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					      GUIDELINES ON
HOSPITAL PREPAREDNESS AND
   RESPONSE PLANNING




      Health Emergency




      Management Staff




       STOP DEATH PROGRAM
      DEPARTMENT OF HEALTH
        MANILA, PHILIPPINES
         1st Edition, July 2000
                                     MESSAGE


       Disasters / emergencies / calamities take many varied forms and may occur
gradually or suddenly, in small, medium, large or initially imperceptible magnitudes.

        For the past years, it seems that disasters were like a thief in the night. It chooses
no victims and strike anywhere - at home, on travel, at work and even at play.

        For the calamity-prone countries like the Philippines which is very vulnerable to
natural and even man-made disasters, disaster management must be a well planned, well-
organized, well-coordinated activity that needs to be given the utmost attention and
highest priority to preclude human suffering and tragedy.

         The Department of Health through the STOP DEATH Program has been very
active in the preparedness and response when disasters / emergencies / calamities strikes.
Through the years of its existence, this Program has always been "on the go" and even
until now they are still very aggressive and pro-active. I am very proud that they have
crafted and formulated standard operating procedures to serve as guide for those working
along this field.

        This manual was designed as a reference guide for those directly involved in the
response mechanism during emergencies / disaster / calamities. It also aims to provide a
practical guide for quick action when disasters strikes and for pre-disaster preparedness
planning. It will be very useful for the regions and hospitals who under the aegis of the
Department of Health are mandated by law to provide health services as a support
mechanism in the event of disasters / emergencies / calamities.

       On this end, I would like to congratulate the people who conceptualized in the
coming out of such very useful operation manual. I understand that your goal of coming
out with this manual is to have a unified response mechanism to protect / preserve lives
through proper medical aid, proper provisions and mobilization of all medical resources.
Be rest assured that I am with you in all your undertakings. It is hoped therefore, that
such application will be properly taught and enhanced when the event calls for.




                                                                                            i
                                  FOREWORD
        This manual is a guide for the disaster managers and staffs in the hospital in their
preparation of a hospital disaster preparedness and response plan appropriate to their
organization. This is a generic guideline that can be applied to any type of hospital
irregardless of size or type. This was developed after a series of meetings and workshops
with the STOP DEATH Coordinators of the 38 hospitals initially called to review the
draft. The primary objective of this manual is to guide all coordinators in the crafting of
their plan to include the important ingredients of a good and effective preparedness and
response plan during emergencies and disasters. Furthermore, it includes hospital
preparedness in cases of internal disaster, external disasters as well as a combination of
both internal and external disasters.

        Most emergencies and disasters are unpredictable but are not totally expected. A
stance of readiness to respond is assumed whenever potential emergencies are foreseen.
Emergency management and control measures are usually indicated for those types of
emergencies. Preventing measures, preparedness program are likewise helpful in
mitigating or preventing the effects of such emergencies and disasters. Hospitals play a
very vital role in emergencies and disasters. The organization of the medical care is
unquestionably the focal point for coordinating the health sector’s response to this host of
complex needs, since response and prompt care is critically important for saving lives.
And since the hospitals are open 24 hours a day with ready teams for dispatch
compounded by the fact that it has the transportation (ambulances) means and the
necessary equipment and supplies makes the hospitals the very visible hallmark for the
health sector’s response during emergencies.

        In the development of this manual which was taken from a lot of resource
materials compiled from previous training locally and internationally, we also reviewed
previous manuals done. Much was done and prepared by Dr. Arnel Rivera as Chairman
of the Standards Committee and his team and other data researched by Mr. Gerry Lirag. I
finally put everything together to come up with a very user friendly guideline that
hopefully could also be used by other non- DOH hospitals. It is my dream and desire that
this be a requirement before any hospital could be licensed.




                                                                                        ii
                     TABLE OF CONTENTS

I.      INTRODUCTION                                                     1


II.     GENERAL PRINCIPLE OF HOSPITAL EMERGENCY PLANNING FOR
        DISASTER SITUATION                                               2

        A.   General Hospital Planning                                   2
        B.   Purpose and Objectives of the Plan                          3
        C.   Characteristics of the Plan                                 3
        D.   Organization of the Plan                                    3

III.    LEGAL MANDATE                                                    4
        A. P.D. 1566                                                     4
        B. Calamities and Disaster Preparedness Plan, 1988               5
        C. R.A. 7160 ( Local Government Code of 1991 )                   8
        D. DOH AO 6-B s of 1999                                          9

IV.     AN EMERGENCY PLANNING PROCESS                                   11
        A. Hospital Emergency Planning                                  12
        B. Summary in Planning                                          13

V.      PLAN FOR DISASTER SITUATIONS OCCURING INSIDE THE
        HOSPITAL                                                        14

VI.     PLAN FOR DISASTER SITUATION OCCURING OUTSIDE THE                15
        HOSPITAL

VII.    ORGANIZING DISASTER COORDINATING COMMITTEES                     16

VIII.   ORGANIZATION AND MANAGEMENT STRUCTURE                           17

        A. HEICS – Organizational Chart                                 17
        B. Assignment of Responsibilities                               19
        C. Organizing Response Teams                                    19

IX.     ROLES AND FUNCTIONS OF HOSPITAL DISASTER RESPONSE TEAMS         21

        A. In-Hospital Response Team                                    21
        B. On-Scene Response Team                                       22




                                                                  iii
X.      ACTIVATION / TERMINATION OF THE PLAN                        23

XI.     ALERT SYSTEM                                                25

        A. Disaster Code White                                      25
        B. Disaster Code Blue                                       26
        C. Disaster Code Red                                        27

XII.    TRIAGE AND COLOR TAGGING                                    30

XIII.   COMMAND AND CONTROL                                         32

XIV. NETWORKING                                                     37

XV.     TRAINING                                                    40

XVI. DRILLS AND EXERCISES                                           41

XVII. LOGISTICS MANAGEMENT                                          43

XVIII. MEDIA RELATIONS                                              44

XIX. UPDATING AND EVALUATING THE HOSITAL DISASTER                   45
     MANAGEMENT PLAN
XX. TEN STEPS TO BECOME A STOP DEATH HOSPITAL                       46
XXI. APPENDICES                                                     47

        1. Triage Tag                                               47
        2. Stop Death Program Assessment Form                       48
        3. Mission – Incident Report Form                           63
        4. Medical Care Survey Form                                 64
        5. List of Drugs and Equipment for Major Disaster           75
        6. Design Consideration for disaster-prone Hospitals        76
        7. Energy and Communications                                80




                                                               iv
I.     INTRODUCTION

         Every type of disaster brings about it’s own special type of catastrophic features.
Some of the disaster events can be fairly predicted e.g. typhoons, floods, and droughts,
whereas earthquakes, landslides, flashfloods because of the suddenness of it’s occurrence
brings about an unexpected outcome. Man has always been vulnerable to natural hazards
but mankind has further exposed itself to various kinds of self made disasters, e.g. war,
riots, accidents, fires, industrial, technological and ecological disasters.

        Hospitals play a very vital role in the management of disaster. Main objective is
to decrease mortality and morbidity and to prevent disability. The hospital phase of
disaster management has emphasis on prioritizing treatment or triage, treatment of mass
casualties, crisis management such as expansion of hospital beds to provide services to
the most number of patients at such a very short notice. Furthermore it highlights the
need of bringing the right patient to the right hospital at the right time.

        Pre-hospital phase is highly important including transportation of casualties by
ambulances or carrier vehicles. Transportation and communications likewise are parts of
the ingredients for a good disaster response. Institutional preparedness of the hospital
will maximize utilization of available resources. There is a definite need for a thorough
carefully studied hospital preparedness plan by every hospital that should be put into
action upon receiving an alert call. All the activities of hospital phase of management
require coordination between all clinical as well as administrative departments.

        The hospitals need special planning for both mass accident as well as damage area
management. This means that every hospital, regardless of its size or specialization
requires a practicable and well-trained plan for such cases. This does not include the
enhancement and coordination of the medical performance but also important additional
tasks, which have to be added to the daily practice.

       Every hospital should have a regularly updated hospital disaster plan. The plan
should be distributed, read and understood by everyone concerned. This will avoid
confusion and chaos at the time of disaster. The purpose of the plan is:

       a. To provide policy for effective response to both internal and external disaster
          situations that can create impact to the operation of the hospital and may
          affect hospital staff, patients, visitors and the community.

       b. Identify hospital capability to handle mass casualty.

       c. Identify responsibilities of individuals and departments in the event of a
          disaster situation.

       d. Identify Standard Operating Guidelines for emergency activities and
           responses.




                                                                                          1
II. GENERAL PRINCIPLES OF HOSPITAL EMERGENCY PLANNING FOR
DISASTER SITUATIONS

It is well for those directly involved in hospital disaster operations to bear in mind the
following:

1. Disasters can occur at any time without warning or signal. Everyone should be
    prepared at all times to render emergency response.
2. Disaster victims often need quick medical assessment and prompt emergency care.
    They should be attended to immediately.
3. Disaster victims are often hurt and confused. They should be treated with
    compassion and caring.
4. The volume of demand and the urgency of need for medical attention are abnormally
    high during disasters. Every available human and material resource must be readily
    mobilized and organized for quick action.
5. The demand for updated and precise information on the status of disaster operations
    and whereabouts of disaster victims is often heightened. An information center
    should be set up in the hospital to collect, process, record, and relay correct and
    timely information to all concerned.
6. The plan should consider any contingencies that may require changes in the health
    system. This means that it should be highly flexible if it is agreed that many types of
    emergency situations may occur.
7. In developing the plan, consideration should be given to the views of the medical
    staff, nurses, and administrative personnel of the hospital involved; opinions of
    community services (police, firefighters, volunteer groups, civil defense, etc.) should
    also be taken into account.
8. The plan should be essentially objective and limited to two specific aspects: probable
    demand and the resources that are available or can be mobilized.
9. The plan should be easy to understand and should be widely disseminated
10. The plan should be put into effect only when necessary.


a. GENERAL HOSPITAL PLANNING

1. An emergency or disaster occurs in a hospital when the resources for dealing with the
   situation are inadequate for immediate action. In such circumstances normal
   procedures should be abandoned and resources increased so as to expand hospital
   capacity.

2. It is the hospital’s responsibility to maintain a continuing education and training
   program to ensure that proper action is taken promptly in the event of an emergency.

3. When the hospital receives more than 100 emergency cases simultaneously, it must
   plan a simplified treatment system; such a system is addressed to preventing loss of
   life, complications, deformities, infections and delayed treatment. This policy should
   be previously discussed with the medical staff, who will decide on the actions to be
   taken at the time of a disaster and develop the hospital’s disaster management plan.

                                                                                         2
b. PURPOSE AND OBJECTIVES OF THE PLAN

        The purpose of a disaster plan is to make it possible to attend, promptly and
effectively, to the largest possible number of people requiring medical care, in order to
reduce the number of deaths and disabilities and bring about recovery. The principal
objectives are:

       1.          To prepare the staff and institutional resources for optimal
            performance in an emergency situation of a certain magnitude.

       2.           To make the community aware of the importance of the “disaster
            plan,” how it is executed and the benefits it provides.

       3.           To establish security arrangements to be implemented in the event of
            an internal accident within the institution.


c. CHARACTERISTICS OF THE PLAN

1. The plan should be functional, flexible and easy to implement so that it can be
   adapted to a different situations and circumstances.

2. It should be permanent and periodically updated, providing for a constant
   availability of resources and of well-informed and capable personnel ready to
   implement the plan.

3. The plan should be coordinated with similar plans of other institutions so that wider
   coverage, greater efficiency, and a better utilization of available resources may be
   achieved.

4. It should form part of a regional disaster plan and contribute to the strengthening of
   civil defense plans.

5. It should be comprehensive, i.e., applicable to disasters within the institution or to
   external disasters of medium or high severity.


d. ORGANIZATION OF THE PLAN – LEGAL ASPECTS – NAME OF PLAN

The plan should contain a description of the legal basis whereby the Department of
Health of the country concerned is authorized to act in disaster situations, both in public
and private institutions.




                                                                                         3
III - LEGAL MANDATE

        For the past 20 years, laws on disaster management have been created and
updated. It is a measure of the government to be more responsive to disasters and
emergencies. The Department of Health is a member of the National Disaster
Coordinating Council (NDCC) and the head of the Medical Service or assumes command
over the health sector. The structure at the national level is supposed to be replicated at
all levels. As such, all Hospital are expected to be aware of these laws. Knowing these
policies will guide disaster manager in making decisions in times of disaster.

      For the purpose of easy identification of the legislation related to disaster
management, we intend to highlight only important laws.


A - Presidential Decree No. 1566

        As early as 1978, then President Marcos signed into law the Presidential Decree
No. 1566 entitled “Strengthening the Philippine Disaster Control Capability and
Establishing the National Program on Community Disaster Preparedness”. This law
implemented the following:

           1. Creation of the National Disaster Coordinating Council (NDCC)

   The National Disaster Coordinating Council aimed to strengthen Philippine disaster
   control capability and to establish a national program on disaster preparedness

           2. Creation of the Multi-level Organizations In Charge of Disaster
              Management

   This decree also created a multilevel organization starting from the National Disaster
   Coordinating Council, the Regional Disaster Coordinating Council, the Provincial
   Disaster Coordinating Council down to the Municipal Disaster Coordinating Council.

           3. Funding for a 2% reserve for calamities

   This decree authorizes the local government to program funds to be used for disaster
   preparedness such as the organization of Disaster Coordinating Councils, the
   establishment of physical facilities and the equipping and training of disaster action
   teams.




                                                                                         4
A Disaster Coordinating Council is composed of Staff and Service Units



The Staff Unit consists of:
       Intelligence and Disaster Analysis Unit
       Plans and Operations Unit
       Resource Unit

Whereas the Service Unit consist of:
      Communication (DOTC) & Warning Unit (PAGASA)
      Transportation Unit (DOTC)
      Rescue & Engineering Unit (LGU’s, AFP)
       Health Unit (DOH)
       Auxiliary Fire Unit (DILG-BFP)
       Police Auxiliary Unit (DILG-PNP)
       Relief Unit (DSWD)
       Rehabilitation Unit (DSWD)
       Public Information Unit (PIA)

B - Calamities and Disaster Preparedness Plan, 1988

        The Department of Health is one of the agencies comprising the NDCC, which is
the lead agency in coordinating, integrating, supervising and implementing disaster
related functions. The Secretary of Health represents the Department and as part of the
national plan, it’s roles are the following:

1. Organizes disaster control group and reaction teams in all hospitals, clinics, sanitaria,
   and other health institutions;
2. Provides for the provincial, city/municipal and rural health services to support all
   disaster coordinating councils during emergencies;
3. Undertakes necessary measures to prevent the occurrence of communicable diseases
   and other health hazards which may affect the populations;
4. Issues appropriate warning to the public on the occurrence of epidemics or other
   health hazards;
5. Provides direct service and/or technical assistance on sanitation as may be necessary;
   and
6. Organizes reaction teams in the department proper as well as in the offices and bureau
   under it.




                                                                                          5
The Health Service Units shall be organized by the Department of Health in all regions,
provinces, cities, municipalities and barangays and shall be constituted as follows:

Chairman: Department of Health
   Members: ( suggested but not limited)
     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


HEALTH SERVICE

Purpose:
   1. To protect life through health and medical care of the populace.
   2. To preserve life through proper medical aid and provision of medical facilities
   3. To minimize casualties through proper information and mobilization of all
      medical resources.


Health Service Units shall be composed of the following sub-units:

       Medical and First-Aid Unit
       Field Emergency Hospital
       Sanitation Service Unit
       Health Supply Unit
       Transportation and Ambulance Unit
       Mortuary Unit
       Records Unit


RESPONSIBILITIES:

           a. The Secretary, Department of Health, is responsible for organizing,
              training and supplying all Health Service elements in the Philippines

           b. The Regional Director, Department of Health, is responsible for providing
              support to the Services in the provincial, municipal and city levels.

           c. The Department of Health officials in the provincial, city and municipal
              levels are responsible for organizing their respective units.

           d. The Local Government Heads are responsible for the operation and
              support of Health Services



                                                                                        6
   e. The Philippine National Red Cross and the Department of Social Welfare
      and Development, within their respective capabilities, are responsible for
      providing support to the Health Service.

   f. The functions of the Health Service sub-units are as follows:

6.1 Medical and First-Aid Unit

      a.   Sorts cases at the scene of the disaster;
      b.   Administer first-aid;
      c.   Attends to the cases referred to emergency aid and stations
      d.   Evacuates patients to emergency hospitals; and
      e.   Detects and controls communicable diseases in coordination with the
           other agencies specifically assigned for the purpose.

6.2 Field Emergency Unit

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

6.3 Sanitation Service Units

      a. Supervises the sanitary conditions of the community during and after
         emergency;
      b. Enforces sanitary regulations relative to housing facilities and shelter;
         and
      c. Promulgates and implements control measures in contaminated areas
         and in evacuation centers.

6.4 Health Supply Unit

      a. Procures, stores and issues medical supplies and equipment during
         emergencies; and
      b. Keeps an accounting of the medical and first-aid instruments and
         supplies.

6.5 Mortuary Unit

      a.   Assists in identifying and tagging the dead;
      b.   Certifies to the cause of death; and
      c.   Supervises the proper disposal of the dead
      d.   Keeps records of the dead, injured, and sick; and



                                                                                7
              e. Issues certificates pertaining to persons who were ill, injured and
                 recovered or died pursuant to existing ,laws, rules and regulations.

Note: (The first 2 legal mandates are still in effect even with the passage of the
Local Government Code but there are efforts to amend several provisions of the
law. The Local Government code in effect have transferred all health services below
the Regional level)



C - Republic Act No. 7160 (Local Government Code of 1991)

       Republic Act No. 716, otherwise known as the Local Government Code of 1991
pointed out these two important guidelines in disaster management:

                Transfer of responsibilities from the national to the local government
                    units (LGUs) thereby giving more powers, authority, responsibilities
                    and resources to the LGUs.

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

        This act empowers the local government to make decisions and to release funds
faster since the budget from the national government are given directly to the local
government units. It also increased the calamity fund from 2% (governed by PD No.
1566) to 5%.

       Immediate and direct response is the primary responsibility of the LGUs.
However, in cases where disasters have reached proportions, which is beyond the
capacity of the LGUs, 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 and
maintain an effective health emergency preparedness and response program.




                                                                                        8
D - DOH - Administrative Order No. 6-B s of 1999

         Through Administrative Order No. 6-B dated February 12, 1999, a Health
Emergency Preparedness and Response Program within the Department was
institutionalized. This program is designed to be a comprehensive, integrated and
responsive emergency, disaster related service and research-oriented program with the
goal of promoting health emergency preparedness among the general public and
strengthening the health sector’s capability to respond to emergencies, disasters and
calamities. The program likewise gives advice and policy directions regarding health
emergencies
         In this administrative order, the roles and responsibilities of the regional health
office, retained hospitals and Stop DEATH coordinator were enumerated. They are as
follows:

1. HEPR (STOP D.E.A.T.H.) Units in the Regions and the Hospitals:

            The units shall be an integral part of the region/hospital

            For the hospital, the Stop Death Unit shall be ideally established and
             situated in the Emergency Room Complex (or any room identified for that
             matter)

            The Unit shall be managed by the Stop Death Coordinator who will then be
             reporting to the Regional Director and Hospital Director respectively. He /
             She shall be supported by a staff who shall be performing their duties in
             addition to their regular assignments.

            Each Unit shall have the following services:
        1.   Service
        2.   Training
        3.   Research
        4.   Social Mobilization
        5.   Networking and Community Involvement

2.   Responsibilities of the HEPR (Stop DEATH) Coordinator:

            Takes the lead in the preparation of the Emergency Preparedness Plan of the
             Region/Hospital and ensure that this is disseminated and regularly updated.
            Responsible for the organization and dispatching of teams to respond to
             emergencies and disasters. The team coming from the Regional Office
             should take charge of the public health aspects of disasters such as rapid
             assessment, monitoring and social mobilization. The hospital team should be
             prepared (but not limited) for trauma related disasters.




                                                                                           9
           Responsible for human resource development in the region, the hospital and
            the communities in their respective catchment areas.
           Ensuring that the necessary equipment, supplies and medicines will be
            properly stocked and available for emergencies and disasters.
           Network with their region catchment areas and the communities.
           Prepare the annual work and financial plan and take the lead in the
            implementation of the Program’s activities.
           Document all activities and report to the Program.
           Coordinate with the Operation Center for all emergencies and disasters
           Submit quarterly reports to the Undersecretary of Hospital and Facilities
            Services attention to the Program Manager of the HEPR (Stop Death)
            Program.
           Develop research proposals that would aid the Program in policy directions,
            program implementation and improvement.
           Performs all other related activities that maybe assigned from time to time.


3.   The Role of the Regional Health Offices/Hospitals:

            Provide support and encouragement to all the activities of the Program. All
             regional health office and retained hospitals, being part of the DOH system
             should provide medical services and mitigate the sufferings of the victims of
             disasters and emergencies.
            Institutionalize the Program/Units in their respective Regional Health
             Office and Hospitals.
            Designate adequate personnel for this unit and the medical teams taking
             into account the category and capability of the hospital.
            Support the training activities and require all personnel to undergo Basic
             Life Support and other training that will enhance the preparedness
             capability of everyone.
            Know and link with your communities and develop a networking
           relationship with all Government Organizations, Non-Government,
           Specialty Society and other People’s Organizations who are involved with
           emergency and disaster.


The plan should be given a name that is easily memorized and retained, commemorating
an important event in the life of the hospital or in medicine.




                                                                                        10
 IV - AN EMERGENCY PLANNING PROCESS

        The planning process is a series of steps to produce an emergency plan. This
process can be applied to any community, organization or activity, e.g. for the health
sector in general, hospitals, search and rescue organizations, etc. It is primarily intended
for preparedness, but can be used for planning during response and recovery
operations. Each step of the planning process is defined briefly as follows:
     An emergency
     planning process
                                 Project definition determines the aim, objectives and
         DEFINE                   scope of an emergency plan, and decides the tasks
        PROJECT                   required, and the resources required performing these
                                  tasks. The emergency scenarios and recommendations
        REVIEW
                                  from the vulnerability assessment should be used to
       PLANNING                   develop planning objectives.
        GROUP                    The formation of a representative-planning group is
                                  essential to emergency planning. Without such a group
                                  it will be difficult, if not impossible, to gather the
       ANALYZE                    required information and to gain the commitment of
      POTENTIAL                   key people and organizations. There may be a need to
      PROBLEMS
                                  review any existing planning group to assess its
                                  appropriateness.
                                 Potential problem analysis further examines hazards,
                                  their causes, possible preventative strategies, response
       ANALYZE
      RESOURCES
                                  and recovery strategies, and trigger events for these
                                  strategies. It will provide information for later steps of
                                  the process.
                                 The resource analysis asks: what resources are
       DESCRIBE                   required for the response and recovery strategies, what
        ROLE &                    is available, what is the variation between requirement
    RESPONSIBILITY                and availability, and who is responsible for the
                                  resources?
                                 A description of roles and responsibilities outlines
                                  who does what.
       DESCRIBE
                                 The management structure concerns the command of
     MANAGEMENT                   individual     organizations     and   control      across
      STRUCTURE                   organizations.
                                 Developing strategies and systems concerns specific
                                  response and recovery strategies, and the systems that
                                  will support these strategies.
                                 Each step of this process must be documented. The
       DEVELOP
      STRATEGIES                  written emergency plan will consist of the outputs of
      & SYSTEMS                   each step of the process.




                                                                                        11
A - HOSPITAL EMERGENCY PLANNING

Hospital emergency planning is an integral part of both the multisectoral community
emergency plan and the health sector emergency plan. The process for planning is the
same as that for communities or organizations and produces many outputs, only one of
which is a written emergency plan.

Hospital emergency planning has two aspects:

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

Consequently, hospital emergency planning should be based on the following:

   A vulnerability assessment of the community to determine the likely medical needs
    of the community before, during and after emergencies;
   A vulnerability assessment of the hospital to determine the likely harm caused to the
    hospital by both internal and external emergencies; and
   An assessment of the reception and treatment capacities of the hospital.

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

          The interaction between the hospital and other hospitals and medical centers;
          The interaction between the hospital and rescue, volunteer, and government
           organizations
          The assignment of major responsibilities within the hospital for emergency
           prevention, preparedness and response;
          The acquisition and maintenance of emergency resources; and,
          The criteria for major evacuation of the hospital and for hospital relocation

There are two aspects to hospital vulnerability assessment: the vulnerability of the
community; and the vulnerability of the hospital as a service provider. Emergencies can
be purely internal, external or combined internal/external. Thus there are three basic
scenarios that hospital emergency planning must satisfy:

          An emergency that disrupts the ability of the hospital to provide it’s normal
           services, but that doesn’t cause harm to the community ( an internal
           emergency);
          An emergency that causes harm to the community requiring increased medical
           services, but that doesn’t disrupt the ability of the hospital to provide medical
           services ( an external emergency );
          An emergency that causes harm to the community requiring increased medical
           services, and that also disrupts the ability of the hospital to provide medical
           services ( an internal/external emergency).


                                                                                        12
Internal emergencies can be caused by a number of hazards, including fire, explosion,
hazardous material incident, food contamination, or loss of electricity supply, water
supply, or other service. Internal emergencies can quickly multiply into a number of
contingent emergencies. For example, a fire may cause injury to patients and staff
resulting in an overload on hospital services, hazardous materials incidents may lead to
fires or explosions, etc…

Community vulnerability should be assessed to determine the likely demands on a
hospital or hospital system (a series of linked hospitals and medical centers). It is
possible to develop a number of credible external emergency scenarios that may
produce unusual medical demands on a hospital.


B - SUMMARY IN PLANNING


1. Emergency planning should be based on an assessment of vulnerability.
2. An emergency plan is an agreed set of arrangements for responding to and recovering
    from emergencies, involving the description of responsibilities, management
    structures, strategies and resources.
3. The emergency planning process can be applied to any community, organization or
    activity.
4. The process of planning is as important as a written emergency plan.
5. An appropriate planning group should develop emergency planning.
6. Potential problem analysis can determine problems, causes, preventative strategies,
    response and recovery strategies, and trigger events.
7. The resources required to support preparedness, response and recovery strategies
    should be analyzed.
8. The roles and responsibilities of people and organizations must be defined and
    described.
9. A management structure for emergency response and recovery should be developed
    based on normal management structures.
10. A series of strategies and systems must be developed for response and recovery.




                                                                                     13
V - PLAN FOR DISASTER SITUATIONS OCCURRING INSIDE THE
HOSPITAL

        The hospital should be prepared when a disaster strikes inside the hospital like
fire, earthquake etc…An intrahospital disaster plan considering all types of disasters
should include evacuation procedures.

       Some of the measures to be taken include:

       1. Development of a plan for assigning personnel to specific duties and
          responsibilities and a system for notifying them.

       2. Instructions on the use of alarm and sign systems.

       3. Instructions on fire fighting methods and directions as to the location of its
          equipment.

       4. Rapid assessment of the extent of damage to buildings and structures and the
          threats to safety of patients and personnel.

       5. Protecting critical facilities and lifelines.

       6. Maintaining communications and security of hospital and patients.

       7. Quick restoration of facilities and lifelines to maintain the service operation of
          the hospital.

       8. Specification of evacuation procedures and routes to include orderly
          evacuation of patients and facilities.

       9. Tapping the network to extend needed services and facilities to patients.

       10. Search and rescue operation.

       All the staff of the hospital should be well acquainted with the plan. Fire drills
and internal disaster exercises should be carried out at least once a year during each
hospital shift in order to:

1. Make certain that the staff on each shift is trained to carry out its assigned duties.

2. Make certain that the staff on all shifts is familiar with the hospital’s firefighting
   equipment.

3. Assess the efficacy of the plan. Evacuation of patients to secure areas during the drill
   is optional.




                                                                                            14
VI - PLAN FOR DISASTER SITUATIONS OCCURRING OUTSIDE THE
HOSPITAL

        Each hospital should prepare a disaster-management plan based on it’s own
operational capacity. The operational capacity of a hospital may cover a range of
services from first aid and immediate emergency care and subsequent transfer to
definitive treatment.

        The planning should include consultation and review with the local civil
authorities and with other medical institutions on establishing an effective command for
appropriate action in the area. It should envisage the training of action teams to perform
on site triage and distribute casualties in such a way as to provide the most effective
possible use of available services and capabilities.

       The disaster plan should include provision for:

1. Evaluation of a hospital’s autonomy in terms of it’s services and it’s source of
   electricity, gas, water, food, and medical supplies.

2. An efficient systems of alerts and staff assignments.

3. A unified medical command.

4. Conversion of all usable space into clearly defined areas for efficient triage, for
   patient observation, and for immediate care.

5. Prompt removal of casualties when necessary (after preliminary medical and surgical
   services have been performed) to the places where medical care facilities are more
   appropriate and definitive.

6. A special medical census for disaster cases.

7. Procedures for prompt transfer of patients within the hospital.

8. Security arrangements to keep curious persons from entering triage areas and to
   protect staff from hostile actions.

9. Prior establishment of a public information center. A public relations team with a
   means of communication to assist in providing an organized source of information.
   The hospital is responsible for keeping the community informed of its potential and
   limitations in disaster situations. The local police, rescue groups, and ambulance
   teams should be aware of the resources of each hospital.




                                                                                       15
VII - ORGANIZING DISASTER COORDINATING COMMITTEES:

       All Department of Health Hospitals shall organize it’s own disaster coordinating
committees and formulate it’s own hospital disaster plan following the guidelines set in
this manual.
       The Chief of Hospital shall determine the composition of the disaster committee,
whose members shall be permanent.
       To the extent possible, the committee shall include the following:

       1.        Chief of Hospital
       2.        Chief Emergency Service (ER)
       3.        HEPR ( STOP DEATH) Coordinator
       4.        Chief of Surgery
       5.        Chief of Anesthesia
       6.        Chief of Medicine
       7.        Chief of Orthopedics
       8.        Chief of Nursing Service
       9.        Administrative Officer

       Note: This is just a suggestion and might not be applicable to all types of
       hospital. Special hospitals may come up with their own members to fit their
       organization.

Responsibilities of the Disaster Committee:

1. Formulate it’s own disaster preparedness and response plans based on the general
   guidelines set in this STOP DEATH disaster manual.

2. Organize and train it’s own disaster response teams and ensure constant state of
   readiness to respond to disasters.

3. Define standards of response and coordination during emergencies and disaster.

4. Activate the disaster plan whenever the situation warrants.

5. Set up information and communication centers to serve various sectors and the public
   during disaster operations. ( Hospital OPCEN)

6. Coordinate / collaborate with the health sector involved during emergencies and
   disasters; likewise be aware of their community and catchment areas.

7. Disseminate, review, assess, evaluate and update the disaster plan to accommodate
   changes brought about by new information, technology changes, and lessons learned
   during emergencies and disasters.




                                                                                     16
VIII - ORGANIZATION AND MANAGEMENT STRUCTURE


An appropriate and effective organization in the disaster area should result in

              the survival and recuperation of as many patients as possible and
              a proportional distribution of patients to several hospitals.


A - HEICS - ORGANIZATIONAL CHART

The Hospital Emergency Incident Command System (HEICS) is an example of an
emergency management system which employs a logical management structure, defined
responsibilities, clear reporting channels, and a common nomenclature to help unify
hospitals with other emergency responders. There are clear advantages to all hospitals
using this particular emergency management system.

Based upon public safety’s Incident Command System, HEICS has already proved
valuable in helping hospitals serve the community during a crisis and resume normal
operations as soon as possible.

HEICS is fast becoming the standard for health care disaster response and offers the
following features:


     predictable chain of management                improved documentation for improved
     flexible organizational chart allows            accountability and cost recovery
      flexible response to specific emergencies      common language to promote
     prioritized response checklists                 communication and facilitate outside
     accountability of position function             assistance
                                                     cost effective emergency planning
                                                      within health care organizations



HEICS is an emergency management system made up of positions on an organizational
chart. Each position has a specific mission to address an emergency situation. Each
position represented below has an individual checklist designed to direct the assigned
individual in disaster recovery tasks. The HEICS plan includes forms to enhance this
overall system and promote accountability.

The HEICS plan is flexible. Only those positions, or functions, which are needed should
be activated. The HEICS plan allows for the addition of needed positions, as well as the
deactivating of positions at any time. This equates to promoting efficiency and cost
effectiveness.



                                                                                     17
              The activation of positions for a mass casualty incident will be different than those
              activated for an earthquake or typhoon. HEICS will flex to accommodate the unique
              needs of each emergency. However, it is important to keep in mind the four basic
              components of ICS, which are Operations, Logistic, Planning and Finance which must
              be retained at all cost.




              HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM
                Organizational Chart




                                                                                                   Incident
                                                                                                 Commander



                                                                         Public Information Officer               Liaison Officer


                                                                        Safety and Security Officer




Logistics Chief                Planning Chief                   Finance Chief                                                                                   Operations Chief




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


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


                                                                                                        Out Patient Services                  Discharge
                                                                                                            Unit Leader                       Unit Leader


                                                                                                                                               Morgue
                                                                                                                                              Unit Leader




                                                                                                                                                                                               18
B - ASSIGNMENT OF RESPONSIBILITIES



Identification of Disaster Personnel

       All hospital personnel should have visible identification badges to help the safety
and security director and his or her assistants identify individuals who do not belong in
the hospital or disaster area. It also will help chiefs and supervisors to identify individuals
who can assist with their needs from those who do not belong in their area. In addition to
standard hospital identification cards, key personnel as identified in the disaster plan
should have specific identifying badges. This will facilitate ease of communication
between the incident commander and his or her subordinates.

        Staff and patient management consists of two phases: incident and post-
incident. During the incident, staff members must be mobilized to perform their
dedicated functions. Key personnel must report to their stations, and nonessential
employees should be put in the labor pool or separated from the affected areas. During
long disasters and cleanup operations, temporary offices and work areas need to be
implemented. The same holds true for patients. They must be removed from the area of
the disaster and placed in temporary care spaces. Part of the plan must include the
locations of the temporary workspaces and patient care areas.

       After the disaster, patients and staff need to be debriefed and counseled about the
event. They may require critical incident stress debriefing to deal with the situation
caused by the disaster. Disaster management staff also should be interviewed to find
ways to improve the plan and process in the future.



C - ORGANIZING RESPONSE TEAMS


       External disasters are emergency situations occurring outside the hospital, in the
community or within it’s catchment area necessitating the activation of the hospital. In
such events upon verification and considering the magnitude of the emergency the
hospital decides when to send responding teams to the site and / or prepare itself to
receive patient / victims coming from the disaster site brought in by paramedic and / or
responding groups.

      Internal disasters are situations wherein the hospital is in itself affected by the
emergency. ( examples: fire, earthquake, etc..)


                                                                                           19
Two core disaster response teams are to be organized for this purpose.

1. THE IN-HOSPITAL RESPONSE TEAM

   The In-Hospital Response Team provides immediate emergency medical
   assistance to victims brought to the hospital for proper medical care. It is
   composed of the following members:

   a. Disaster Control Coordinator (Chief of Hospital, STOP DEATH
      Coordinator, Officer of the Day )
   b. Deputy Disaster Control Coordinator ( assists the Coordinator or acts as
      Coordinator in the absence of the Coordinator )
   c. Hospital Triage Officer ( Surgical Resident on Duty preferably the Team
      Leader)
   d. All hospital personnel on duty


2. ON – SCENE RESPONSE TEAM

   The On – Scene Response Team is a small group of specially qualified
   physicians and other hospital personnel who shall rush to the scene of the
   disaster as soon as ordered by the hospital’s Disaster Control Coordinator or
   his Deputy. It provides quick and immediate medical assistance to disaster
   victims. It is composed of the following members:

   a.   An On – Scene Response Officer or Team Leader
   b.   Surgical Resident
   c.   Internal Medicine Resident
   d.   Nurses
   e.   Aide or Helper
   f.   Driver
   g.   Others ( depend on the situation )




                                                                             20
IX - ROLES AND FUNCTIONS OF HOSPITAL DISASTER RESPONSE TEAMS:


A. IN-HOSPITAL RESPONSE TEAM


  1. Initiate the activation of the emergency plan that will authorize respective
      members of the disaster team of their duties and responsibilities.
  2. Provides immediate emergency medical assistance to victims brought to the
      hospital for proper medical care.
  3. Classify victims and retag them as need be based on degree of injury and need for
      immediate medical care. Identify who will be accommodated to the hospital based
      on it’s capability and number of operating rooms and who should be transferred to
      a higher level hospital;
  4. Coordinate with the DOH OPCEN for reports and for possible transfer of some
      patients;
  5. Make available number of beds with expected number of victims. The beds to be
      freed are those of elective patients who can be discharged without threat to their
      safety and final recovery. All elective admissions and operations can be
      postponed. In some cases, not so emergency cases can be transferred to nearby
      hospitals with proper coordination.
  6. Ensure that emergency drugs, supplies, necessary equipment are at their disposal
      and are available.
  7. Coordinate with the administrative officer, property officer, pharmacist etc… to
      inform them of the expected influx of patients; likewise anticipate type of
      expected patients so that necessary medicines and supplies are made available.
  8. Anticipate manpower needs and shifting including nurses and other support staff
  9. Assign someone to answer queries of relatives and of the press;
  10. Administer appropriate patient care through:
       Charting out all patients regardless of where they were seen or referred from;
       Conducting patients to a suitable area for examination or treatment. Do
          contamination if need be;
       Noting in the chart, by the admitting section clerk, the area or the hospital
          origin and any accompanying forms, notes or letters;
       Initiating patient care;
       Assessing patient’s condition to determine his status, including a quick
          history, physical examination, vital signs, inspection of injuries, etc…
       Performing basic ABC’s of first aid or resuscitation in accordance with
          general principles to stabilize the patient to prevent further life-threatening
          situation or condition.
       Performing diagnostic tests to aid in the diagnosis and determine severity of
          condition;



                                                                                     21
B. ON – SCENE RESPONSE TEAM


       The on-scene response team shall rush to the disaster scene to attend to the
medical emergency needs of victims and patients on-site and to make proper
arrangements for their transport to the hospital for proper medical attention.

      The following protocols should be observed:

      1. The head of the team should be responsible that all necessary emergency
         drugs, supplies, medical equipment etc..be available in the ambulance. All
         teams should follow the principle to be self-sufficient and not be a burden to
         others. Hence even food etc., should be thought of when mobilizing teams.

      2. The head of the team should understand the necessary protocols for each kind
         of situation. E.g. if it is fire, the team should coordinate first with the fire
         marshall and not enter the facility on fire; if it is a bomb explosion, the team
         should first have clearance first with the bomb squad before entering the
         premises etc.
.
      3. The team should be ready to be the medical on-scene commander if they are
         the first to arrive in the scene with the assumption that the head is
         knowledgeable on Mass Casualty Handling and understand the Incident
         Command System. He shall establish a Command Post for Health Services
         and take charge of operations. In the event that there is already an On-Scene
         Commander he shall coordinate and report to the person in authority.

      4. Mass casualty principle should be followed such as triaging etc….

      5. The team should continuously coordinate with the DOH Operation Center for
         additional back-up teams, for transport of patients to the appropriate hospitals
         and for reporting.

      6. There should be a responsible person to document everything going on during
         the operation especially the record of all patients treated on-site and all those
         transported to the different hospitals.

      7. The team leader should coordinate with the Overall Scene Commander for
         proper coordination. He should do this together with the representative
         coming from the Regional Health Office or the representative coming from
         the Central Office.




                                                                                      22
       8. They should submit a mission incident report within 24 hours after the disaster
          to the Chief of Hospital / STOP DEATH Coordinator and to the DOH
          Operation Center.



X – ACTIVATION/TERMINATION OF THE PLAN


        In case of emergency the alarm has to be quick and reliable. The competence to
set the alarm in motion has to be settled as low as possible in the hierarchy. Otherwise
time is lost during early phases of the plan. It is essential that the plan designate an
individual who has the responsibility to put the hospital’s disaster plan into effect. An
alternative person or persons who have this authority should also be specified. It must be
clearly defined how the on-duty physician and nurse determine when to mobilize staff
from other departments or when to dispatch teams in cases of external disasters.
Following activation of the plan, there must be immediate mobilization of all disaster
resources likely to be needed. These include personnel, supplies, equipment,
communication and transportation.

        In conclusion, alarm has to be given early and generously even upon mere
suspicion of a major accident. Delayed mobilization is irreparable. A surplus of
personnel can always be dismissed later at any time. Alerting must never be a privilege
of the director or administrator or chief of clinics.

       Mobilized people will have to know where to go (defined meeting point) and
what to do. Furthermore, roles and responsibilities should be clearly defined. Command
and control as well as coordination center should be established. Competencies will
influence to a great extent the ability to act in a timely fashion. The declaration of an
emergency state in case of a major accident will be indispensable.


       As such several activities may follow after the activation of the plan.         The
following are examples but are not limited to the following:

          Putting in place the hospital’s organization in times of disaster (HEICS)
          mobilization of personnel
          cancellation of leaves of personnel ( in cases of extended periods of disaster)
          transfer of patients and/or premature discharge of patients from the hospital
          postponement of scheduled elective admissions and operations
          release of beds and operating rooms
          procedures to increase the number of available beds by use of available space
          preparation and reservation of rooms
          protection and certain restrictions concerning visitors and patients
          instructions concerning releasing of information to relatives and to the public



                                                                                        23
TERMINATING THE DISASTER PLAN


        When the disaster coordinator determines that the stage of emergency no longer
exist, an announcement to terminate the disaster operation is made. The telephone
operator shall be notified that the disaster plan is no longer in effect. In turn, the operator
shall be notified that the disaster plan is no longer in effect. In turn, the operator shall
inform all units or departments of the termination of the disaster operation plan. A report
on the disaster operation may be prepared by individual units and submitted to the
Disaster Committee for evaluation.




                                                                                           24
XI - ALERT SYSTEMS

        Some events, which trigger disasters, such as typhoons and volcanic eruptions, or
threats of civil disorders, may be expected several hours before they occur. Others, such
as earthquakes, may occur without warning. All hospitals must get ready to respond
whenever disasters are foreseen and/or declared.

       A code alert system is adopted to describe the expected levels of preparation and
the most suitable responses by all concerned.

        The hospital alert status shall be declared either by the DOH Central Office, the
Chief of Hospital or his designated STOP DEATH Coordinator or head of the disaster
committee. Moreover, the alert system is suspended by the Chief of Hospital or his
designate once the threat is no longer present or available. Furthermore, a system of
calling off the alert level should also be discussed in the plan.



A - DISASTER CODE WHITE

This is automatically declared in the following conditions:

1. a strong possibility of a military operation, e.g. a coup attempt;
2. any planned mass action or demonstration within the area;
3. forecast typhoons, the path of which way affects the area;
4. national or local elections or plebiscites;
5. national holidays or celebrations especially New Year’s Eve, Labor Day,
   Independence Day, All Saint’s Day, Holy Week etc… and
6. other conditions which may be declared as disasters by the Chief of Hospital or other
   appropriate authority.

        Normally, schedules of back-up teams should be organized and included in the
monthly schedules with the required compositions/members and should be on call
anytime during his duty days. (This is a separate team, from those who are on regular
duty for the day). Once this code is raised the team should report to the hospital and the
alert shall continue to be in effect until cancelled by the Chief of Hospital or his
designate. There should likewise be preparation of the necessary medicines and supplies
that might be needed and anticipated. The following are the manpower requirement
needed:

1.   Surgeons;
2.   Orthopedic surgeons;
3.   Anesthesiologists;
4.   Internists;
5.   O.R. nurses;



                                                                                       25
6.   Ophthalmologists;
7.   Otorhinolaryngologists;
8.   2nd response team should be on call
9.   emergency service personnel, nursing personnel and administrative personnel
     residing at the hospital dormitory shall be placed on call status for immediate
     mobilization.


NOTE: The composition of back-up and on-call teams would depend on the type and
level of the hospital. The suggestions here are based on a general tertiary hospital. Each
hospital can come up with their own team members. In some places like Metro Manila
there can also be designated support hospitals (usually special hospitals) who acts as a
support to a receiving hospital. E.g. San Lazaro and Fabella Hospital supporting Jose
Reyes Memorial Medical Center.



B - DISASTER CODE BLUE

       Disaster code Blue is proclaimed when 20-50 casualties (red tags) are expected.
This may require the activation of the hospital network or, at the discretion of the disaster
coordinator, may only involve the hospital nearest the emergency site.

The following are to respond when Code Blue is on:

1. On- Scene Response Team;
2. Medical Officer in charge of the Emergency room;
3. All residents of the Department of Orthopedics;
4. Medical Officer in charge of the Operating room;
5. Surgical Team on duty for the day;
6. Officer in charge of supplies at the CSR;
7. Surgical Team on duty the previous day;
8. All Anaesthesiology residents;
9. Nursing supervisor on duty;
10. Operating room nurses living within, or in the vicinity of the hospital;
11. The entire security force;
12. All third and fourth year residents;
13. All OR nurses; and
14. Institutional workers on duty




                                                                                         26
C – DISASTER CODE RED


       Disaster Code Red is put into effect when more than 50 (red tag) casualties are
momentarily anticipated or expected or suddenly brought to the hospital. The situation
may require that more than one hospital respond by sending an on-scene team. All
hospitals involved will be notified to activate their disaster control plans.

The following shall respond to disaster code Red:

1.   All persons enumerated under Code Blue
2.   All institutional workers
3.   All nursing attendants
4.   All nurses
5.   All medical interns and clinical clerks


Situations may arise when there would be a need to change the alert status from code
white to code blue or code red. If there is a strong possibility that this may happen, the
Chief of Hospital is authorized to:

1. Cancel all leaves of personnel and for them to report to the hospital.

2. Put on standby within the hospital back-up teams for rapid deployment.

3. Take other steps necessary to respond to the emergency situation.



THE ALERT STATUS SHALL CONTINUE TO BE IN EFFECT UNTIL
CANCELLED BY THE CHIEF OF HOSPITAL OR THE STOP DEATH
COORDINATOR




                                                                                       27
STANDARD OPERATING PROCEDURES:

       The following are standard protocols that must be observed and carried out in the
event of any emergencies and disasters:

       1. Information Management System shall be established to handle messages
          related to emergencies and disasters and shall relay the same to the DOH
          Regional and/or Central Operation Center (DOH OPCEN). In effect the
          hospital shall open it’s own operation center preferably in the Emergency
          Room or any place designated by the Chief of Hospital.

       2. Emergency Response Teams (ERT) shall be organized if within it’s catchment
          area and made ready to respond as soon as possible. (ERT’s could have
          monthly schedules or on call basis). The team members sent are expected to
          be knowledgeable on Mass Casualty handling and the Incident Command
          System.

       3. A pre-designated ambulance shall be available for dispatch at all times. All
          ambulances sent to the site should be equipped with all the necessary
          equipment, medicines and supplies required in emergencies. Likewise, it
          should have the necessary communications that will enable it to coordinate
          with it’s hospital and the DOH Regional and Central Operation Center.

       4. All Emergency Response Teams shall wear the prescribed STOP DEATH
          Uniform when responding to any emergency with their corresponding
          identification cards.

              STOP DEATH Coordinator - Blue Jacket with STOP DEATH seal
              Medical Officers – Orange STOP DEATH Jacket
              Nurses and other team members – Orange STOP DEATH Bib

       5. Situations Requiring Automatic dispatch of On –Scene Response Teams

          Any mass casualty situations especially within it’s catchment area
          .
          Fire or explosions involving hospitals, malls, schools, squatter areas that
          usually house a large number of people during it’s operation hours. This
          should be properly coordinated with the Bureau of Fire since they have also
          their own EMS Teams, which could also handle these cases.

          Airline Crash or sea vessel mishap with possible mass casualty within it’s
          catchment area.




                                                                                     28
6. In responding to any emergencies or disasters a responding team should be
   equipped with the necessary amenities such as tents if need be. Likewise,
   they should bring with them streamers or anything that could identify them as
   representatives from the Department of Health and/or the hospital they
   represent.

7. During actual operations all communications shall be coursed through the
   DOH Regional and/or Central Operations Center (OPCEN). The On-Site
   Teams should report regularly by radio to the OPCEN. If the team assumes
   the Incident Medical Commander he shall manage all the responding teams
   and follow the Mass Casualty Handling System. He is responsible for
   coordinating with the OPCEN for requests for additional team and for transfer
   to the hospitals.

8. Furthermore, the team should coordinate with the head of the Medical
   Services, most often representatives of the Regional Health Office who serves
   as the Head of the Medical Services in times of disaster. The DOH Regional
   Offices is responsible for coordinating with the Regional Disaster
   Coordinating Center (RDCC), PDCC etc…and other agencies such as the
   Local Government, the Department of Social Welfare and Development (
   DSWD) the Philippine National Red Cross ( PNRC ), NGO’s etc..

9. All responding teams shall submit a Mission Incident Report to the Office of
   the STOP DEATH Coordinator of it’s respective hospital who shall then
   provide a copy to the Region and/or Central Operation Center as soon as
   possible, on or before 24 hours after the activity.

10. All STOP DEATH Coordinators shall ensure that all teams mobilized are
    knowledgeable on the procedures and protocols. He shall also be allowed to
    have cash advances (based on existing orders) and ensure that the teams are
    adequately equipped and provided for all their needs.

11. All emergencies and disasters should be very well documented with pictures
    and write-ups together with their experiences and lessons learned. This could
    serve as inputs to help them in their future planning and to improve future
    responses. Researches are likewise encouraged.




                                                                              29
XII - TRIAGE AND COLOR TAGGING

       Patient classification based on severity of injury and need of Emergency Medical
Service and evacuation. ( Annex I )

       1. PRIORITY FOR IN-HOSPITAL CARE

RED – Priority One: Life threatening/immediate. The patient requires immediate
attention and transport. The following factors should be used to determine when a mass
casualty incident ( MCI ) victim is a Priority One.

           a. Obstruction or damage to airway
           b. Disturbance of breathing – respiration above 30/min
           c. Disturbance in circulation – capillary refill greater than 2 seconds or
              carotid pulse weak , irregular or absent, radial pulse absent
           d. Does not follow commands or altered level of consciousness
           e. Need for life-saving measures ( BLS and ATLS) and urgent hospital
              admission
           f. Victims whose injuries demand definitive treatment in the hospital but
              which treatment may be delayed without prejudices to ultimate recovery.

YELLOW – Priority Two: Urgent. Patient has passed primary survey, but major
system injury limits delay of transport to one hour. Any one of the following factors
could take place a victim into a Priority Two category:

           a. Needs to be treated within 4-6 hours 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; Heat injuries with a normal level of
              consciousness.

GREEN – Priority Three: Delayed. An injury exists but treatment can be delayed for
toww to six hours. Generally ( but not always ), anyone who can walk to a designated
area for treatment will be a Priority Three. The following injuries are example:

           a. Minor injuries not threatened by ABC instability
           b. Minor fractures, minor soft tissue injuries, minor burns
           c. Victims whose injuries are so severe that survival cannot be expected even
              under the most ideal conditions; obviously mortal wounds where death is
              certain ( such as head injuries or massive burns ).




                                                                                        30
BLACK – Priority Four

           a. Patient is dead.
           b. Victims who are clinically dead.
           c. Those who die while awaiting treatment, and those in cardiac arrest
              following trauma.
Legend:

A = Airway                   B = Breathing                 C = Circulation

BLS = Basic Life Support
ACLS = Advance Cardiac Life support
ATLS = Advanced Trauma Life support

The following information shall be hand printed on the Patient’s color Tag:
        Patient’s sequence number
        Name of patient
        Tentative diagnosis or suspected injury
        Previous treatment as stated on the tag which was placed on the patient at the
          scene of the disaster
        Blood type ( cross matching/signature)
        X-ray number

Priority for Evacuation ( On-Scene)
So as to have a common standard in color tagging of victims, we follow the same color
tagging as the in-hospital.

RED TAG

   -   FIRST PRIORITY FOR EVACUATION
   -   NEEDS IMMEDIATE CARE

YELLOW TAG

   -   SECOND PRIORITY FOR EVACUATION
   -   PATIENT NEEDS CARE. INJURIES NOT LIFE THREATENING

GREEN TAG

   -   THIRD PRIORITY FOR EVACUATION
   -   MINOR INJURIES

BLACK TAG

   -   LAST PRIORITY


                                                                                     31
XIII - COMMAND AND CONTROL

        A command site within the hospital should be established, preferably in a pre-
designated area. This center should be able to communicate with the patient receiving
area (triage site), patient care areas, and with local EMS, police, fire, and government
authorities. Provision for multiple modes of communication (mobile phone, two-way
radio, runners, etc.) should be made. The command personnel should include at least a
physician, a nurse and an administrator.

       The internal command and control of an incident at Health Services would
include ultimate control as incident commander with the Health Services Director or
designee. The Span of Control should be kept within manageable means by dividing the
incident into pieces. Under normal situations this division would be into a Medical
Commander and a Logistical Commander under the overall Incident Commander.

        It is recognized that the overall Incident Commander be stationary in the
command post to make timely decisions as information and requests reach him or her. In
the command structure, the two operational commanders (Medical and Logistical) will
have the role to evaluate the entire Health Services’ conditions. These commanders need
not be completely stationary to be effective in directing their specific areas.

These individual commanders should have mobile communications in the command post
  at all times.
The area commanders are the eyes and ears for the Incident Commander. It is only
   through proper evaluation of the on-going incident and constant feedback to the
   command post that the incident can be best managed.
A telephone call-tree shall be maintained and kept up-to-date with current staffing needs
   and information. This telephone tree shall be utilized by those designated to initiate
   the recall of personnel when directed by the Incident Commander.

      As part of disaster planning, it is essential that certain areas of the hospital be
designated for specific functions such as reception of casualties, treatment, and discharge
of patients. The plan should be quite specific as to the function of these areas, staffing
requirements and basic supplies to be utilized. The areas to be incorporated in each plan
include:

1. An Emergency Operation Center (EOC) must be established to provide overall
   command and coordination of the hospital’s disaster response activities. These
   activities include activation of the plan, coordination of hospital activities with those
   at the disaster site and adjusting the plan as necessary. Good communication is
   absolutely essential for these coordination activities and must be immediately
   available via telephone, radio and messengers. EOC responsibilities include opening
   up additional hospital wards or clinics, obtaining assistance, evacuation of
   endangered patients, and assignment of staff to treatment areas and revision of
   original job assignments.


                                                                                        32
STANDARD OPERATING PROCEDURES FOR EOC’S
  Activation             Operations                                   Closing-down
Open EOC             Message Flow                                     File messages & other
                                                                      Documents
Mobilize staff                    Information display

Activate communications           Information processing              Release staff
Systems

Prepare/post up maps &            Control resource mobilization       Close down
Display boards                      & deployment                       communications

Draw up support staff            Drafting of situation reports        Close down EOC
Roster                           Decision-making                      Organize operational
                                                                      Debrief
                                 Briefings

                                 Reporting to higher authority


2. Triage. In order to maximize efficiency, entry of all patients should be restricted to
   only one location, the triage area. The primary function of a disaster triage area is
   rapid assessment of all incoming casualties, the assignment of priorities for
   management, and classification of disposition (i.e., distribution of patients to various
   other patient care areas in the hospital). Without a triage area to manage the patient
   flow, the major treatment area may become overwhelmed.

3. Patient Care Stations

                 One suggested method of organizing patient care stations includes the
                 following:

                    Major Trauma and Medicine

                        From the triage location, most if not all of the seriously injured
                        patients will be sent to the major trauma/medicine area (e.g.,
                        trauma and cardiac resuscitation, treatment of hypovolemic shock,
                        severe respiratory distress, etc.). This is usually physically located
                        in the Emergency Department.

                    Minor Trauma-Primary Care:

                        In most disaster situations, the majority of patients are not very
                        seriously injured. A great percentage of these will be classified as
                        the “walking wounded”. These low priority patients can be sent to


                                                                                          33
   an “urgent care” area often designated as the Minor
   Trauma/Primary Care Area for definitive care including splinting
   of fractures, primary closure of lacerations and tetanus
   prophylaxis. This minor trauma/primary care area can be
   established in the hospital’s outpatient clinics.

c. Admission Pre-Surgical Holding:

   Most trauma patients stabilized in the Major Trauma Area
   (emergency department) will be sent to the Admission Pre-surgical
   Holding area.

d. Surgery:

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

Morgue:

   Many disasters can result in a large number of fatalities. This may
   require that present morgue capacities need to be expanded or
   other outside facilities such as church or stadium temporarily
   utilized.

Decontamination

   Hospitals must have provisions for emergency treatment and
   decontamination of individuals who are radioactively or
   chemically contaminated. Some basic requirements for hospitals
   are:

      A safe area for decontamination
      A means of washing external contamination from the patients.
      A method of containment of contaminated materials.
      Adequate protection for persons handling the patient, and other
             hospital personnel.
      Disposal/cleanable medical equipment.

Psychosocial Care

   In the event of a disaster involving mass casualties, and even
   property damage with loss of possessions, it is common for
   patients to present with episodes of anxiety, depression, and



                                                                    34
                       psychotic episodes. Hysterical persons whether patients, visitors or
                       staff, can be extremely disruptive to hospital disaster operations. A
                       separate isolated area must be pre-designated to receive individuals
                       in need of psychological intervention.

                   Family Waiting and Discharge Area:

                       As past experiences in disasters has shown, families and friends
                       will converge en masse to the hospital seeking information about
                       victims. This convergence can seriously interfere with efforts of
                       the hospital to respond effectively to the situation. For this reason,
                       a separate area must be pre-designated for family members seeking
                       information. This area may also be utilized to discharge in-hospital
                       patients and victims of the disaster.


The hospital during emergency has two major activities:

       B.    Administrative

       Administrative activities involve setting the hospital disaster plan into action and
a Disaster Officer should be identified who will get and give all information and take all
administrative actions and will co-ordinate with chiefs of various clinical specialties. The
hospital phase is highlighted by following activities –

Alert - all the hospital medical and paramedical staff is alerted to assemble in the hospital
casualty.

Expansion of casualty area -- If it is expected that the hospital casualty will not be
enough, then the main O.P.D. hall (or some other place) shall be opened to receive the
casualties.

        Adequate accommodation to be arranged in various wards side rooms/ seminar
rooms / halls or any other space and later on by discharging certain categories of patients.
All existing operation theatres should be opened up.

        Security arrangements by hospital staff with the help of police personnel. They
should act as traffic- controllers and direct patients and relatives to respective reception
centers. The complexity of problem gets compounded when one finds that it is not merely
the numerical load of patients, but also a large number of relations, attendants and public,
which by their natural anxiety add further liability to the management of casualties. If
required the hospital entry/exit should be controlled by Police personnel.




                                                                                         35
Clinical

Management of casualties - Principle of triage is to be applied so that casualties can be
classified for priority of need and proper place of treatment. The goal of triage is two-
fold:

            1.   To select those patients in greatest need of medical attention and

            2.   To arrange for their treatment.

To ensure that a patient presents for treatment only to the appropriate forewarned medical
faculty as a means of limited personnel and supply sources.

The triage should be performed by senior clinicians and for heavy load it is suggested to
have four teams each consisting of

       One General Surgeon

       One Orthopedic Surgeon

       One Physician

       One Anesthetist

       Two Staff Nurses

       Two Nursing Attendants

       One Sweeper




                                                                                       36
XIV - NETWORKING

         It is imperative that every hospital integrates its own disaster plan with those of
community disaster management agencies. This is especially important regarding disaster
notification and communication transportation of casualties and provisions for dispatch of
hospital medical teams to a disaster site. Strong relationships with community agencies
(e.g. fire department, the local EMS, local emergency management or the civil defense
agency) are important to ensure a coordinated disaster response.

       Other organizations that a hospital may interact with during the disaster planning
process may include the military, local chapters of Philippine National Red Cross and
other volunteer agencies, along with other national agencies.

        Hospital disaster plan should anticipate information about specific hazards which
are of common occurrence in the community (e.g. typhoons, landslide), expert personnel
(e.g. poison control) and special supplies (e.g. antidotes) not readily available may be
needed in a particular disaster situation. Plans should consider how to rapidly access
these resources. Plans for obtaining additional shelter, food and water should also be
considered.

        The hospital network is a sharing arrangement between several hospitals of
different levels and specialties in a given area to work together for the purpose of
managing medical emergencies more efficiently. The hospital network shall be
mobilized during disaster operations. The hospital also needs to develop its external
disaster plan in conjunction with other emergency facilities in the community. For
example, there should be pre-arranged memorandum of agreement with hospitals outside
the immediate area should hospital capacities be exceeded. There should also be
preplanning and prearranged referral to tertiary medical centers and special units whether
private or government institutions (e.g. burn, spinal, pediatric trauma centers).

        Under the network arrangement, each hospital’s capability rating is initially
assessed by collecting the information about the hospital through a questionnaire. Using
the responses to the questionnaire, the hospital capability is evaluated in terms of
specialty manpower, existing training program, available personnel in the emergency
room capable at all times of handling specific sub-specialty problems. The hospital
capability rating also takes into account the available equipment, therapeutics and
communication facilities, infrastructures and service performance. All hospitals are
classified according to their capabilities in handling specific sub-specialty programs.




                                                                                        37
 The following hospital capability ratings are recommended:

         RATED 1 means that the hospital is capable of accepting all cases of this
         specialty. A hospital Rated 1 is an end-hospital that will not refuse patients unless
         the situation makes admission extremely difficult or impossible.

         RATED 2 means that the hospital is capable of handling sub-specialty cases but
         has some limitations such as bed capacity, equipment, etc.. and cannot be
         expected to offer definitive care. It may also mean there are not enough full-time
         consultants or residents available on a 24 hour basis or that there is no training
         program and therefore no front-line personnel in this specialty.
         RATED 3 means the hospital is incapable of handling cases of this sub-specialty
         beyond giving primary care and resuscitation.

        The rating system should be agreed upon by all concerned. A lead hospital is
 assigned for each sub-specialty to coordinate the compilation of treatment protocols. All
 lead hospitals are Rated 1 for their respective sub-specialties. A two-way referral system
 between the lead hospital and other hospitals in the network shall be established. A team
 leader for each lead hospital shall also be designated. Hospitals both private and
 government should work together to form the network irrespective of specialty and
 capability. There should be a clear system of referral so as to prevent patients referred to
 the wrong hospital. An illustrative example of a network hospital capability-rating sheet
 is shown below:
                        An Illustrative Example
                        Hospital Network Capability Rating sheet


   Service Capability        Hospital 1        Hospital 2         Hospital 3       Hospital 4

 1. Orthopedics                   2                 3                  1                 2
 2. Neurosurgery                  2                 3                  1                 2
 3. Abdominal                     1                 1                  1                 1
 Urology                          1                 2                  1                 1
 ENT                              1                 2                  1                 2
 Maxillo-Facial                   1                 3                  1                 1
 Burns/Plastic                    2                 2                  2                 1
 TCV                              1                 2                  1                 1



          The rating of the hospital serves as a practical guide in the referral of patients. For
instance, victims of serious burns shall be referred to the hospital rated 1 on burn treatment
capability. Similarly, disaster victims requiring neurosurgical services capability shall be
referred to the lead hospital ( rated 1) in neurosurgery. The capability rating of each
hospital should be made known to all the hospitals in the network to ensure smooth and




                                                                                             38
appropriate referral of cases. Referral of patients to a hospital, which is not capable of
providing the services required, should be avoided.

         A system of communication and patient referral shall be established to avoid
overloading of individual hospitals and to ensure that patients are referred to the hospital
most capable of managing the emergency.




                                                                                         39
XV - TRAINING

        The medical personnel comprising the response teams should have basic and
specialty training on the specific skills needed for disaster response. The training
program should include both medical and management skills as well as team-building,
psychosocial, and human relations skills.
        As a minimum, members of the on-scene response teams should have skills on
cardiopulmonary resuscitation (CPR), trauma care, patient assessment and classification,
and proper transport of patients. In most cases, members of the in-hospital disaster
response teams, being medical personnel may assume to have adequate technical training
in their respective specialties. It should, however, be confirmed that they indeed possess
the needed skills. In addition, they may still need to be trained on the procedures and
policies embodied in the hospital’s disaster operation’s plan.
        All responding teams should be knowledgeable in mass casualty handling as this
is a special concept. A carefully directed training is mandatory. No personnel should be
dispatched without knowledge in this area. Treatment protocols for most common
emergency cases encountered during disaster operations should likewise be included in
the training or orientation program for the hospital disaster response team.
        It may also be advisable (optional) that members of the community within the
catchment area of the hospital be included as a target group if the hospital goes into
community disaster preparedness program. Training in basic CPR and trauma care may
spell a difference because they may be the first to arrive at the scene of disaster, and the
time between onset of circulatory arrest and initiation of resuscitation is critical. Hence,
if police officer, traffic enforcers or just bystanders at the site of disaster are able to begin
CPR on those with signs of cardiac arrest before the arrival of the scene response team,
the chances for long-term survival of the patient are likely to be increased. Likewise,
skillful handling of patients with traumatic injuries may have a difference between
recuperation and an invalid state.
        Lastly, people who are given the authority to command and control disaster
operations should have training in MANAGEMENT in the real sense of the word. This
would mean training in planning, organization, evaluation, monitoring, logistic and
personnel management, information systems management and a lot more. You maybe
the best surgeon or the best EMS personnel but doesn’t know how to manage your
resources might result to a second disaster.

        The objectives of training and education in emergency management are:
         to manage and coordinate emergencies and disasters inside the hospital and/or
           within the catchment area;
         handle mass casualties inside and outside the hospital;
         response teams as well as hospital personnel are able to carry out the tasks
           allotted to them;
         the community knows the appropriate actions for different types of
           emergencies, and the organizations it can turn to for assistance




                                                                                             40
XVI - DRILLS AND EXERCISES

        Theoretical education has to be followed by periodical exercises. Drills can range
from full-scale community-wide simulations with moulage victims to table top triage
games to mini-drills that test only certain components of the disaster plan such as call-up
of personnel, and test of communications. Mock disasters have to be well prepared and
executed preferably without announcement. It is suggested that it should be conducted at
least twice a year (especially during Disaster Consciousness Month every July) and the
scenario should reflect incidents that are likely to occur in the hospital or in the
community. It is important that the hospital takes all precautionary measures not to alarm
the patients during disaster preparedness drills.


Objectives of drills are:

1. To train the hospital staff involved in disaster operations
2. To detect errors or flaws in the disaster plan; and
3. To minimize the time required for the hospital staff to respond to actual emergency
   situations


      Drills must be well organized and coordinated, so that each participant will perform
his role and know the work he has to do. In scheduled drills the following training
sessions should be done:

1. A session to explain what each participant has to do.
2. A separate partial rehearsals for each section or group of participants (including the
   simulators).
3. A comprehensive rehearsal involving the entire hospital system. It is important to
   make sure that all staff included in the plan participates.


      A practical drill program on disaster preparedness should be developed for each
hospital. For instance, traffic routes of incoming medical emergency patients, pr escape
routes in case of internal hospital disasters are tailored to the specific condition of the
hospitals.




                                                                                         41
The Practice Drill should include the following:


4. Identification of key functions and information of special teams responsible for those
   functions. For example, in a fire drill, the following key functions/teams may be
   identified:

                   a. Floor nurse or disaster coordinator to direct patients and personnel
                      proper escape routes;

                   b. Fire-fighting team to try to control the spread of fire, or extinguish
                      fires before they spread;

                   c. Communication team to call the fire department, issue correct
                      information on the location of the fire and escape routes to take;

                   d. Patient evacuation team to be in charge of the orderly and
                      systematic transfer of patient to declared evacuation sites;

                   e. Critical equipment rescue team to take care of saving critical life-
                      saving equipment;

                   f. Search and rescue team to look for, and arrange rescue of, patients
                      or personnel that may have been trapped or left behind; and

                   g. Post- assessment team to monitor the conduct of the drill and
                      identify weaknesses that should be corrected.


5. Briefing of all personnel on the highlight of the practice drill and the expected tasks
   and behavior of all concerned.

6. Conduct of practice drill based on various types of internal as well as external disaster
   situations. It is suggested that the practice drill be done twice a year.

7. Post drill assessments to determine how to further improved the practical drill
   exercises and programs.




                                                                                           42
XVII – LOGISTICS MANAGEMENT


        During a disaster, necessary supplies and equipment must be ready for immediate
distribution to appropriate locations in the hospital (e.g., stretchers and wheelchairs to the
receiving area). Each hospital will have to estimate the amount of medicines and supplies
that will be needed to stock over and above their regular hospital supply. In many
instances, this will not need to be increased because many hospitals and medical centers
already have a three-month supply of most of their emergency drugs/supplies. Some
investments may be expensive but are most likely well worth it.

       The hospital should be in constant state of readiness to respond to any disaster.
The needed facilities and support for disaster operations should be in place and regularly
maintained. The essential medical facilities that should always be available by the On –
Scene Response Teams and In Hospital Response Teams should always be monitored.
This includes ambulance facilities that enable the Scene Response Teams to conduct
rescue operations at the site of the disaster, transport and communication facilities, and
standby power generators.

       Prior arrangements should be made with suppliers of critical supplies for opening
of credit lines during disaster to ensure continuous supply of medicines and other
consumable. Likewise, arrangements have to be made with maintenance service
providers for similar credit arrangements to ensure prompt repair and/or temporary
replacement of critical medical equipment that break down during disasters.

        Whether it be natural or manmade disasters or emergencies the requirement of the
sudden use of specific medical items suddenly produce a short supply. Even during
normal times with the present procurement procedures supply of the needed medicines
might be a problem. Institutions especially the hospital has to come up with procedures
for an organizational shift in times of emergencies and disaster. Logistic management
thus far could break or make responses to emergencies and disasters.




                                                                                          43
XVIII MEDIA RELATIONS



       In a disaster, the hospital may become inundated by more members of the media
than by actual disaster victims. The presence of these individuals can definitely impair
the performance of an already stressed hospital staff. For this reason, members of the
press and other news media representatives should be directed to a room or office of the
hospital away from the emergency department or other areas where patient care activities
are going on. A hospital administrator or public relations specialist should closely
supervise the press room. This person should be in direct contact with the emergency
operation center. Hospital staff must leave all communication with the press to this
person and should direct any member of the media to the public relations area so as to
have consistent information given out by the hospital.

       The media can be used as a communication tool to the outside world by releasing
information that informs families of potential victims and hospital personnel of the status
of the situation. Authorities can be contacted to activate the Emergency Broadcast
System to disseminate information on very short notice to a large number of people.

       Information does not only include the contact between rescue staff and media at
the damage area. Information flow is also important within the hospital. Information
chaos with subsequent criticism can only be prevented by a clear information concept.
This concept consists of:

              information of staff
              information of neighboring hospitals and operation partners, such as
               ambulances, police, etc.
              information of friends and relatives,
              information of media (Media always get their information - the better way
               is the controlled one)




                                                                                        44
XIX.       UPDATING AND EVALUATING THE HOSITAL DISASTER
          MANAGEMENT PLAN


 Updating:

         The hospital disaster plan should be reviewed regularly and updated frequently to
 include changes in manpower, resources, protocols and any other changes since the plan
 was made. Usually the plan is reviewed after an actual disaster, after a disaster simulation
 exercise or any other type of test and the changes reflects the correction of failings
 detected during the exercise. Interval between one updating and the next will vary
 according to the conditions in each hospital and would depend on the number of disasters
 occurring on the catchment area of the hospital, on the number of simulation exercise or
 drills and /or evaluations done. Ideally, it should be done once a year.

 Evaluation:

         Changes normally occur in institutions including movement of staff, changes in
 position, new employees even new superiors. It is along this light that evaluation of
 one’s hospital preparedness plan should be reviewed regularly and evaluated to determine
 if the plan is still up-to-date, if the roster of personnel and material resources are
 complete and the activities are being carried out according to the plan. Furthermore, the
 evaluation is being carried out to check the condition of equipment, availability of
 resources such as drugs etc…

         Evaluation is deemed effective if carried promptly and followed by correcting all
 the errors detected during the evaluation. Hence, even if errors are noted but are not
 corrected and included in the plan the evaluation is useless. However well the plan was
 made and however complete it is it cannot be proven unless it is evaluated.

        The real purpose of an evaluation is to measure efficiency and detect deficiencies
 in order to correct them at all levels. Evaluation is carried out under the supervision of
 relevant officials. Evaluation validates and complements planning. It should be
 remembered by everybody that in order to check that everything is proceeding in
 accordance with established plans, it must be verified that it is should not only be well
 understood by everybody but intellectually and emotionally accepted by those in charge
 of executing the plan.

         Types of evaluation methods are simulation exercises, and drills: scheduled,
 unannounced, and in-service. Best evaluation of a hospital disaster plan is one carried
 out after an actual disaster, since it is then that all the factors involved come into play
 under conditions of real pressure.




                                                                                         45
XX - TEN STEPS TO BECOME A STOP DEATH HOSPITAL

1. The hospital should have an institutionalized disaster preparedness and response plan,
   regularly updated and disseminated to all hospital personnel;

2. The hospital should have an emergency response team that can be mobilized at once to
   respond to any emergencies and disasters;

3. The hospital should have an ambulance equipped with all the needed equipment, emergency
   drugs and supplies ready to attend to an unstable victim; furthermore all the personnel should
   be knowledgeable of all the use of the equipment and medicines and supplies inside the
   ambulance;

4. The emergency room of the hospital should be equipped with all the necessary equipment,
   medicines, supplies and communication ready to respond to any form of mass casualty
   handling; it shall be ready to receive an influx of emergency cases and be able to adapt to the
   sudden change due to the emergency;

5. The hospital should be able to activate the hospital’s Emergency Operation Center (EOC)
   once a disaster occurs and responsible for coordination during the disaster; the EOC should
   also be equipped with all types of communication ( telephone, radios, fax machines,
   computers, runners etc.) to be able to properly coordinate with all the agencies involve in
   disaster situations;

6. The hospital shall have a continuous training program for all the hospital staff but specifically
   for the response team and the emergency room staff; Basic Life support ( BLS ) for all
   hospital personnel; Advance Cardiac Life support ( ACLS ), Pediatric Cardiac Life support (
   PCLS ) for all emergency room medical personnel; Emergency Medical Technician ( EMT )
   for response team and health emergency management for all stop death coordinators;

7. The hospital should know: his community and be knowledgeable of all the hazards and the
   vulnerable population in it’s area; existing members of the health sector in their respective
   community; relevant government and non-government organizations to whom it can
   coordinate. and network during emergencies and disasters;

8. The hospital should have an ongoing advocacy campaign to disseminate preparedness among
   the general population in it’s community; it should advise the public on health issues
   appropriate to the type of disaster; it should have regular seminars on emergency
   preparedness; it shall have at least twice a year disaster drills to review and update the plan;

9. The hospital should follow and observe all the needed fire-safety requirements as embodied
   in the Fire Code; furthermore, procedures like formation of fire marshals responsible for
   ensuring evacuation of patients and important documents and equipment be in place and
   regularly updated.

10. Lastly, the hospital should exert all efforts to document all it’s experiences, do researches
    pertinent to emergencies and disasters and shall serve as inputs to improve their plan or come
    up with standards and protocol.




                                                                                                46
                   Appendix 1
XXI - APPENDICES


Triage tag




                   47
                                                   Appendix 2




STOP D.E.A.T.H. PROGRAM ASSESSMENT FORM



        ___________________________________
                 Date of Assessment


        ________________________________________
                   Name of Hospital


        ________________________________________
                   Name of Director


        ________________________________________
              STOP DEATH Coordinator




                  Team Members:

      ________________________________________

      ________________________________________

      ________________________________________




                                                   48
49
OBJECTIVE:

To assess the implementation of the Stop Death Program in the Hospital.



SPECIFIC OBJECTIVES:

To assess the following:

1) The Emergency Preparedness Plan of the Hospital

2) The Emergency Room capability of the Hospital.

3) The Communications capability and the existence of an Operations Center of the
   Hospital.

4) The Transportation (Ambulance) capability of the hospital.

5) The response team of the hospital.

6) The Human Resources of the Hospital.

7) The Community Involvement of the Hospital.

8) The Advocacy activities done by the STOP DEATH Program of the Hospital.

9) The Fire Safety of the Hospital.

10) The Research Activities done related to Disaster.

11) The performance of the STOP DEATH Coordinator.

12) The Hospital Director’s perception and concerns to the STOP DEATH Program.




                                                                                 50
           ASSESSMENT TOOL FOR THE STOP DEATH PROGRAM
                    FOR DOH RETAINED HOSPITAL

      The assessment tool is designed to assist in the evaluation of the STOP DEATH
Program being implemented in the DOH retained Hospitals.

      1.     Emergency Preparedness Plan                 20%

      4%     1.1    Does the hospital have an emergency plan?
                           ___________ Yes
                           ___________ No

      4%     1.2    Is the hospital emergency plan documented in writing?
                            ___________ Yes
                            ___________ No

      4%     1.3    Is there a flow chart (organizational chart) for disaster situation?
                            ___________ Yes
                            ___________ No
      4%            1.4     Is there a hospital directive in the implementation of the
                    emergency preparedness plan?
                            ___________ Yes
                            ___________ No

      4%     1.5    Are the members made aware of the program and their role?
                           1.5.1 Director
                                         _____ Yes
                                         _____ No
                           1.5.2 Medical (Chief of Clinics)
                                        ______ Yes
                                        ______ No
                           1.5.3 Administrative Division
                                        ______ Yes
                                        ______ No
                           1.5.4 Nursing Service
                                        ______ Yes
                                        ______ No




                                                                                    51
       2.     ER/AS Capability                         15%

              What are the equipment available at the ER/AS?

4%   EMERGENCY ROOM EQUIPMENT             Quantity      Date Acquired Functional Non-Functional


1. Ambu Bag Adult Set               Pedia Set
2. Anesthesia Machine *
3. Blood Pressure Apparatus
4. Cardiac Monitor w/ Defibrillator
5. Cervical Collars         Indicate sizes
6. Crutchfield Tongs *
7. Cardiac Board
8. Floor Lamps
9. Intravenous Fluid Stands
10.Closed Tube Thoracostomy Set
11.Cutdown Set
12.Minor Surgical Set
13.Tracheostomy Set
14.Intubation Set
15.Laryngoscope           Adult Set        Pedia Set
16.Light Ceiling-mounted
17.Mayo Table/Tray
18.Mechanical Ventilator *
19.Nebulizer
20.Otoscope-Ophthalmoscope Set
21.Oxygen           Tanks        Wall-Mounted
22.Pulse Oxymeter
23.Spine Boards ( short / long )
24.Splints
25.Stethoscope
26.Suction Apparatus
27.Straps ( cloth )
28.Stretcher
29.Wheelchairs
30.Flashlight / Penlight




                                                                                 52
4% EMERGENCY ROOM DRUGS                          QUANTITY
1. Dopamine 200 mg. / amp.
2. Dobutamine 250 mg. / vial
3. Lidocaine 5% Vial/ Polyamps
4. Epinephrine 1 mg./ml. Amp.
5. Atropine Sulfate 1 mg./ml. Amp.
6. Magnesium Sulfate 25 mg./ml./Amp.
7. Calcium Gluconate 100 mg./ml./Amp.
8. Aminophylline 25 mg./ml/Amp.
9. Terbutaline Sulfate 0.5 mg./amp.
10. Verapamil 5 mg./2 ml./Amp.
11. Nifedipine 5 mg./cap.
12. Sodium Bicarbonate 50 mEq./vial
13. Isordil 5 mg./ tab
14. Digoxin 0.5 mg. /ml./amp.
15. Nitroglycerine 5 mg. Patch/paste
16. Furosemide 20 mg./amp.
17. Ranitidine HCl. 50 mg./amp.
18. Plain LR 500 ml.                             1 liter
19. Plain NSS (0.9 NaCl) 500 ml.                 1 liter
20. D5-LR 500 ml.                                1 liter
21. D5-W 250 ml.                     500 ml.     1 liter
22. D10-W 500 ml.
23. D5-0.3 NaCl 500 ml.                          1 liter
24. D5-0.9 NaCl 500 ml.                          1 liter
25. D5-NM 500 ml.                                1 liter
26. D5-NR 500 ml.                                1 liter
27. Mannitol 20% 250 ml.             500 ml.
28. Halopuredol
29. Chlorpromazine 25 mg./ml./amp.
30. Dilantin 100mg./amp.
30. Dexamethasone 5mg./vial
32. Plasma Expander
33. Salbutamol Nebules
34. Terbutaline Nebules 0.5 mg.
35. Paracetamol 300 mg./amp.
36. Sodium Chloride 0.9% Iso. Soln. 20cc./vial
37. D- 50 -50 50 cc. / vial
38. Diphenhydramine HCl. 50 mg. / amp.
39. Diazepam 10 mg. / amp.
40. Nalbuphine HCl. 5 mg. / amp.
41. Activated Charcoal *
42. Tranexamic Acid 500 mg./ml./amp.
43. Hydrocortisone 100 mg./vial
44. Metoclopromide 10 mg./ml./amp.
45. Potasium Chloride 40 mEq./50cc. Vial



                                                            53
EMERGENCY ROOM SUPPLIES                                   QUANTITY
1. Gloves
2. Mask
3. Butterfly          G. 25        G. 23               G. 21               G. 19
4. I.V. Catheter      G. 24        G. 22               G. 20               G. 18
5. Macroset
6. Microset
7. Blood Transfusion Set
8. Syringes           1 ml.     3 ml.       5 ml.      10 ml.     20 ml.      50 ml.
9. Sterile Gauze
10. Airway
11. Endotracheal Tube
12. Tracheostomy Tube
13. Betadine
14. Cotton Balls
15. Cotton Pledget
16. Plaster
17. Oxygen Mask Pedia                      Adult
18. Suction Catheter
19. Tourniquet
20. Urinary Catheter
21. Bandages
22. Thermometer
23. NGT
24. Asepto Syringe
25. Splints

2.2   Manpower Resources

             Staff composition for the ER?
                            _________      Doctor
                            _________      Nurse
                            _________      Nursing Attendant
                            _________      Institutional Worker




                                                                                   54
3.   Communication / Operation Center                     10%


3%   3.1    Internal Communication

            What are the forms of internal communication being used by the
     hospital?
                  _________       telephone
                  _________       public address system
                  _________       intercom
                  _________       runner
                  _________       cellular telephone
                  _________       beeper
                  _________       others, please specify ________________


3%   3.2    External Communication

            What are the forms of external communication being used by the
            hospital?

                   _________       telephone
                   _________       short wave
                   _________       public address system
                   _________       runner
                   _________       fax machine
                   _________       cellular phone
                   _________       beeper
                   _________       others, pls. specify ____________________

4%   3.3    Is there an operation center established for disaster response?

                   _______ Yes
                   _______ No




                                                                              55
      4.    Transportation (Ambulance)               5%

     1%    4.1   Is there an available ambulance in the hospital?
                          ____________ Yes
                                           If yes, how many? ____________
                          ____________ No

      1%    4.2   Is there an available communication equipment in the ambulance.
                          ____________ Yes
                                          If yes, what kind? ____________
                          ____________ No




      3%    4.3   LIST OF AMBULANCE EQUIPMENT


EQUIPMENT                                    AVAILABILITY
FUNCTIONALITY
1. Cardiac Monitor w/ Defibrillator
2. Oxygen Mask
3. Pulse oximeter
4. Sphygmomanometer
5. Stethoscope
6 Oxygen Tank w/ Regulator & O2 Meter
7. Ambu-bag
8. Suction Machine ,portable
9. Emergency Medical Kit w/ Drugs & Supplies
10. Spine Board w/ Straps
11. Cervical Collar (adult/pedia)
12. Stretcher ( scoop / wheeled type )
13. Minor Set
14. Tracheostomy Set
15. Flashlight
16. Fire Extinguisher




                                                                               56
5.   Response Team               5%


2%   5.1   Do you have an available response team?

                  _________ Yes
                  _________ No

1%   5.2   Composition of the emergency medical team?

                  _________      Doctor
                  _________      Nurse
                  _________      Nursing Aide
                  _________      Ambulance Driver


1%   5.3   How many response team can be mobilized to respond to disaster?

                  _________      Team/s


1%   5.4   Is there an available schedule of the response team?

                  _________      Yes
                  _________      No




                                                                        57
6.   Human Resources           15%


     2%   6.1    Does the hospital conduct training of personnel for emergency
          preparedness?
                        __________ Yes
                        __________ No

     3%   6.2   How many have attended the BLS conducted by the hospital?
                      __________ Total no. of hospital personnel trained
                      __________ Total no. of hospital personnel. (Personnel
                            Dept)

     2%   6.3    Who is conducting the BLS training program?
                        __________ Hospital
                        __________ Red Cross
                        __________ Joint (Red Cross & Hospital)
                        __________ others, pls. specify ________

     2%   6.4   Is there any available training manual for BLS.?
                         __________ Yes
                                         If yes, show us a copy.
                         __________ No

     2%   6.5    How many of the ER staff have undergone ACLS training?
                      __________ Total no. of E.R. staff who have ACLS
                              training
                      __________ Total no. of E.R. staff ( E.R. Head Nurse )

     2%   6.6    Has the STOP DEATH Coordinator/Asst. Coordinator attended
          the Disaster Preparedness Management Course?
                         _________      Yes
                                If yes check if he has attended the following
                                _________       module I
                                _________       module II
                                _________       both module I & II
                          _________      No

     2%   6.6    What are the available training materials?
                       _________1. Megacode
                       _________2. BLS training mannequin
                       _________3. Others, pls. specify



                                                                                 58
    7.   Community Involvement               10%


   3%   7.1   Is there vulnerability assessment done at the community level?

                      ___________ Yes
                                  If yes, show documentation.
                      ___________ No

    3%   7.2   Are you involved in the community?

                      ___________ Yes
                                      If yes, show documentation (pictures, memo)
                      ___________ No

    3%   7.3   Do you have a directory of local officials.

                      ___________ Yes
                                  If yes, show documentation.
                      ___________ No




                                                                                    59
8.   Advocacy Activities          10%


2%   8.1    Are there means to create public awareness of the disaster plan of
     the hospital?

                   ________1.     Yes
                   ________2.     No

2%   8.2    What are these measures?

                   ___________    Posters
                   ___________    Hanging signs
                   ___________    Sign boards
                   ___________    Signages
                   ___________    Others, pls. specify _______________

2%   8.3    What methods are used to disseminate information to the public?

                   ___________    Local press
                   ___________    IEC material
                   ___________    Public meetings
                   ___________    Others, pls. specify _______________

2%   8.4    Are there networking activities done?

                   _________      Yes
                                  If yes, what kind of activities and show
                                  documentation..
                   _________      No

2%   8.5   What are the agencies you have networked with?(Show
     documentation)

                   __________     Other Hospitals
                   __________     Local Government
                   __________     NGO's
                   __________     Others, pls. specify




                                                                             60
9.    Fire Safety

9.1   Does the hospital have an evacuation plan in case of fire?
             __________ Yes
                           If yes, provide a copy
             __________ No

9.2   Are there fire drills, simulation exercises conducted in the
      hospital?
             __________ Yes
                              If yes, show documentation
                              (eg. Pictures, Certificate from Bureau of Fire)
             __________ No.

9.3   Does the Hospital have an established fire brigade?
             __________ Yes
                          If yes, show organizational chart.
             __________ No

9.4   Does the hospital have adequate fire escapes?
             __________ Yes
             __________ No
                           If no, cite reason. __________________


9.5   Are the fire escapes easily accessible?
             __________ Yes
             __________ No
                            If no, cite reason. __________________


9.6   Does the fire escapes have emergency lights?
`            __________ Yes
             __________ No
                            If no, cite reason. __________________

9.6   Does the hospital have emergency lights?
             __________ Yes
                           If yes, is it functional.
                                     __________ Yes
                                     __________ No
             __________ No




                                                                          61
               9.7    Does the hospital have a fire alarm?
                             __________ Yes
                                           If yes, is it functional.
                                                     __________ Yes
                                                     __________ No
                             __________ No

               9.8    Does the hospital have a smoke detector?
                             __________ Yes
                             __________ No

               9.9    Are the signages easily seen?
                             __________ Yes
                             __________ No

               9.10   Does the hospital have a sprinkler system?
                             __________ Yes
                             __________ No

               9.11   Are fire extinguishers provided in every station?
                             __________ Yes
                             __________ No

               9.12   Are there fire hoses in the Hospital?
                             __________ Yes
                             __________ No


( Director )   9.12   Provide plan of the hospital showing location of fire escape, fire
                      extinguishers, fire hoses.


               9.13   Provide a copy of fire inspection result given by the Bureau of Fire
                      Protection.




                                                                                       62
(Coordinator) 10.    Research Activities Related to Disaster Preparedness Program
+ 5%


              10.1     Are there research activities being conducted in relation to
                     STOP DEATH Program?
                           __________ Yes
                                          If yes, show / furnish copy.
                           __________ No


              11.    Exit Interview with the STOP DEATH Coordinator
                     10%
                     (STOP DEATH Central Office will be the one to rate)


              11.1    Submission of Utilization Report

              11.2    Submission of Accomplishment Report

              11.3    Attendance in Meetings

              11.4    Problems encountered


              12.    Exit Interview with the Hospital Director


              12.1    Emphasize the objective that the purpose of the assessment is only
                      a survey of the STOP DEATH Program.

              12.2    Recapitulate the criteria’s of the of the assessment tool.

              12.3    Summary of the findings.

              12.4    A copy of the report will be furnished to the director.

              12.5    Ask the Director a feedback / perception to the STOP DEATH
                      Program.




                                                                                      63
                                                                                                                                                Appendix 3
             STOP D.E.A.T.H. PROGRAM                                                            MISSION-INCIDENT REPORT
National Health and Emergency Services Network                                                  SUMMARY REPORT-COVER PAGE
Department of Health, Republic of the Philippines
OSEC, Bldg 1, DOH San Lazaro Cmpd., Sta. Cruz, Manila                                           Classification:
Tel. No. 711-6075, 743-8401 loc. 1105, 1106, 1111, 1113                                         File Code      :
Telefax 711-6050, 743-8301 loc. 1109, 1110

 Submitted to:                                                                                                         Routing/Copy furnished

                          (Name)                                           (Position)                                     (Office/Unit)

 Submitted by:

                 (Name and Signature)                                      (Position)                                         (Date)

 Title of mission/assignment/incident :                                                                            Inclusive dates/time of mission/incident




 Indicate name and location of mission/assignments/incident, etc                                                                       (From)         (To)

 Other co-participants in the mission/assignment :




 (Name(s)/Office

 Objective(s) of mission/assignment :




 Enumerate the specific tasks which had to be accomplished.

 Brief summary:




 Cite clearly the outcome of the mission/assignment. Include important and useful statistics.

 Recommendation(s)/Action to be taken:




 Enumerate the specific tasks which had to be accomplished.


 Note:
 This summary report shall be prepared and submitted to the DOH-Operation Center/HEMS Office not later than 48 hours or two (2) days
 after completion of a specific mission or assignment. A copy of this form will serve as Report Cover Page if a detailed report is prepared
 subsequently. This serves as the standard mission/incident report form of the STOP DEATH Program.
 Revised: November 17, 2000



                                                                                                                                                              63
                                                                                            Appendix 4

Medical Care Survey Form
        The purpose of this survey is to solicit information on health care centers at the
national level and the availability of their human and material resources, in order to organize
plans and programs for medical care in the event of public disasters. It is important to obtain
detailed information in order to create a regionally-organized file of resources that makes
possible the quick deployment of those resources to meet requirements in the country’s
various regions.

                                  Medical Care Survey Form

1. General Data
   1.1 Name of Medical care center

   1.2 Address

   1.3 Telephone (s)

   1.4 If the center has radio equipment:

        i) Call letters

        ii) Operating frequency

   1.5 Area served (geographic)

   1.6 Comments:



        i) Type of center:
            Hospital
            Health center
            Dispensary
            Health unit
            Clinic
            Service module




                                                                                            64
2. Environment Structures
   2.1 Hospital capacity
                               Indicate the total available number of:
        i)    Beds:
       ii)    Intensive therapy beds:
      iii)   Infectious-case beds:
      iv)    Beds for burn victims:
       v)    Intermediate therapy beds
      vi)    Specialty beds (specify):

                      Specialty                                          Number
a.
b.
c.
d.
e

      vii) Operating rooms:
     viii) Morgue:
       ix) Others (specify):

                        Name                                             Number
a.
b.
c.
d.
e
f




                                                                                  65
Describe the characteristic of convertible areas and spaces that might be utilized to increase
hospital capacity in the event of an emergency or disaster. Specify the size (in square meters)
of each area or space, the services available in it (water, light, telephone, others), and provide
any other information that may be useful for assessing the suitability of each for medical care
in the event of an emergency or disaster.

Area 1
Surface area                                           m2
Water                                    Yes      No
Light                                    Yes      No
Telephone                                Yes      No

Area 2
Surface area                                           m2
Water                                    Yes      No
Light                                    Yes      No
Telephone                                Yes      No

Area 3
Surface area                                           m2
Water                                    Yes      No
Light                                    Yes      No
Telephone                                Yes      No

Area 4
Surface area                                           m2
Water                                    Yes      No
Light                                    Yes      No
Telephone                                Yes      No

Area 5
Surface area                                           m2
Water                                    Yes      No
Light                                    Yes      No
Telephone                                Yes      No

Area 6
Surface area                                           m2
Water                                    Yes      No
Light                                    Yes      No
Telephone                                Yes      No




                                                                                              66
  2.1 Autonomy
      The following information will make it possible to determine the length of time over
which the facilities can continue to be operated autonomously in the event of a disruption of
basic services or a supply crisis.

                   i) Plant
                              List of building making up the hospital’s plant
                                       (including maintenance areas)

Building          Number of      Number of en-    Year of con-   Type of con-       Number of beds    Medical services
(Name/Identifi-   floors         trances/exits    struction      struction          in the building   in the building
cation No.)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.


Others (attach additional sheet (s)
        Does the hospital have extensive and unobstructed grounds nearby where field
hospitals and/ or emergency services can be located? Include parking areas, green areas, and
others. For each area include dimensions in meters.

1. Area                                Location                                 Surface area                     m2
2. Area                                Location                                 Surface area                     m2
3. Area                                Location                                 Surface area                     m2
4. Area                                Location                                 Surface area                     m2

                   ii) Electricity
                       If the facility has a power generator, include:

                         a. Type of plant:
                         b. Capacity (kw):
                         c. Fuel used:
                         d. Fuel storage capacity:
                         e. Autonomy:




                                                                                                                  67
f. Indicate whether the feeding of the plants by the electric company is
   by means of an independent circuit or a circuit serving various users:

                Independent                      Various users

g. Indicate the supply voltage (number of volts):
h. Identify the power substation supplying the hospital and give its
   location:
i. Indicate the electric company’s three substations which are closest to
   the hospital and may be usable as sources of supply by direct special
   line in the event of an emergency.

     1)    Substation                       Address
     2)    Substation                       Address
     3)    Substation                       Address

j. Average daily use of electricity in 24 hours                       Kv/24.
k.   Is the hospital’s physical structure such that certain areas can be
     supplied with electricity independently?
     Yes                                 No

l.   If yes, explain whether the normal power system has special feeder
     circuits for:
     Feeder circuits for:                          Yes         No
     Emergency units                               Yes         No
     Operating rooms                               Yes         No
     Intensive care units                          Yes         No
     Laboratory                                    Yes         No
     Sterilization center                          Yes         No
     X-rays                                        Yes         No
     Elevators                                     Yes         No
     Kitchen (cold storage rooms)                  Yes         No
     Water pumping systems                         Yes         No

m.   Is there any emergency lighting system (batteries or stationary
     lights, etc.?

     1)    Area             Type of lighting                 No.
     2)    Area             Type of lighting                 No.
     3)    Area             Type of lighting                 No.
     4)    Area             Type of lighting                 No.
     5)    Area             Type of lighting                 No.




                                                                         68
iii) Water supply
      a.   Source:
      b.   Capacity of tanks:                                  liters
      c.                       Cubic meters.
      d.   Reserves estimated for                              hours.
      e.   Hospital’s monthly water use:                       m3
      f.   Diameter of supply pipe(s):
           1)
           2)
           3)

    g.    Does the hospital have a water pumping system?
                      Yes                   No

    h.    If yes, indicate:
          Number of pumps                   Capacity of each



    i.    What would be the way of supplying water to the hospital in an
          emergency?

iv) Sewage
     Type of disposal:


v) Food
     a.   Freezers and refrigerators
          Indicate the characteristics and capacity (cubic feet or cubic meters
          of each:




    b.    Reserve supply of food estimated to last:
           Nonperishable food:                                     days.
           Perishable food:                                days.

vi) Drugs
     Reserve supply of drugs estimated to last:                days.




                                                                             69
3. Technical Resources
   Indicate the characteristics, quantity, and capacity of available technical resources.
   3.1 Surgical instruments
        Indicate specialty, characteristics, and quantity of available surgical instruments:
              i) General surgery boxes
             ii) Trauma boxes
           iii) Neurosurgery boxes
            iv) Laparatomy boxes
             v) Thoracotomy boxes
            vi) Boxes for
           vii) Boxes for
          viii) Boxes for
            ix) Boxes for
             x) Boxes for

   3.2     Sterilization systems
           Indicate with respect to each system:
           i) Type:
          ii) Capacity:
         iii) Energy sources:
               a.
               Type:
               Capacity:
               Energy sources:
               b.
               Type:
               Capacity:
               Energy sources:
         iv) Total number of sterilization systems:
          v) Total capacity:

   3.3    X-ray equipment
          Indicate with respect to each set of x-ray equipment:
             Stationary                                   Portable

   Type
   Characteristics:




                                                                                               70
  Total number of sets of x-ray equipments:
          Stationary                                  Portable


  3.4  Other equipment
       Indicate with respect to any other available equipments:
  Name:
  Type:
  Characteristics:


  Name:
  Type:
  Characteristics:


  Name:
  Type:
  Characteristics:



  3.5   Blood bank
        If the facility has a blood bank, indicate:
           i) Capacity:                                  liters
          ii) Average reserve:                           liters
         iii) Number of associated donors:


4. Human Resources
   4.1 Physicians
              Specialty:                                 Number:




                                                                   71
               Specialty:                          Number:




   4.2 Nonmedical personnel
             Specialty:                            Number:
          Dentists ………………………..
          Bioanalysts ……………………
          Psychologists ………………….
          Sociologists ……………………
          Anthropologists ………………..
          Social workers     ………………..
          Nursing professionals ………….
          Medical technicians ……………
          Social auxiliaries ……………...
          Nursing auxiliaries ……………




   4.3 Employees and workers
          i) Number of employees
         ii) Number of workers


5. Transportation and Mobilization
   5.1 Number of ambulances:
   5.2 Other transportations vehicles (specify):
        Type:
        Characteristics:




                                                             72
     Type:
     Characteristics:

     Type:
     Characteristics:


5.3 Access and transportation facilities:
       i) If there is a heliport near the facility, indicate:
           a.    Geographic location:

             b.    Distance between the heliport and the facility:

        ii) If there is an airport or landing strip near the facility, indicate:
            a.    Geographic location:

             b.    Characteristics:

       iii) If there is a port near the facility, indicate:
            a.    Geographic location:

             b.    Distance between the port and the facility:

             c.    Characteristics:




        iv) Indicate the name and best means of access to the facility:




                                                                                   73
6. Emergency Plans
    6.1 If there is an emergency plan, indicate the following (attach a copy of the plan):
      i) Has the plan been put into practice?
          Yes                  Dates:

          No
      ii) Have emergency or disaster simulation exercises been carried out?
          Once                Dates:
          Several times (how many?)
          Periodically (how often?)

          Never

     iii) If simulation exercises have been held, what have been the results?




                                                                                             74
                                                                                           Appendix 5


List of Drugs and Equipment for Major Disasters
1.              Antibiotic, different types of antibiotics to cover and treat infections already
    established and infections expected in nonoptimal treatments of this type.
2.              Oral, intramuscular, and intravascular analgesics.
3.              Gauze, elastic, and plaster bandages.
4.              Ferrules for immobilization, traction equipment.
5.              X-ray plates of different sizes, as well as reagents for mass development of
    plates
6.              Rubber or vinyl disposable gloves, preferably sterile, for the operating room
    and handling of patients.
7.              Vesical catheters, Foley-type No.s 10 to 18.
8.              Probes for nasogastric suction, different calibers.
9.              Catheters or tubes for thoracic drainage, with equipment and flasks (water-seal
    type).
10.             Sterile, and preferably disposable, operating room robes, sheet, boots, caps,
    and masks: these are among the most important supplies, since in a state of emergency
    there may be obstacles to washing and sterilizing clothes. Disposable equipment thus
    provides an acceptable solution to hospital requirements for a certain period of time.
11.             Intravenous solutions and equipment for administering them, preferably in
    plastic bottles and syringes. The hospital should make local arrangements for the shipment
    of crystalloid solutions and equipment for administering them. It is important that national
    inventories be exhausted before international aid is received.
12.             Orthopedic material such as plates, pins, screws, and ferrules for managing and
    treating fractures.
13.             Antiseptic solutions (iodized, with hexachlorophene).
14.             Creams or pomades (Vaseline, furacin, etc.)

       As will have been noted, no mention is made of a priority need for the shipment of
blood, plasma, or vaccines; these items should be sent only on specific request.




                                                                                             75
                                                                                               Appendix 6

Design Consideration for disaster-prone Hospitals
Introduction

        The types of disasters that may occur during the useful life of the hospital are
earthquakes, fires, floods, and explosions. The frequency and intensity of these phenomena
will differ according to the building’s location. Owing to the highly important function
performed by hospitals times of disasters, the safely provisions for the protection of human
lives and equipment are the same regardless of the types of disaster.
        Minimum requirements to be met by all hospitals are discussed below.

Structure

         The structure should be designed in accordance with the national antiseismic
regulations. In the absence of national regulations, the use of the Uniform Building Code
(U.B.C.) of California (USA), is recommended.
         It will be necessary to calculate the seismic risk over the useful life of the building,
using attenuation coefficients appropriate to the place. The structure will be designed for the
highest-intensity earthquake expected during that period.
         The construction materials used should be reinforced concrete or steel, depending on
the availability and cost of each. In all cases, the parts of the structure should be reinforced to
attain a 180-minute resistance to fire (RFA 180). The inner walls and partitions should be
RFA 120.
         Stairwells should be located so as not to produce a torque effect on the structure when
it is subjected to horizontal forces.
         The structure of the stairways should have the same resistance to fire specified for the
structure of the building.

Location within the property

       The main façade of all building should face a public thoroughfare and another façade
should face a private street or inner court at least 10 m 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 compartments
protected with fireproof walls. In buildings four or more stories high, bedroom areas escapes
routes should be compartmentalized.

Escapes routes

      All door should open in the direction of traffic exiting through an escape route.
Automatically closing doors with “antipanic” locks should be installed in places designed to
accommodate 50 or more people. Hospital and infirmary exits should be at least 1.20 m wide.
      Ward of 15 or more persons should have at least two exits, one at each end.


                                                                                               76
        Ward exits should open directly onto hallways.
        Hallways should be at least 1.5 m wide. A hallway along which beds or stretchers are
moved should be at least 2.40 m 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 door opening onto an escape route should be at least 1.10 m wide.

Signs

        The following signs should be put in place: a) signs indicating the escape routes; b)
signs indicating equipment; and c) building layout diagrams. “Exit” signs should be placed at
all emergency exit doors providing access routes and stairways. These sign should be placed
over the door at a height 2.25 m above the floor.

        All signs should be lit as long as the building is occupied.
        All buildings should contain diagrams showing the location of the various types of
alarm and firefighting equipment. Such diagrams should be placed on each floor of the
building in places where they are visible to personnel in the building.
        All firefighting equipment that can be used by the staff should have precise
instructions beside the equipment itself.
        A diagram showing a person’s location in relation to escapes routes should be installed
in each area.

Fire detection, alarm, and control equipment

       Ionic-type, linear-operation fire detection equipment should be installed at the rate of
one detector for every 50 m2 of floor space. The building should have an alarm center,
preferably in the basement.
       The building should be equipped with ABC type portable extinguisher for every 200
m2 of floor space and at least one per floor. An extinguisher should never be more than 20 m
away.

Services

        Water supply

       The fire extinguishing system should consist of a tank with a capacity of at least 30 m2
, a pumping system capable of providing a pressure of 75 lbs./inch2 , and iron piping. The
system’s distribution line should have a built-in automatic extinguisher system with automatic
sprinklers. There should be one sprinkler for every 15 m2 of floor space.

        Drains

        The drainage system should be of the separator type; if there is no connection to the
public sewer system, a septic tank or seepage pit should be provided.




                                                                                            77
       Contaminants and/or radioactive materials

       If it is necessary to dispose of this type of material 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 m thick.

       Drills

       Simulation exercise for any type of disaster should be conducted at least once a year.
       Each member of the hospital should be assigned a specific function to facilitate
evacuation of the building.




                                                                                          78
                                                                                             Appendix 7


Energy and Communications
Electric energy

        The following points should be checked with respect to the hospital’s electrical
installations.

     1)         That plans of the installation are available and up-to-date.
     2)         Is the switchover to the emergency power plant automatic or manual?
     3)         If automatic, check to see that it is operating normally; if it is not, determine
          the procedure to be followed to transfer the load.
     4)         If the switchover is normal, step-by-step instructions for transferring the load
          should be available in an accessible place.
     5)         How long are the emergency plant’s fuel reserves designed to last?
     6)         Check the equipment once a month.
     7)         Keep the fuel tank full.
     8)         Identify the equipment and installations that operate with the emergency plant.

         If the hospital does not have an emergency plant, a generator with at least 40 percent
of the transformer capacity of the hospital substation should be requested. In so doing, it is
important to know the cycles (60 or 50 Hz) of the generator required, the type of connection
to the distribution line (delta or star), and the voltage of the hospital’s system. The following
steps should be taken:

     1)           Determine where the generator will be placed and how it will be connected.
        Bear in mind noise and contamination problems.
     2)           Determine the fuel consumption of the generator to be installed, per-24
        hour period.
     3)           Determine how fuel is to be supplied to the generator to keep it in
        operation.
     4)           Have a diagram showing the distribution boxes that must be disconnected
        in order for the generator to function correctly.

       It is imperative to know the source of electric supply for the x-ray equipment:

       a)          if it is connected to the main distribution box, it may be fed by either the
          hospital’s emergency plant, if one exists, or by the generator furnished for the
          emergency;
       b)          if the x-ray equipment has its own feeder system, it will be necessary to
          install a generator solely for that equipment; its capacity should be that of the x-ray
          equipment; its capacity should be that of the x-ray equipment. Steps 1, 2, and 3
          above should be considered.




                                                                                               79
        If should be ascertained whether there is a special system to provide emergency
service in operating rooms and intensive care units. This system makes it possible to provide
an uninterrupted energy supply to those areas. It should be noted that the emergency system is
an alternative to those describe above and refers to a direct current system.

        It is necessary to check the batteries (charge and acid) at least once a week. It is also
important to know exactly how long the batteries will continue to hold the charge with all the
equipment in operation and ascertain the source of power for charging the batteries in the
event of failure of the power distribution network. Finally, it is important to know the hospital
substation’s transformer capacity.

Communication service

       The hospital’s communications diagram should be available and updated. The
following should be taken into account for this purpose:

     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:
            a. whether it will be fed by the hospital’s emergency plant (the hospital’s own
                generator or a borrowed one); or
            b. whether it will be fed by a generator operating exclusively for hospital
                communications;
            c. determine the size of the generator in relation to the communications system’s
                load, cycles (50 or 60 Hz), type of connection, and feeder voltage of the
                communication network;
            d. know where the generator will be placed and how it will be connected;
            e. determine the generator’s consumption of fuel in a 24-hour period and the type
                of fuel it uses.
     3)    Locate and identify all of the hospital’s secondary telephone lines.
     4)    Locate all the loudspeakers of the hospital’s public address system.
     5)    Check the operation of the telephone switchboard and the public address system, if
          any. Preferably, there should be a switchboard for the reserves loudspeakers and the
          use of the switchboards should be alternated.
     6)    Check the operation of the blinker paging system or any hospital communication
          equipment at least once every two weeks.
     7)    Have in mind place for locating and feeding a set of equipment for communication
          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)    It is further recommended that some battery-operated portable speakers be kept on
          hand for emergencies.




                                                                                             80
Bibliography



        City of Charlottesville, VA Fire Department, Standard Operating Procedures.
http://www.cstone.net/firedept/book3.htm.

       Disaster Management, A Disaster Manager’s Handbook, W. Nick Carter, A
publication of the Asian Development Bank, 1991.

       Emergency Medical Services System. Module 5,.Pesigan, A., et al.

      Emergency Preparedness, A Guidebook on Health Emergency Management. STOP
D.E.A.T.H., Department of Health, Manila, Philippines.


       Health Services Organization in the Event of Disaster. Pan American Health
Organization, U.S.A., 1983.

        Hospital Emergency Incident Command System., A Project of San Mateo County
Department of Health Services Emergency Medical Services Agency. Volume 1 and 2
http://www.emsa.ca.gov/heics3.htm. 3rd ed. June, 1998.

       National Hospital Disaster Plan (Draft),, Prepared under the direction of Dr. Antonio
O. Periquet, with the participation of Dr. Antonio Limson, Dr. Margarita Galon, Dr. Romeo
Cruz, Dr. Teddy Recto, Dr. Primo Brillantes, Dr. Linda Milan, and Ms. Elynn N. Gorra,
August 11, 1992.

      Protocols for Assessment of the Capacity of Health Facilities in the Western Pacific
Region in Responding to Emergencies, World Health Organization, Regional Office for the
Western Pacific, November, 1998.




                                                                                         81
DEPARTMENT OF HEALTH – DIRECTORY OF METRO MANILA HOSPITALS
 Lung Center of the Philippines DR. FERNANDO MELENDRES       DR. DAVID GEOLLEGUE
 Quezon Blvd, Quezon CIty       T – 925 2021, 925 2020       T – 926 9763 / 924 6101 loc. 803
                                F – 925 2021                 ® - 931 2620
                                    924 0707                 P – 150 - 302636
                                                             Cell: 0919-3645662
National Kidney & Transplant    DR. ENRIQUE ONA              DR. ROSEMARIE LIQUETE
Institute                       T – 924 01 35                T – 923 0137, 924 3601 to 19 loc 246
East Avenue, Quezon CIty            922 1038                 ® 645 7481, 645 4011
                                F – 922 5608                 P – 634 3333 # 891754
                                    924 0701                 MS. MA. BELINDA EVANGELISTA
                                                             T – 926 8967, 924 3601 to 19 loc 432/
                                                                    325/ 245 / 418
                                                             P– 151-8408534, 141-131862
                                                             C : 0917-7734767 / 0917-9514096 /
                                                                  0918-8953822
Philippine Children’s Medical   DR. LILIAN V. LEE            MS. LEILANI A. ARQUERO
Center                          T – 924 0836                 T – 924 0870 / 924 6601 to 25 loc. 252 /
Quezon Blvd, Quezon CIty        F- 924 0840                  237 / 262 / 212
                                Email: lylee@WebQuest.Com    F - 926 - 9012
                                                             ® - 7131642
                                                             C - 0918-892 7686
Philippine Heart Center         DR. LUDGERIO D. TORRES       DR. ADRIANO DELA PAZ
East Avenue, Quezon City        T – 922 0551                 T- 923 1301 loc. 3203 Fax- 922 1890
                                F – 922 0551                 ® 646 1913, 922 1890
                                                             DR. JOSETTE VILLANUEVA
                                                             T - 922 1810 (med. services)




                                                                                          82
Dr. Jose Fabella Memorial Hospital    DR. RICARDO GONZALES                 DR. ROMEO BITUIN
Lope de Vega St., Sta. Cruz, Manila   T – 735 7146                         T – 734 5561 to 65 / 314 6357
                                      F – 735 7146, 735 7144               F - 735 7146
                                                                           Beeper 141-228391
                                                                           ® 726 0455
                                                                           DR. ANTOINETTE PACAPAC
                                                                           T- 314-6357
National Center for Mental Health     DR. BERNARDINO VICENTE               DR. ROMEO IMBUIDO
Nueve de Pebrero, Mandaluyong City    T – 531 8578, 533 6054               T – 531 9001 loc. 351
                                          531 9001, 533 4893               ® 531 9001 loc. 402 / 533 4759
                                      F – 531 8682                         Cell- 0918-8841655
                                      ® – 531 0513, 532 8275               DR. ROMEO SABADO
                                      Beeper 1441-120141                   T- 531-8682
                                                                           Beeper 1441-130613
National Children’s Hospital          DR. MA. ISABELITA GOZON              DR. EPIFANIA SIMBUL
E. Rodriguez, Quezon City             T – 725 4533                         T – 724 0656 to 59 / 749 9276
                                      F – 721 9125                         F – 721 9139
                                                                           Beeper 125-7016316
                                                                           ® 731 3456
                                                                           DR. MYRNA T. VALENCIA
                                                                           T – 724 0656 to 59
                                                                           Beeper 141-230114
                                                                           F – 721 9139
                                                                           ® 939 9779 / 930 2546
                                                                           MR. EDWIN ROJAS
                                                                           Cell - 0918-8271859
                                                                           Beeper 1277-14522
Philippine Orthopedic Center          DR. JESUS DUEÑAS                     DR. EDWARD A. SARROSA
Banawe, Quezon City                   T – 742 5651 / 712 4746 / 712 6871   T – 711 4276 to 80 loc 254 Fax- 435 8887
                                          732 0464                         Beeper 1441-127960
                                      F – 712 4746                         Cell: 0918-5340349
                                                                           Email: edward@planet.net.ph




                                                                                                        83
Research Institute for Tropical        DR. REMIGIO OLVEDA            DR. NOEL MACALALAD
Medicine                               T – 809 7599                  T – 807 2628 to 32 / 842 2079 / 850 7830
Alabang, Muntinlupa                    F – 842 2245                  F – 842 2245 / 837 4721
                                       Email: ritm@doh.gov.ph        ® 837 1814
                                                                     Beeper 141-075725
                                                                     C– 0917-5246223
San Lazaro Hospital                    DR. BENITO ARCA               DR. MIGUEL MONTES LA’O
Quiricada St., Sta. Cruz, Manila       T – 711 6979 / 309 9543       T - 732 3776 (information)
                                       F – 711 6979                  Beeper 141-616523
                                           711 6966 (admin office)   Cell: 0918-8952038
                                                                     Info - 309 9539 ER- 3099541
                                                                     ® 364 1287 / 252 3004
                                                                     DR. GREGORIO KABIGTING
                                                                     T - 874 9869
                                                                     Cell: 0917-4006267
                                                                     Pager: 634333 ID # 227984
Amang        Rodriguez       Memorial DR. RUBEN FLORES               DR. ROMMEL T. MENGUITO
Medical Center                        T – 941 6289/ 941 3441         T – 942 0245 / 942 0055 / 941 8231 /
Marikina City                         F – 941 6854 / 941 3441            934 5519
                                      Beeper 141-106478              Beeper 1441-145750
                                                                     ® 642 5095
Dr. Jose R. Reyes Memorial Medical DR. ALICIA M. LIM                 DR. ARTHUR V. PLATON
Center                             T – 781 7052                      T – 740 3785, 711 9491
Rizal Avenue, Sta. Cruz, Manila    F – 732 1077                      Beeper 125-1001855
                                                                     ® 419 9284
                                                                     DR. ENRICO DE JESUS
                                                                     Beeper 1277-95783
                                                                     DR. JERRY DOMINGO
                                                                     Beeper 141-239490




                                                                                                   84
East Avenue Medical Center        DR. ORLANDO P. PUA                 DR. POTENCIANO MALVAR
East Avenue, Quezon City          T – 927 9900 / 926 9740            T- 921-6480
                                      928 0611                       DR. INOCENCIO OBALLO, JR.
                                  F – 426 4405/ 926 9740/ 924 7685   T – 924 8999 / 928 0611
                                                                     F – 921 6480
                                                                     C- 0918-8556923 / 0918-867788/ 0919-
                                                                     6035144
                                                                     ® 642 6470

Quirino Memorial Medical Center   DR. DOMINGO DE GUZMAN              DR. ROBERTO DALMACION
Project 4, Quezon City            T – 913 4758                       T – 437 3662 / 438-4421
                                  F – 913 4758                       Beeper 125-1172612
                                                                     C- 0912-3152330 / 0918-9121169
                                                                         0918-8729115
                                                                     ® 921 5343 / 927 5486
                                                                     DR. JOSE ALBERT CAPUNO
                                                                     T- 913-4759
                                                                     Beeper 125-8001377
                                                                     Cell (0912) 313-0454
Rizal Medical Center              DR. ROMEO CRUZ                     DR. MANUEL A. OLIVEROS
Shaw Blvd., pasig City            T – 671 4216 / 671 9740 to 43      T – 671 9740/ 6710424
                                      645 4592 / 650 1758            Beeper 1277-64508
                                  F – 671 4216                       ® 650 2318
                                  C – 0918-8475012                   C – 0917-9049568
Tondo Medical Center              DR. VICTOR J. DELA CRUZ            DR. ARNEL Z. RIVERA
Balot, Tondo, Manila              T – 252 8661                       T – 251 8419 to 23/ 252 8661/ 251 8422-23
                                  F – 252 8661                       ® 362 3408, 362 3393
                                                                     C – 0919-3214433 / 0918-5314626




                                                                                                  85
Las Piñas District Hospital    DR. ROLAND CORTEZ                   DR. RODRIGO H. HAO
Las Piñas, Metro Manila        T – 874 6872 to 73 / 872 1891       T – 873 1887 / 873 1891
                               F - 874 6873                        Beeper 125-1002244
                               Beeper 125-1025003                  ® 801 4916
                               C – 0919-3173608
                               ® 931 3562
Valenzuela District Hospital   DR. WINSTON GO                      MS. AIDA CUADRA
Polo, Valenzuela               T – 874 6872 / 440 5534/ 292 2985   Cell- 0919-5564463
                               F – 440 5534 / 293 2936             T - 294 6711 to 18 loc. 105
                               TL - 294 6711 to 18
                               Beeper: 141- 926730
                               Cell: 0919-3516893




                                                                                                 86
REGIONAL FIELD HEALTH OFFICES AND REGIONAL HOSPITALS
RHO-I                            DR. JOVENCIO ORDOÑA                    MS. MICHELLE F. DUMBRIQUE
San Fernando, La Union           T – (072) 8884326                      T – (072) 413 395
                                           412 190                               888 3395
                                           413 478                      Trng.-    413 478
                                 F - (072) 413 395                      RD -      414 326
                                          242 4774                      TSD -     242 4773
                                 Cell: 0917-5640559                     RESU- 242 4592
                                 Email: dohlu@net.com.ph                ® -       242 2346
                                        dohrfo1@lu.csi.com.ph
Mariano Marcos Memorial Hospital DR. REUBEN SALVADOR                    DR. JESUS B. TOMAS
Batac, Ilocos Norte              T – (O77) 792 3133 TO 44               T – (077) 792 3144
                                 F-        792 3133                     F-        792 3133
                                                                        ® (077) 776 0261
                                                                                 771 4178
                                                                        DR. WENDELL Q. CALDERON
                                                                        T – (077) 792 3144
                                                                        F - (077) 792 3133
                                                                        ® - (077) 792 3062
Ilocos Training Regional Medical Center   DR. JUANITO RUBIO             DR. GUALBERTO T. BASCO
San Fernando, La Union                    T – (072) 242 5543 / 415057   F – (072) 541 2399
                                                    242 1143            ®-       700 2272
                                                    242 3915            Beeper 125-9012658
                                                    415864              JOSEPH ABAT
                                                    412399              Cell – 0918-8655099
                                          F – (072) 412 399
                                                    888 2399
                                          Email: irh@lu.csi.com.ph




                                                                                               87
Region I Medical Center            DR. GIL DEL ROSARIO          DR. DOMINADOR MANZANO
Dagupan City                       T – (075) 523 4103           T – (075) 522 0041
                                                                          502 3608
                                                                          522 0040
                                                                F - (075) 523 3867
                                                                ® - (075) 522 0702
                                                                          523 3857
                                                                          515 4925
RHO-II                             DR. MERCEDITAS CAVANEYRO     DR. CIRILO M. PINTUCAN
Carig, Tuguegarao, Cagayan         T – (078) 844 1748           T - (078) 844 5178
                                            846 7230                      844 5341(RESU)
                                   F - (078) 844 4368           F –(078) 844 7230
                                             844 1748           ® - (078) 844 3992
                                             846 7230                     846 7637
                                   Email: dohreg2@scan.com.ph             844 3795
                                                                Cell- 0912-2442805
Cagayan Valley Regional Hospital   DR. MANUEL ACLUBA            DR. JAIME BALUBAL
Tuguegarao, Cagayan                T – (078) 844 3789           T – (078) 844 3789
                                   F-       844 3789                      844 1319
                                   ®- (078) 844 1459                      844 1810
                                   Cell- 0912-3927382                     844 1410
                                         0917-9356201                     844 0034
                                                                DR. FONACIER
                                                                T - (078) 844 4115
                                                                            844 5637
Veterans Regional Hospital         DR. CIRILO GALINDEZ          DR. JOSELITO A. GONZALES
Bayumbong, Nueva Vizcaya           T – (078) 321 2090           T- (078) 321 3561 to 64
                                   Cell: 0917-9497153           F-        321 3560
                                                                ® (078)321 2632




                                                                                        88
RHO-III                           DR. ETHELYN NIETO                      DR. NEMESIO V. SANTOS
San Fernando, Pampanga            T – (045) 961 3844 to 45               T – (045) 961 3845, 961 3822
                                           961 3822                               961 3860
                                           961 3802 (Disaster)                    961 3912
                                  F -(045) 961 3580                      F – (045) 961 3580
                                  Email: epndoh@sfp.irnet.net.ph                  961 3802
                                                                         ® -(045) 931 0055
                                                                         Cell – 0918-3907754
Dr. Paulino J. Garcia Memorial    DR. GLORIFINO JUAN JR.                 DR. HUBERTO F. LAPUZ
Research and Medical Center       T – (044) 463 1484                     T – (044) 463 454, 463 8888
Cabanatuan City                            463 1610                                463 1610
                                  F – (044) 463 1607                     F – (044) 463 8286
                                           463 4701                      ® - (044) 463 0037
                                           463 8286                      Cell- 0912-3350669
                                                                               0918-3005603
                                                                         Beeper 125-7003919
Jose B. Lingad Memorial General   DR. VENANCIO BANZON                    DR. ROBERTO AMANSEC
Hospital                          T – (045) 961 3921                     T – (045) 961 3940
San Fernando, Pampanga            F-        961 3921                               963 2114
                                                                                   9614128
                                                                                   963 7390
                                                                         F – (045) 961 3921
RHO – IV                          DR. CONRADO R. GALSIM                  DR. AURORA ENOJADO
Project 4, Quezon City            T – 913 0864 / 913 4704 / 912 9985 /   T – 913-0864/ 913 4654/912-9985
                                      913 4650 / 913 4526 to 30          ® 932 4654
                                  F – 913 4654                           F- 912-9985/913 4704
                                  Email: rho4@doh.gov.ph
                                         rambo@doh.gov.ph




                                                                                                        89
Batangas Regional Hospital           DR. VICENTE GAHOL              DR. ERNESTO REYES
Batangas City                        T – (043) 723 0165             T - (043) 723 2284 (clinic)
                                              980 1733              F-        723 0165
                                              723 3390              ® -(043) 723 1026
                                                                    Beeper 150-609077
                                                                    Cell- 0912-3145985
RHO-V                                DR. GERARDO BAYUGO             DR. EDGARDO SARMIENTO
Legaspi City                         T – (052) 483 0693             T - (052) 483 0372
                                               483 0363             Cell: 0918-50903360
                                     F – (052) 245 5046
                                     Cell: 0918-5090358
                                     Email: doh5@globalink.net.ph



Bicol Regional Training & Teaching DR. JOSE DAEP                    DR. ROY RANDOLF PALANCA
Hospital                           Tel/fax - (052) 483 0636         T – (052) 483 0810
Legaspi City                                                                  483 0015
                                                                              483 0014
                                                                              483 0016
                                                                    F - (052) 551 1234
                                                                             483 0636
                                                                    ® - (052) 483 0143
                                                                    Cell – 0918-2121876

Bicol Medical Center                 DR. EDGARDO ESPLANA            DR. REGINALDO S. PERILLO
Naga City                            T – (054) 811 1463             T – (054) 811 2941
                                     F-        732 261                        811 1163
                                                                    F - (054) 725 041
                                                                               726 167
                                                                    ® - (054) 726 167




                                                                                                  90
RHO – VI                          DR. LYDIA RAMOS             DR. ELIZABETH YLLAGA
Iloilo City                       T – (033) 321 0364          T – (033) 321 0235
                                             327 0367                   321 0364
                                             327 0967                   321 0297
                                             321 0312         F - (033) 321 2158
                                  F – (033) 321 1036          ® - (033) 320 2454
                                             321 0235                   329 5863
                                  Email: arthur@iloilo.net    Beeper (033) 3381561 to 65
                                         dohrfob@easycom.ph      ID# 6011608
                                                              Cell – 0912-8870218 / 0917-9021618




Western Visayas Medical Center    DR. JOSE MARI FERMIN        MS. FREIDA G. SORONGON
Mandurriao, Iloilo City           T – (033) 327 7742          T– (033) 321 2841 to 48 loc. 118
                                           321 1797           F-       321 1797
                                  F – (033) 327 7742          ® -(033) 320 0257
                                                                       5093902
                                                              Beeper 141-321534
                                                                      127-772765
                                                              Cell- 0918-7616275
Corazon      Locsin   Montelibano DR. DOMINGO VEGA            DR. DOMINGO P. VEGA
Memorial Hospital                 Officer In Charge           T – (034) 433 2697
Bacolod City                      T – (034) 433 2697          F-        433 2697
                                                              ® - (034) 432 0680
                                                              Cell – 0912-5107678




                                                                                            91
RHO – VII                            DR. DAVID J. LOZADA JR.              DR. SUSAN MADARIETA
Cebu City                            T – (032) 253 6355 loc. 3970         T - (032) 254 0109
                                     F-        254 0109                   DR. ENRIQUE SANCHO
                                     Cell: 0918-90211251 / 0917-3221934   T- (032) 254-0657/254-0134
                                     Email: dohrho7@cvis.net.ph           Cell- 0917-327-3070
Vicente Sotto     Memorial   Medical DR. EUSEBIO ALQUIZALAS               DR. JOSEPH AL ALESNA
Center                               T - (032) 255-1595                   T - (032) 253 9891 loc. 306 / 254 2612
Cebu City                            F-        253 9882                            255-1592
                                     Email: vsmmc@cvis.net.ph             F - (032)253 9882
                                                                          Email: jalesna@cvis.net.ph
Governor        Celestino    Gallares DR. NENITA PO                       DR. EDGAR O. PIZARRAS
Memorial Hospital                     OIC                                 T – (038) 411 3185 - ER
Tagbilaran City                       T – (038) 411 4831                  F-         411 4831
                                                                          ® (038) 411 3608
                                                                          Cell - 0918-6002756
RHO – VIII                            DR. MILAGROS BACUS                  ATTY. ANNABELLE DE VEYRA, RN
Tacloban City                         T – (053) 323- 5027                 T – (053) 323 5069
                                                                                    323 5297 (RESU)
                                      F – (053) 323 5069                  ® (053) 327 1629
                                      Email: doh@tac.weblinq.com          DR. NICOLAS BAUTISTA JR.
                                            Loa@tac.webling.com           ® - (053) 322 2088

Eastern Visayas Regional Hospital     DR. ADELAIDA ASPERIN                DR. ALDEN TABAO
Tacloban City                         T – (053) 321 3363                  T – (053) 325 8438
                                               321 3129                            321 3129 (tel/fax)
                                      F- (053) 321-8724                            321 3363
                                                                                   321 3133
                                                                          F – (053) 325 6470
                                                                                   325 7103




                                                                                                        92
RHO- IX                         DR. LOURDES LABIANO             DR. MARCOS C. REDOBLE JR.
Zamboanga City                  T – (062) 991 3380/991-1995     T – (062) 991 1995
                                F-        991 3380                        991 1313 (RESU)
                                Email: dohrfo9@jetlink.com.ph   F – (062) 991 3380
                                                                ® - (062) 992 1540
                                                                Cell- 0912-2408102
                                                                DR. RAYMOND MAJINI
                                                                Cell- (062) 0919-4222945
Zamboanga City Medical Center   DR. ROLANDO BUCOY               DR. ALFONSO MONTUNO
Zamboanga City                  T – (062) 991 2934              T – (062) 991 1995/002-0546/991-2934
                                F - (062) 991 0573                         991-3795
                                                                           991-9463 (OPCEN)
                                                                           991 1313 (RHO)
                                                                          991 2934
                                                                F – (062) 991 0573
                                                                          993 0565
                                                                ® - (062) 993 0565
                                                                Beeper: 125-8880368
                                                                DR. GEORGE ROJO
                                                                T - (062) 991 6998
                                                                Beeper: 125-9014543 / 125-9912492
RHO – X                         DR. MARIETTA FUENTES            ENGR. NESTOR O. ABONITALLA
Cagayan de Oro City             T – (088) 858 4627              T – (088) 858 7132
                                         858 4001                         858 7123
                                F – (088) 727 400/233-2306      F - (088) 858 7130
                                Cell: 0919-3578078
                                Email: mcf@hamis@doh10.gov.ph
                                       vmu@hamis.doh10.gov.ph




                                                                                            93
Northern Mindanao Medical Center   DR. JOSE ACAYLAR                 DR. ENRIQUE P. SAAB
Cagayan de Oro City                T – (08822) 726 362              T – (08822) 726 362
                                               723 735              F-          728 829
                                               856 4147             ® (08822) 857 1606
                                   F - (08822) 728 829              Beeper 141-431035 / 125-7007863
                                                                    Cell: 0917-4042987
Mayor Hilarion Ramiro Sr. Regional DR. JOSE VILLANUEVA              MS. MILA P. GAMAYA
Training &Teaching Hospital        T – (088) 521 0022               T – (088) 521 0022
Ozamis City                                  521 0440               ®        521 2745
                                             521 3581               Cell- 0919-6031263
                                    F - (088) 521 0022
RHO – XI                           DR. DOLORES CASTILLO             DR. RENE LOPEZ
Davao City                         T – (082) 227 5903               T – (082) 226 9362 / 227 3976 (Technical)
                                   F - (082) 221 6320                         226 2493 / 227 2463
                                   Email: dohrfo11@dv.webling.com             227 4826
                                                                    F - (082) 221 6320
                                                                              221 6321
                                                                              217 3337
                                                                    ® - (082) 299 2888
                                                                    DR. ROGELIO PEÑERA
                                                                    T- (082) 227-3976
                                                                    Cell (0917) 7015204
Davao Regional Hospital            DR. ROMULO BUSUEGO               DR. SERGIO DALISAY
Tagum, Davao City                  T – (084) 217 3347               T – (084) 211 6900
                                             218 2823                        211 2453 (OPCEN)
                                   Cell - 0912 – 7010747            ® - (084) 217 3573
                                   F - (084) 400 3050               Cell : 0918-4151065,
                                                                           0918-4000994




                                                                                                 94
Davao Medical Center                 DR. GERARDO CUNANAN                    DR. RICARDO AUDAN
Bajada, Davao City                   T – (082) 221 6574                     T – (082) 227 2532
                                     F-       221 7029                                227 2731
                                                                            F - (082) 227 2355
                                                                                      221 7029
                                                                            ® (082)222 7253
                                                                            Beeper 125-6004328
                                                                            Cell – 0918-8075405
RHO – XII                            DR. ROGELIO CHUA                       MR. LEO CHEONG
ORC, Compound, Cotabato City         T – (064) 421 7436                     T - (064) 421 7436 (opcen)
                                               421 2196                                421 4583
                                     F - (064) 421 6531                     F – (064) 421 4726
                                               421 2373                                421 6531
                                     Cell - 0917-4015833                    ®-         421 5148
                                                                            Cell - 0919-3660094
                                                                                   0917-4653701
Cotabato Regional & Medical Center   DR. ARIADNE SILONGAN                   MR. TEOFILAMENA C. TUPAS
Cotabato City                        T – (064) 421 2192                     T - (064) 421 7228
                                              421 7228                               421 2340
                                     Cell - 0918-4010163                    F –(064) 421 2194
                                                                            ®-       421 5262
                                                                            Cell - 0919-4025248
RHO – CAR                            DR. ERIBERTO POLICAR                   DR. JANICE BUGTONG
Baguio City                          T – (074) 442 8097                     T – (074) 442 7591
                                              442 8098                                442 7591
                                              442 3809                      F - (074) 442 7591
                                     F – (074) 443 8342                                444 5255
                                              442 7591                                 444 5255
                                     Email: dohcar9@bgo.cyberspace.com.ph




                                                                                                     95
Luis Hora Memorial Regional     DR. EDGARDO BOLOMPO               DR. EDGARDO BOLOMPO
Hospital                        Cell: 0918-2820278                Cell: 0918-2820278
                                ® - (074) 443 5653                ® - (074) 443 5653
                                                                  DR. NENITA LIZARDO
                                                                  Cell: 0918-2820280
Baguio General Hospital & Medical DR. MANUEL FACTORA              DR. MANUEL QUIRINO
Center                            T – (074)442 3165               T – (074) 443 5678
Baguio City                       F - (074)442 8354                         442 3765
                                           442 8240               F - (074) 442 3165
                                           443 8342                         443 8342
                                                                  ® (074) 442 3787
                                                                            442 3011
                                                                  Beeper 125-7003481
                                                                  Email: quirinostpd@yahoo.com
RHO-CARAGA                      DR. CHARITO AWITEN                DR. BRENDA A. LOPEZ
Pizarro St., Butuan City        T – (085) 342 5208                T – (085) 342 5228
                                F - (085) 225 2970                          343 1384
                                Email: doh13@btnmail.mozcom.com   F - (085) 225 2970
                                DR. BRENDA A . LOPEZ              Cell- 0918-8020301
                                Asst. Reg'l Director
CARAGA Regional Hospital        DR. HILARION DAMIAO               DR. MEDIATRIX G. DELA PAZ
Butuan City                     T – (086) 826 3157                ® - (086) 232 6339
                                         826 2459                 F - (086) 826 2459




                                                                                                 96
RHO – ARMM                        DR. JAINAL JAMAD                  MR. JOSE LINO ESTARIS
Regional Complex, Cotabato City   T – (064) 421 6842                T – (064) 213 988
                                            421 6889                         421 2434
                                            421 4583                Cell: 0917-7260317
                                  F- (064) 421 2373                 MS. JULIE VILLADOLID
                                            421 6842 / 421 4726     T – (064) 421 6889
                                  Cell: 0918-5201066/0917-7260317            425 0218
                                                                    Cell - 0919-3013960 /0918-5201066
NATIONAL CAPITAL REGION FOR DR. ELVIRA DAYRIT                       DR. CLARENCE CONSIGNA
HEALTH                      T- 743-83301 loc. 1652                  T- 743-8301 loc. 1627
                            Email : mbc@doh.gov.ph                  Beeper 145-505322
                                                                    MS. IRMA JAVIER
                                                                    T- 743-8301 loc. 1627
                                                                    Beeper 1441-666855
                                                                    ® 922-3429
                                                                    Cell- 0917-4331355




                                                                                                97

				
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