-WPRO, 2006a. Field Manual for Ca-
pacity Assessment of Health Facilities in
Responding to Emergencies. World Health
Organization (Western Pacic Region Ofce).
WHO-WPRO, 2006b. Managing Health
Emergencies: A Guide for Establishing, Op-
erating and Evaluating an Emergency Opera-
tions Center, Version 3 (Draft). World Health
Organization (Western Pacic Region Ofce).
November 12, 2006.
WHO-WPRO, 2007a. Mass Casualty Man-
agement Conceptual Framework. A Regional
Training Course in Mass Casualty Manage-
ment and Hospital Preparedness. World
Health Organization (Western Pacic Region
275
Ofce). Cambodia. September 24-29, 2007.
WHO-WPRO, 2007b. Regional Training Course
on Mass Casualty Management and Hospi-
tal Preparedness. World Health Organization
(Western Pacic Region Ofce).
276
277
278
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