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Health Emergency and Disaster Con ngency Plan

HEALTH EMERGENCY AND DISASTER

CONTINGENCY PLAN

First Edition

Emergency Medical Services Division Department of Medical Services

Ministry of Health Royal Government of Bhutan

Thimphu


© 2016 Emergency Medical Services Division, Department of Medical Services, Ministry of Health

Cover Design Courtesy: Mr. Tashi Duba, Program Of icer, Department of Public Health

Printed at : TN Printing Press.


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TABLE OF CONTENTS

Foreword................................................................................v

Acknowledgement...............................................................vii

Executive Summary..............................................................ix

Acronyms..............................................................................xi

Chapter 1: Introduction....................................................... 11.1 Background1.2 Disasters and Health Emergencies1.3 Legal Framework1.4 Defi nition of Contingency Plan1.5 Objectives of the Contingency Plan

Chapter 2: Hazards and Health impact...............................62.1 Hazard Profi les2.2 Risk Analysis from hazards

Chapter 3: Preparedness and Responses...........................163.1 Preparedness3.2 Responses3.3 Recovery in Health Emergencies:3.4 Emergency preparedness and response action plan

Chapter 4: Role and Responsibilities...................................624.1 Disaster Management Act 20134.2 Health Emergency Management Committee4.3 Technical Advisory Committee 4.4 Health Rapid Response Team at National level4.5 Rapid Response Team at District Level4.6 Emergency Medical Services Division 4.7 Health Help Center


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4.8 Department of Medical Supply and Health Infrastructure4.9 Department of Public Health4.10 Dzongkhag Health Sector 4.11 Hospitals4.12 BHUs:

Chapter 5: Coordination, Resource Mobilization and Monitoring.........................................................715.1 Coordination and Communication Mechanism 5.2 Financial and Resource Mobilization at National Level5.3 International Emergency Relief

References............................................................................80

TablesTable 1: Classifi cation of Disasters 2Table 2: Health emergency indicators 3Table 3: Number of deaths and individuals affected by natural disasters 1994-2016 6Table 4: Risk analysis of disasters from Public Health Perspectives 10Table 5: Risk analysis of Communicable diseases: 11Table 6: Risk analysis of Zoonotic diseases: 12Table 7: Risk analysis of food safety: 13Table 8: Risk analysis of Chemical events: 14Table 9: Risk analysis of Radiological events: 15Table 10: List of Emergency Medical and Trauma Centers 19 Table 11: Emergency Preparedness Action at Community Level 31Table 12: Emergency Response Action at Community level 33Table 13: Emergency Preparedness Action for Displaced/ Isolated Population 37


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Table 14: Emergency Response Action for Displaced/ Isolated Population 39Table 15: Emergency Preparedness Actions at Dzongkhag Level 45Table 16: Emergency Response Action at Dzongkhag Level 47Table 17: Hospital Emergency Preparedness in Hospital 49Table 18: Emergency Response in Hospital 52Table 19: Emergency Preparedness Action at National Level 57Table 20: Emergency Response Action at National Level 60Table 21: Emergency/Disaster Incident Recording Format 76Table 22: Contact numbers of District Health Offi cers 77Table 23: Incident Report Template 78Table 24: Situation Report Template 79

FiguresFigure 1: Mechanism of Medical Surge System 24Figure 2: Triaging Procedures in Mass Casualty Management (MCM) 26Figure 3: Principles of color tagging after Triaging 26Figure 4: Mass Casualty management system at District/ Hospital level 27Figure 5: Incident Management System at Gewog level 28


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FOREWORD

The Ministry of Health is responsible of delivering medical services at all times, especially “during and after the occurrence of natural and man-made disasters and emergencies.” To ensure this, it is critical that the ministry is prepared at all times to respond to such emergencies and disasters. This requires

the Ministry of Health, the health facilities and all concerned stakeholders to work systematically and make certain that the health sector is prepared in terms of infrastructure, emergency plans and procedures, and that the health staff are trained and equipped to provide emergency medical response during an crisis.

This Health Emergency and Disaster Contingency Plan is developed as per the mandates enshrined in the National Disaster Management Act, 2013. The main aim and objective of this plan is to enhance preparedness and response capacity for emergency and disaster in the health sector. The plan highlights some of the common hazards in Bhutan, based on which the plan was conceived and developed. This document covers various emergency preparedness subjects such as institutional mechanism, roles and responsibilities,communication and key actions crucial for emergency and disaster management.

The plan delineates health emergency preparedness and response action at different levels of health institutions, and responsibilities in terms of who, what resources and when. Coordination is a key to successful management of emergencies and disasters, which call for a coordinated response between


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curative and preventive health services, as well as food supply, water and sanitation. The Ministry of Health established the Emergency Medical Service Programme and later upgraded to Division level under the Department of Medical Services to act as the nodal body to direct, coordinate and manage medical responses during disasters and health emergencies.

We are hopeful that this plan will serve as a guiding document for programs in the ministry, health sectors of the districts, hospitals, basic health units, and communities for disasters and emergencies. I would like to, personally, urge the ministry colleagues, districts and hospitals to take immediate steps to implement the preparedness measure outline in this plan as we are uncertain when an emergency may occur.

Moreover, since simulation exercise is the only way to keep ourselves prepared for emergency and disaster in the absence of responding to events, I would like to urge districts and hospitals to conduct simulation exercises at least two times in a year. The Ministry of Health looks forward to the continued cooperation and support from all the stakeholders in implementing the interventions under this plan.

(LyonpoTandinWangchuk) Health Minister

(L T di W h k)


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ACKNOWLEDGEMENT

The Ministry would like to acknowledge health offi cials from districts, BHUs and villages, community leaders, and offi cials from various international organizations for their contribution in developing this document. The ministry also offers its sincere thanks to the World Health Organization for providing fi nancial and technical support. In particular, the Ministry would like to acknowledge the following offi cials for their contribution:

Contributors & Editors:1. Mr. Jamtsho, Chief Program Offi cer, EMSD, DMS2. Mr. Chador Wangdi, Program Offi cer, NACP, DoPH3. Mr. Tashi Duba, Program Offi cer, DPRP, NCDD, DoPH4. Mr. Ugyen Tshering, Program Offi cer, EMSD, DMS5.Mr. Sonam Wangdi, Program Offi cer, EMSD, DMS

Reviewers:1. Mr. Jamtsho, Chief Program Offi cer, EMSD, DMS2. Mr. Ugyen Tshering, Program Offi cer, EMSD, DMS3. Mr. Chador Wangdi, Program Offi cer, NACP, DoPH4. Mr. Tashi Duba, Program Offi cer, DPRP, NCDD, DoPH5. Mr. Rinchen Namgyel, Dy. CPO, HCDD, DMS6. Dr. Tashi Tenzin, Neurosurgeon, SD, JDWNRH7. Dr. Karma Tenzin, Dy. Dean, FoPG, KGUMSB8. Mr. Tshewang Dorji, Dy. CPO, EMSD, DMS9. Ms. Pem Zam, Dy. Chief Program Offi cer, HCDD, DMS10. Mr. Laigden Dzed, Program Offi cer, NP, DoPH11. Mr. Kencho Wangdi, Program Offi cer, IHR, DoPH12. Mr. Rinchen Wangdi, Chief Engineer, PHED, DoPH13. Mr. Sonam Wangdi, Program Offi cer, EMSD, DMS14. Mr. Sonam Phuntsho, Planning Offi cer, PPD


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15. Mr. Som Bdr.Darjee, Sr. Program Offi cer, HCDD, DMS16. Mr. Sonam Wangdi, Program Offi cer, RHP, DoPH17. Mr. Tshering Dendup, Dy. Chief Research Offi cer, PPD18. Mr. Tshering Dorji, Sr. Laboratory Offi cer, PHL, DoPH19. Mr. Karma Wangdi, Sr. Program Offi cer, OHP, DoPH20. Mr. Tandin Dendup, Planning Offi cer, PPD21. Ms. Pemba Yangchen, Sr. Program Offi cer, NP, DoPH22. Mr. Tashi Dendup, Program Offi cer, TBP, DoPH23. Mr. Tandin Chogyal, Dy. Chief Program Offi cer, DoTM

The ministry also offers its sincere thanks to all the members of the high level committee, without whose comments and support, this document would not have been possible.


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EXECUTIVE SUMMARY

The Ministry of Health through its Emergency Medical Service Division aims to develop safer communities that suffer fewer deaths, physical injuries and psycho-social trauma as a result of disasters and health emergencies. To achieve this the health system must be capable of providing a coordinated response during disasters/emergencies and deliver effective mitigation and preparedness programs before an impact. The health sector has a vested interest and a key role in this process since safer communities are healthier and the health of the population is an important contributing factor to individual and community safety.

The Health System can be put under considerable strain due to disaster and emergency situations that can result in high mortality and morbidity. The resulting health problems might be related to food and nutrition, water and sanitation, mental health, climatic exposure and shelter, communicable diseases, health infrastructure and population displacement.

Bhutan has confronted several disasters in the past. Whether it is man-made disasters or natural disasters, the Royal Government of Bhutan has taken measures to provide relief and response in a coordinated manner. Now that the world is facing new challenges due to the emergence of infectious diseases like avian infl uenza, SARS, MERS-CoV, and most recently the Zika virus, the re-emergence of previously easily contained diseases like Ebola and TB, and the health effects of chemical, radio nuclear and food safety events. Thus the health emergency contingency plan needs to be a comprehensive plan that will address all hazards.


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It is the outcome of the concerted efforts of stakeholders from various international and national organizations drafted since 2011 with the funding and technical support from both RGoB and WHO. This is also part of the fulfi llment of the mandates enshrined in the Disaster Management Act of Bhutan 2013.

This document has been developed adopting a community based approach through consultative process. It highlights some of the common natural hazards and health emergencies in Bhutan, upon which the plan was conceived and developed. It contains fundamental public health preparedness and response activities and responsibilities in terms of what resources when, who, and from where.

This document will serve as the basis for preparedness and response activities for emergencies and disasters in the health sector and therefore will be reviewed and updated every 3 years or as and when required. This is done to make the emergency management more practical and effi cient in the coming years.


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ACRONYMS

AMP Advance Medical PostARI Acute Respiratory InfectionAIDS Acquired Immunodefi ciency SyndromeBHU Basic Health UnitBMAT Bhutan Medical Assistance TeamCBRP Community Based Rehabilitation ProgramCDD Communicable Disease DivisionCMO Chief Medical Offi cerDHMS Department of Hydro Met ServicesDHO District Health Offi cerDMS Department of Medical ServicesDoPH Department of Public HealthDoMSHI Department of Medical Supply and Health InfrastructureDDM Department of Disaster ManagementDMAB Disaster Management Act of BhutanDoTM Department of Traditional Medical EMSD Emergency Medical Service DivisionEMT Emergency Medical TechnicianED/ER Emergency Department/RoomHA Health AssistantHIMS Health Information and Management SystemHHC Health Help CenterHEDCP Health Emergency and Disaster Contingency PlanHEMC Health Emergency Management CommitteeHEOC Health Emergency Operating CenterICU Intensive Care UnitIEC Information Education CommunicationIFRCRCS International Federation of Red Cross and Red Crescent SocietiesIMNCI Integrated Management of Neonate and Childhood Illness


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JDWNRH Jigme Dorji Wangchuck National Referral HospitalMCH Maternal and Child HealthMCI Mass Casualty IncidenceMCM Mass Casualty ManagementMEC Medical Evacuation CenterMoH Ministry of HealthNCDD Non-Communicable Disease DivisionNDMA National Disaster Management AuthorityNSB National Statistical BureauOPD Outpatient DepartmentPHED Public Health Engineering DivisionPPE Personal Protective EquipmentRCDC Royal Center for Disease Control RH Reproductive HealthRRT Rapid Response TeamSOP Standard Operating ProcedureTAC Technical Advisory Committee for Emergencies and DisastersKGUMSB Khesar Gyalpo University of Medical Science of BhutanUNICEF United Nations International Children’s Emergency FundUNDP United Nations Development ProgramUNDRO United Nations Disaster Relief OrganizationVHW Village Health WorkerWHO World Health OrganizationWFP World Food Program


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CHAPTER 1: INTRODUCTION

1.1 Background

Bhutan is a mountainous country covering an area of 38,394 square kilometers situated between China and India. The diffi cult geographical terrain and mountainous ridges poses challenges for the health facilities to provide service for the population in the far-fl ung settlements. The settlements are scattered across the mountains characterized by few households in some rural areas to over a thousand households in urban areas. The population of Bhutan in 2014 was 745,153 with over 70% of its population living in the rural areas.

The risk of disaster is high in Bhutan as it lies in greater Himalayan range, which is one of the most seismically active zones especially zone IV and V. The fragile eco-system, geographical conditions and climate change, have resulted many disasters in the past, such as:

a. Landslides closely linked with fl ooding situation.b. Flooding due to Glacial Lake Outbursts/natural dam formation and dam outburstc. Flash Floodd. Earthquakee. Fire in forest and human settlements.f. Windstorms/snowstorms and hailstormsg. Epidemic and Disease Outbreaks.

1.2 Disasters and Health Emergencies

Disasters happen when the forces of a hazard (an extreme event that disrupts the lives of people) exceed the ability of a community to cope on its own. Not all communities are at risk of every type of disaster, but every community is at risk of some particular disaster. The UNDRO defi nes a disaster


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as:“a serious disruption of the functioning of a society, causing widespread human, material, or environmental losses which exceed the ability of the affected society to cope using its own resources.”

As per the DMAB 2013 (Chapter 9, Section 92-96), disaster is classifi ed into three types based on geographical impact, coordination and management capacity as indicated in table 1:

Table 1: Classifi cation of Disasters

A health emergency can be any sudden public health situation endangering the life or health of a signifi cant number of people and demanding immediate action. As per WHO, public health

Criteria Type I Disaster Type II Disaster

Type III Disaster

Geographical Impact

Affects a single Thromde or Gewog or any part thereof;

Affects a Dzongkhag or more than one Dzongkhag;

Affects the nation as a whole or in part;Other special cir-cumstances warrant such classifi cation

Overall Coordination and Manage-ment

Managed with available resources and is within the coping capacity of the Gewog concerned (Thromde or Gewog Disaster Management Committee)

Managed with available resources and is within the coping capacity of the Dzong-khag concerned (Dzongkhag Disaster Management Committee)

Severity and mag-nitude is so great that it is beyond available resources and the coping capacity of the Dzongkhag con-cerned (National Disaster Manage-ment Authority)

Health Sec-tor Coordination

Health Assistant or Thromde Health offi cer.

Chief Medi-cal Offi cer and Dzongkhag Health Offi cer

Technical Advi-sory Committee for Emergency and Disaster at national level



emergency is “an occurrence or imminent threat of an illness or health condition, caused by bio terrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a signifi cant number of human facilities or incidents or permanent or long-term disability (WHO, 2001).The main Cut Off indicators for health emergencies defi ned by WHO are described below:

Table 2: Health emergency indicators

1.3 Legal Framework

The Fifty-Eight World Health Assembly urged WHO to increase its role in risk reduction and emergency preparedness in the health sector. Subsequently WHO recommended every countries to develop national health emergency preparedness and response policies after the completion of Global Assessment of National Health Sector Emergency Preparedness and Response in 2008.

At the national level, the DMAB 2013 (Chapter 6, section 67 & 76) mandates agencies notifi ed by NDMA to prepare, implement, review and update emergency contingency plan. The Chapter 10, section 111 of the Act also mandates Health Ministry to manage emergency medical services during disaster.

Status Indicators Cut off value

Health/Diseases

Daily crude mortality rate >1/10,000popDaily under 5 mortality rate >2/10,000 children under 5

Nutrition

Nutrition Acute malnutrition in under 5

10% of under 5 years old

Growth faltering rate in Under 5

30% of monitored children

Low birth weight ( <2.5 kg) 7% of live birth



Further the National Health Policy 2012 enshrined the mandates of all health facilities to institute appropriate system of care to deal with emergencies, disasters, epidemics and outbreaks. National emergency preparedness and response plans shall be maintained and appropriate resources provided at all levels to respond rapidly and effectively to all health related emergencies of national and international concerns.

Accordingly, the Ministry of Health has developed the Health Emergency and Disaster Contingency Plan (HEDCP).

1.4 Defi nition of Contingency Plan

A contingency plan is a plan that enables an organization to respond well to an emergency and its potential humanitarian impact when disaster occurs. It contains operational procedures for response,management of human and fi nancial resources, coordination and communication procedures.

The HEDCP outlines the level of preparedness and the arrangements made and as well highlights process and system that needs to be in place in terms of Health Response in anticipation of a health emergency during disaster/crisis/disease outbreaks. This plan will serve as the guiding document for appropriate health and humanitarian interventions before, during and after health emergency or disasters.

1.5 Objectives of the Contingency Plan

The main objectives of the HEDCP are to ensure that the health sector’s preparedness and response to emergencies is not only effective and timely but also coherent and well-coordinated. The processes and management structures outlined within this plan serve as the foundation for an all-hazards response



framework, which will be supplement through a series of annexes providing guidance and information specifi c to a particular hazard or process. The specifi c objectives of the plan are as follows:

a. Increase organizational readiness in the preparation for and disaster.

b. Ensure timely and effective provision of health care services when health emergency and disaster occurs.

c. Institutionalize emergency management at all levels of health facilities.

1.6 Strategiesa. Conduct hazard mapping and vulnerability assessmentb. Delineate job responsibilities at different level of health

institutionsc. Develop guidelines and SOPs for various levelsd. Establish resource mobilization mechanism (HR, medical

supplies, equipment and funds)e. Establish networking, information sharing and communication

within and outside MoHf. Establish effective early warning and surveillance system

related to health emergencyg. Develop effective coordination mechanism at all levels

of health facilitiesh. Establish psychosocial support and rehabilitation processi. Establish internal coordination mechanism for disease

of national and international concern



CHAPTER 2: HAZARDS AND HEALTH IMPACT

2.1 Hazard Profi les

Bhutan is a mountainous country and highly prone to a range of hazards, including glacial lake outburst fl oods (GLOFs), fl ash fl oods, riverine fl oods, landslides, landslide dam outburst fl oods, cloudbursts, windstorms, and river erosion. It ranks fourth highest in South Asia in terms of relative exposure to fl ood risks, with 1.7 percent of the total population at risk. With climate change, the frequency and intensity of extreme events are expected to increase. The country is also located in the seismic zone V of high earthquake occurrence. It ranks fourth highest in the South Asia region in terms of relative exposure to fl ood risks, at 1.7 percent of the total population at risk.

Between 1994 and 2016, some 87,000 people were affected and over 380 deaths occurred due to natural disasters in Bhutan— mostly arising from the impacts of fl oods, windstorms, earthquakes, and GLOFs. Floods and storms account for about 95 percent of total deaths related to natural disasters; the remaining 5 percent resulting from earthquakes.

Table 3: Number of deaths and individuals affected by natural disasters 1994-2016t

Source: EM-DAT: The OFDA/CRED International Disaster database

Number of deaths and individuals affected by natural disasters 1994-2011Disasters Deaths Affected

Flood 222 1600Storm 29 65000Earthquake 12 20028Total 304 87369



a. Earthquakes

The risk of earthquakes is high in Bhutan as it lies in one of the most seismically active zones. The recent major earthquake(September,2011) measuring 6.8 in Richter scale claimed one life, injured people, damaged nearly 7,965 houses, 50 health facilities and other important offi ces and functionaries across 6 Dzongkhags.

b. Glacier lakes

Out of 2674 glacier lakes,25 have been identifi ed as potentially dangerous. These glacial lake outburst (GLOFs) pose serious risk to the human settlement in the reverine areas. The threat of GLOFs is increasing as temperature increases from global warming and cause rapid and unprecedented rate in the retreat of glaciers. The major GLOFs and fl ash fl oods that occurred along Punatshangchu in October 1994 caused 22 casualties.

c. Flash fl ood

In 2004, major fl ash fl oods occurred due to heavy precipitation affecting 6 eastern Dzongkhags. It claimed 9 lives and damaged 1,437 households. In May 2009 Cyclone Aila caused incessant rainfall throughout the country resulting in fl ash fl oods and 13 lives were lost that year.

d. Fire

Fire is another major hazard for Bhutan affecting both the human settlements and forest. It is mainly caused by electric short-circuit, fuel woods used for cooking, heating, and negligence of people in particular by smokers, campers, trekker. The common use of woods as construction materials mainly in rural areasis alsorisk for fi re.



In May 2014, forest fi re in Bartsam and Bidung under Tashigang Dzongkhag razed down 22 houses, damaged 4 rural water supply schemes, 7 irrigation channels and 3844 fruits trees beside affecting other plants and animal species. Also, fi re in Chamkhar (2010) razed down 58 structures and affected 64 families. 2 lives lost and 1 seriously injured.

e. Road Traffi c Accidents

Road Traffi c Accident is common occurrence in Bhutan due to winding roads, speeding, reckless driving and driving under intoxication are some of the risk for accidents. In 2010, public transport accident at Lamperi claimed 9 lives and injured 26 people.

f. Disease Outbreaks

The disease outbreak affects large number of people demanding immediate health actions resulting in huge government losses in terms of drugs and equipment. This is further worsened by porous borders in the south, which gives way to unchecked movement of people between the borders. In 2012, the fi rst Chikungunya fever was detected in Samtse Hospital and over the period of 33 weeks, 64 cases of chikungunya were detected in Samtse, Gomtu, Sipsu and Phuntsholing areas. Weak disease surveillance and porous border were attributed to various disease outbreak and importation of new infectious diseases.

g. Snowstorms, hailstorms, windstorms and draughts

Snowstorms, hailstorms, windstorms and droughts in Bhutan also cause loss of lives, animals, food crops and properties. The wind Storm of May 2014 in Samtse blew away roofs of many households and Samtse hospital.



h. Chemical, Biological, Radiological and Nuclear Weapons (CBRNs) Disaster

Disaster due to CBRN is one such high priority subject, as it can be a highly traumatic event. At times, it can result in irreparable damage to the environment; both biotic and abiotic, and also cause fatality to a large number of population. Biological hazards includes infectious, zoonosis and food events which constitute major risk to our populations.

i. Bomb Blast

In 2013, eight soldiers were killed instantly in the bomb explosion in Haa. About a dozen more soldiers were injured. Some of the seriously injured persons were fl own to Thimphu in helicopters. The dead and injured were members of the bomb disposal squad of the Royal Bhutan Army.

2.2 Risk Analysis from hazards

A risk profi le identifi es and ranks risks according to seriousness of hazards. Risk analysis identify the locations that are particularly vulnerable, and their likelihood and impact. The following tables illustrate common public health risks caused by different hazards including epidemics:



Natural/ man-made Disasters

Specifi c Location

Likeli-hood

Impact Public Health Risk

EarthquakesWhole Country Moderate High

LandslidesWhole Country Infrequent Medium

FloodsWhole Country Likely

Low/Medium

Fire Whole Country

Moderate Medium

Road Traffi c Accidents

Whole Country

Frequent Medium

• Deaths and Injuries• Increased risk for vulnerable groups*• Displaced people• Unavailability of clean water and proper sanitation• Malnutrition• Disruption of essential services• Psycho-social problems/mental disturbances• Environmental and Public Health (PH) issues in shelters• Health infrastructure damage• Affected health workers and family• Disease outbreaks• Sexual violence and STIs• Deaths and Injuries• Increased risk for vulnerable groups• Malnutrition• Unavailability of clean water and proper sanitation• Disruption of essential services• Inaccessibility of PH facilities• Psycho-social problems /mental disturbances• Environmental and PH issues in shelters• Health infrastructure damage• Disease outbreaks• Displacement

• Deaths and Injuries from drowning• Malnutrition• Unavailability of clean water and proper sanitation• Psycho-social problems /mental disturbances• Inaccessibility of public health facilities• Environmental PH issues in shelters• Health infrastructure damage• Disease outbreaks• Displacement• Deaths and Injuries• Disabilities• Psycho-social problems /mental disturbances• Deaths and Injuries• Disabilities• Psycho-social problems /mental disturbances



Table 4: Risk analysis of disasters from Public Health Perspectives Table 5: Risk Analysis of Communicable diseases:

Communicable Disease Risk

Specifi c Location/Setting

Likelihood Impact Public Health Risk

Seasonal infl u-enza

Whole country, out-breaks in institutions and schools

Likely Low/Medium

Chikungunya Southern region (with case movement to other areas)

Moderate Low/Medium

Dengue Southern region (with case movement to other areas)

Likely Medium

Malaria Southern region (with case movement to other areas)

Likely Medium

Meningitis Whole country, Insti-tutions and schools

Infrequent High

Increasing burden of HIV/AIDS

Whole country Moderate High

Chicken pox Whole country, out-breaks in institutions and schools

Moderate Low

Mumps Whole country, out-breaks in institutions and schools

Likely Low

Measles Whole country, out-breaks in institutions and schools

Moderate Medium

Cholera Risk of imported cases

Infrequent Medium

Typhoid Central area, not verifi ed, lack of diag-nostic capacity

Moderate Medium

Kala-azer/ Leishmaniosis

Cases in Eastern region but vector in whole country

Infrequent Medium

Hepatitis B Whole country Moderate Medium/High

MERS Current risk of imported cases

Infrequent High

Rota viral diarrhoea

Whole country Moderate Medium

MDR TB Bhutan and SEA Moderate High

Hepatitis C Very few cases reported

Infrequent High

• Morbidity• Disability and Death• Socio economic impacts• Psycho-social problems / mental disturbances



Zoonotic Disease Risk

Specifi c Location/Setting

Likeli-hood


Rabies Southern Region Moderate- Likely in South

High

Anthrax Whole country, mainly in villages

Infrequent Low/Medium

Leptospirosis Whole country Infrequent Low/Medium

Scrub typhus Whole country, seasonal March-October

Moderate Medium

CCHF- Crimean Congo Haemor-rhagic Fever

Southern region, risk to whole country

Infrequent High

Echinococcosis / Hydatidosis


Taeniasis Whole country in meat handlers/ con-sumers/ Hunters

Likely Medium

Brucellosis Whole Country Infrequent Low

HPAI Whole Country Infrequent High

LPAI Whole Country Infrequent High

Swine Flu Whole Country Infrequent Medium/High

JE Southern Region Infrequent Medium

Bovine Tubercu-losis

Whole country, no cases detected

Infrequent Medium

Q Fever South East Asia, limited to animal handlers

Infrequent Medium

Toxoplasmosis Whole country, pregnant women

Infrequent Medium

• Morbidity• Disability and Death• Socio economic impacts

Ebola Risk of imported cases during on-going outbreaks

Infrequent High

Community acquired pneumonia

Whole country Moderate Medium/High

Health care acquired infections


AMR infections Whole country Moderate High

Hand, Foot and Mouth

Whole country, schools

Infrequent Low

Table 6: Risk Analysis of Zoonotic diseases:



Food Safety Risk

Specifi c Loca-tion/Setting

Likeli-hood


Foodborne Illness Whole country Moderate Medium

Food adulteration Whole country, particularly urban areas

Moderate Medium

Antibiotic/hor-monal residue


Afl atoxin poison-ing

Whole country Infrequent High

Pesticide/herbi-cide/or fertilizer contamination of food

Whole country Likely (imported goods)

High

Salmonellosis Whole country Moderate Medium

Staphylococcus. aureus


Listeria monocy-togens

Whole country Infrequent Medium

Heavy metals Whole country Infrequent High

E. coli Whole country Moderate Medium

Contamination from unsafe han-dling of food

Whole country, institutions

Moderate Medium/High

Food Preserva-tives and addi-tives (imported foods)

Whole country Moderate (imported goods)

High

C botulinum Whole country Infrequent High

Trichenellaspi-ralis


T solium& T saginata

Whole country Moderate Low/medium

Alcohol Whole country Moderate/Likely

Medium/High

• Malnutrition• Severe diarrhoea or debilitating infections including meningitis• Acute poisoning or long-term diseases, such as cancer• long-lasting disability and death

Table7: Risk Analysis of food safety:



Chemical Event Risk


Likeli-hood


Lead poisoning Industrial areas, laboratories, imported prod-ucts, foods

Infrequent Medium

Mercury poison-ing

Health facilities, Labo-ratories Black smith, Industrial areas

Infrequent Medium

Gas poisoning Mining areas, industrial areas

Infrequent Medium/High

Chlorine poison-ing

Swimming pools, water treatment


Acid burns Laboratories and workshops, industrial areas

Moderate Low/Medium

Pesticide/herbi-cide/or fertilizer poisoning

Farmers and chemical indus-tries

Moderate Low/Medium

Deliberate event Whole country Infrequent High

Industrial pol-lutants


Foreign industrial accidents

Border areas Moderate Medium/High

Asbestos Whole country, Through the packing materi-als and used in houses,


Arsenic Whole country/region patient exposure


Cadmium Pasakha Ferro alloy factory in Bhutan-likely chance


Ethilium bromide Laboratories Infrequent Low/Medium

• Stress and anxiety• Deaths and illness• Societal and economic costs• Environmental damage

Table 8: Risk Analysis of Chemical events:



Radiological Event Risk


Likelihood (Infrequent, Moderate,

Likely)

Impact (High, Me-dium, Low)

Public Health Risk

Radiation injuries

Hospitals, air-ports, recycled materials

Infrequent High

Bomb blast Whole country (Foreign deto-nation, local effects)

Infrequent High

Diagnostic/Therapy radia-tion

Health facilities (accidental overdose)

Infrequent High

Radiation Factories from Pasakha (Bhutan)

Infrequent High

Nuclear Power Plant Accident

Countries in Region, with local impact

Infrequent High

• Lethal at high doses• Mutagenic• Carcinogens

Table 9: Risk Analysis of Radiological events:



CHAPTER 3: PREPAREDNESS AND RESPONSES

3.1 Preparedness

Recent events have demonstrated that no one is exempted from a disaster situation and people everywhere need to be prepared. Therefore, preparedness encompasses all those measures taken before a disaster and emergency events which are aimed at minimizing loss of life, disruption of critical services and damage when the disaster occurs.

Preparedness increases the community’s ability to respond effectively to hazard impacts and to recover quickly from the long-term effects. It involves planning, training and education, resource management, and exercising. It builds better coordination and cooperation between agencies within the community.

Thus, preparedness is a protective process which enables governments, communities and individuals to respond rapidly to disaster situation and cope with them effectively. Preparedness includes following activities which are being implemented and are going to be implemented:

3.1.1 Health Emergency Operation Centre (HEOC)

HEOC is a central command, control and communication facility for the effective administration of emergency response and disaster management in any emergency situation. It will be managed and operated by Emergency Medical Services Division under the directives of Health Emergency Management Committee (HEMC) during the times of emergencies and disasters. HEOC will host necessary resources and data for effective coordination and response during emergencies. (See Chapter 4 of this Plan and Guideline and SOP for HEOC” for more details.)



3.1.2 Seismic Vulnerability Assessment of Hospitals and Health facilities

The hospitals and other health facilities in Bhutan faces high earthquake hazard combined with a geographic isolation that will make post-earthquake relief and medical supplies diffi cult. Thus it is important to assess the structural and non-structural earthquake vulnerability of all the hospitals and health facilities. The assessments is intended to provide an overview of the hospital’s seismic vulnerabilities, and to recommend actions to improve the hospital’s ability to deliver medical care following a major earthquake.

WHO's Regional Offi ce for Southeast Asia (SEARO), MoH, DDM and GeoHazards International (GHI) agreed that the hospitals will have an essential role following a damaging earthquake and that an assessment of the hospital’s current level of earthquake safety and preparedness was necessary. So GHI performed an initial seismic vulnerability assessment of JDWNRH from May to July in 2012. Subsequently GHI evaluated Trashiyangtse District Hospital and Trashigang District Hospital from August to December 2013.

EMSD has fi nalized and printed the “Guideline on Vulnerability Assessment of Health Facilities” and it will be used to conduct seismic vulnerability assessment of remaining hospitals and other facilities. It will be done as per the availability of budget and technical support. This activity shall be considered as one of the main priorities for EMSD.

3.1.3 Emergency Medical Supplies Buffer Stores

At the moment 30% buffer stock is kept for essential drugs, 10% for vital drugs and 10% for essential consumables at



Medical Supply Division Store, Phuntsholing for the use during emergencies. Further Ministry have identifi ed 3 medical buffer stores in Paro, Gelephu and Monger considering the feasibility of transportation and suitable location. 3.1.4 Field Hospitals

MoH will have fi eld hospitals in three regional referral hospitals in Thimphu, Gelephu and Mongar. Field hospitals will be used to substitute or complement medical systems in the aftermath of sudden-impact events that produce disasters for three distinct purposes:

a. Provide early emergency medical care (including Advanced Trauma Life Support - ATLS). This period lasts only up to 48 hours following the onset of an event.b. Provide follow-up care for trauma cases, emergencies, routine health care and routine emergencies (from day 3 to 15 days).c. Act as a temporary facility to substitute damaged installations pending fi nal repair or reconstruction (usually from the second month to two years or more).

The following are some essential requirements to ensure that it benefi ts the affected population:

a. Be operational on site within 24 hours after the impact of disaster Be entirely self-suffi cientb. Offer comparable or higher standards of medical care than were available in the affected country prior to the precipitating eventc. Be familiar with the health situation and culture of the affected country (medical aid to other countries)



3.1.5 Emergency Medical and Trauma Centers

Emergency Medical and Trauma Center is a specialized and organized health facility distinguished by the immediate availability of health personnel, equipment and capabilities on a 24x7 basis to care for critically injured patients and other medical emergencies. Ten district hospitals are/will be established at the strategic locations as the Emergency Medical and Trauma centers to adequately respond to the obstetrical and surgical emergencies and trauma related injuries. These trauma centers are/will be ranked from Level I (comprehensive service) to Level III (limited-care) depending on the availability of services and specialists in a trauma center. List of these facilities are given in table below:

Table 10: List of Emergency Medical and Trauma Centers

For more details on Emergency Medical and Trauma Centers, refer “Guideline for establishing Emergency Medical and Trauma Centers.”

Sl.No.

Name of Center Bed strength

Region Catchment Dzongkhags

Dewathang hospital 40

Eastern

SamdrupJongkhar, Pemagatshel and lower part of Trashigang

2 Trashigang hospital 40 Trashigang and Trashiyangtse

3 Riserboo hospital* 20 Southern Trashigang and Pemagatshel

4 Trongsa hospital 20Central

Trongsa and Bumthang

5 Yebilaptsa hospital 40 Zhemgang Dzongkhag

6 Damphu hospital 40 Tsirang and Dagana

7 Wangdue hospital 40

Western

WangduePhodrang, Punakha and Gasa

8 Phuentsholing hospital 50 Chhukha

9 Samtse hospital 40 Samtse

10 Gedu hospital 20 Chhukha



3.1.6 Hazard Monitoring and Early Warning Systems

This refers to systems and mechanisms for monitoring and anticipating hazard events and communicating early warnings to ensure rapid response actions by response organizations and at-risk communities.

a. Royal Centre for Disease Control (RCDC)

It is a centre of excellence on health and disease prevention and control in the country, with the facility of bio-safety level-3 laboratory. The centre shall generate reliable scientifi c information on health and diseases to ensure well-informed policies and promote effective and sustainable public health interventions.

Surveillance and reporting mechanism have been developed in the form of National Early Warning, Alert & Response Surveillance (NEWARS) to be able to notify Public Health Events of International Concern as required by the IHR (2005).

b. Seismology Division

Seismology Division under Department of Geology and Mines, Ministry of Economic affairs is responsible for setting up the seismic monitoring network to improve understanding of earthquake processes and impacts. Further the preparation of seismic hazard & risk maps will be also done by Seismology Division.

c. Department of Hydromet Services (DHMS)

The DHMS provide early warnings and alerts of extreme events including Glacier Lake outburst Floods (GLOF).



In addition DHMS will provide forecasts and warnings of fl oods and related information within the country. Currently DHMS operates 25 hydrological stations, 15 Flood Warning Stations, 20 Agro-meteorological stations and 76 Climatology stations and a GLOF Early warning system in the Punakha-Wangdi valley.

3.1.7 Capacity building

Capacity building here refers to various training and public education measures that are designed to provide organizations, staffs, fi rst responders, volunteers and at-risk community members with the knowledge and skills to prepare and respond effectively to disasters and health emergencies. Thus capacity building can be a key to minimizing the impact of disasters and to ensure a robustand resilient response system and population.

The capacity of the community to deal with the effects of the disasters and emergencies can be improved by training fi rst aid responders or volunteers in fi rst aid. First responders should be trained in providing pre-hospital care for anyone in a medical emergency. First responders shall include police, Desuups, fi re fi ghters, EMTs, tourist guides, among others.

In health care facilities’ setting, health workers including doctors and nurse shall be trained and updated on PALS, ATLS and ACLS. At Ministry level and Dzongkhag level, program personnel and district health offi cers should be trained in Emergency Management. In addition, integrating a Health Emergency Management course in any pre-service training for the new civil servants should be mandated in order to be more equipped with skills and knowledge during the times of emergencies.



3.1.8 Mock Drill Exercises and Simulations

Exercising is the culminating component of response preparedness. Exercising brings the skills, knowledge, functions and systems together and applies them against event scenarios. This provides the closest thing to an event to evaluate the state of response preparedness. (Refer Emergency/Disaster Simulation and Drill Guideline for more details)

Exercises are generally classifi ed as: Tabletop: discussions and problem solving in an open forum. Paper: event and response actions simulated using paper as the form to communicate and take action. Communications (electronic): event and response actions are simulated and all information fl ow is conducted using the communications systems which would normally be used to facilitate information fl ow. Practical or fi eld exercise: events are physically simulated. Responses are carried out using the resources that would be employed during a “real” emergency or disaster.

3.1.9 Risk Reductions

Risk reduction is the concept and practice of reducing disaster risks through systematic efforts to analyze and reduce the causal factors of disasters. Reducing exposure to hazards, lessening vulnerability of people and property, wise management of land and the environment, and improving preparedness and early warning for adverse events are all examples of risk reduction of emergencies and disaster. Risk reduction aims to reduce the damage caused by natural hazards like earthquakes, fl oods, droughts and cyclones, through an ethic of prevention. Risk assessment on natural disasters, epidemics, chemical, biological and radiological will be carried out in collaboration with different relevant stakeholders.



3.1.10 Risk Communication

Risk communication plays a key role in responding to public health emergencies and disasters. The systems and processes within MoH and among relevant sector/stakeholders for an effective risk communication will be established. Different communication approaches will be identifi ed to reach different target population including vulnerable and at risk populations. Risk communication teams will coordinate and implement the activities in consultation and guidance of the associated response plan.

3.2 Responses

The health sector focus on following types of responses:

3.2.1 Rapid Health Assessment

When disasters occur, the health sector will carry out rapid fi eld assessment within 24 hours of reported incidents. The rapid health assessment format and guideline will be distributed throughout the country by EMSD. It is expected to facilitate the rapid fi eld assessment aftermath of any disasters.

3.2.2 Medical Surge Capacity

The ability to respond effectively to events like disasters and epidemics producing a massive infl ux of patients that disrupt daily operations requires surge capacity. Surge capacity is the ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the current capacity of the health care system” (Hick et al. 2004)Key components of surge capacity include the four S’s: ‘staff,’ ‘stuff,’ ‘structure,’ and ‘systems.’Staff refers to health personnel, stuff consists of supplies and equipment, structure refers to facilities, and systems include integrated management policies and processes.



In order to deploy health personnel and mobilise supplies effectively and effi ciently during the times of emergencies and disasters, MoH has identifi ed and clustered 20 districts into 3 hubs (as shown in the fi gure no 1). The 3 hubs will function as follows:

a. Surge capacity to respond in 3 regions i.e. Western, Eastern and Central Region.b. The National Referral Hospital and Regional Referral Hospitals will serve as the hubs for medical emergency response. c. Health facilities in the Dzongkhags of respective region will form a cluster under each of the hub.d. Hubs will have the team of trained health workers and fi eld hospitals as well as stock pile of medical supplies. Health personnel can be deployed from the districts to the site of the disaster within each cluster.

Figure 1 Mechanism of Medical Surge System



3.2.3 Mass Casualty Management

Mass casualties following disasters and major incidents are often characterized by a quantity, severity, and diversity of injuries and other patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and defi nitive medical care. Casualties associated with natural disasters, particularly rapid-onset disasters, are overwhelmingly due to:

a. blunt trauma.b. crush-related injuries.c. drowning.d. mental health issues.

Most people affected by natural disasters DO NOT DIE and many deaths and long term consequences for casualties are preventable with timely and appropriate intervention. Therefore it is important to have an effective mass casualty incident management.

Mass Casualty Incident Management involves the following areas:

a. Establishment of fi eld command post nearest to the emergency site from where all the involved agencies operates in close coordination.b. Applying principles of medical and non-medical triage.c. Establish Advance Medical Post (AMP) which includes:

- Medical Evacuation Centre (MEC)- Dispatching of the patients - Network of receiving hospitals- Transportation of injured/ill patients- Medical life-saving procedures

d. Principles of color tagging



Figure 2: Triaging Procedures in Mass Casualty Management (MCM)

Figure 3: Principles of color tagging after Triaging

Color Tag

On Scene Hospital Care

Priority for evacuation Medical needs Priority Conditions

Red 1st Immediate care 1st Life-threatening

Yellow 2nd Need care, injuries not life threatening

2nd Urgent

Green 3rd Minor injuries 3rd Delayed

Black Not a priority Dead Last Dead

DELAYED

PRIORITY 3

DEAD

BREATHING BREATHING

WALKING

OPEN

AIRWAY

YES

YESYES

NO

NO

RESPIRATORY

RATEIMMEDIATEIMMEDIATE

PRIORITY 1PRIORITY 1

PULSE

RATEURGENT

PRIORITY 2

NO

10 or less30 or more

11 - 29

under 120/min

over

120/m

in

Capillary refill test (CRT) is an alternative to pulse rate, but is unreliable in the cold or dark: when used, a CRT >2 secs indicates PRIORITY 1

INJURED

NOT

INJURED

SURVIVOR RECEPTION CENTRE

Keep a record of the NUMBER and PRIORITY of casualties you triage

Pass this to the AMBULANCE COMMANDER on completion



Health Services in Mass Casualty Management includes following:

a. Casualty management (fi rst aid, triage, transport, pre- hospital care, in-patient care, out-patient care).b. Communicable disease control (surveillance, tracking, treatment, prophylaxis, isolation and quarantine).c. Continuity of delivery of critical services.d. Management of the dead.( in preservation and e. Management of information (public information; support activities; health info system).f. Mental health.g. Environmental health.

Figure no 4 and 5 illustrate the mass casualty management system at District/Hopital and geog level respectively. Refer “SOP for Mass Casualty Incident Management” for more details on mass casualty management.

Figure 4: Mass Casualty management system at District/Hospital level

Disaster (MCI)

DHO/MS/CMO receive information

Control Room Health Emergency Operation Center

HoDs and Unit Incharge

Trauma Team Rapid Response Team

Activ

ate

Mov

e to

site

Emergency Department (ER)

Respective Wards

Refer



BHU Level(Health Assistant)Health SectorCoordinationTechnical support tocommunity level workers

Gewog Level(Gup)Incident Command Post

Dzongkhag DMC(DHO)

Admin & financialsupport

Other Sectors’support

Village Level(VHW)

Village Level(AdditionalCommunityWorkers)

Injury CareFirst aid, Triage, Tagging,

Referral to sub District HospitalSearch & Rescue – by other than health teams

Community Care for SurvivorsPrevention of Disease OutbreakMother, Child & Neonatal careAddressing Reproductive Health NeedsPrevention of Sexual ViolenceChronic disease care, Elderly handicapped care

Figure 5: Incident Management System at Gewog level

3.2.4 Ambulance Services

The primary role of all ambulance services is to provide timely delivery of emergency medical services, thus improving accessibility of health care services. At the moment, country provides the ambulances services through 130 land ambulances and 2 helicopter around the country. Health Help Centre shall ensure the effective communication and dispatch of land ambulances through toll free number 112. (Refer “Ambulance Service Guideline” for more details on ambulance service). Further the helicopter services shall be availed for an evacuation of critically ill or injured patients as per the criteria set in the “Guideline on use of Helicopter for medical Emergencies.”



3.2.5 Sphere Project in Heath SectorThe Sphere Project’s Minimum Standards in disaster response provide useful guidelines for provision of humanitarian assistance in emergencies. Although these key recommendations are not country-specifi c, they can be of great use to health sector in Bhutan. The recognition and use of internationally recognised guideline will certainly improve the health sector’s responses during the times of emergencies and disasters. The following box summarise the Sphere Project’s key recommendations regarding the health sector disaster response:

Sphere Project regarding the Health Response1. Analysisa) Initial assessment – The initial assessment determines as accurately as

possible the health effects of a disaster, identifi es the health needs and establishes priorities for health programming.

b) Data collection – The health information system regularly collects relevant data on population, diseases, injuries, environmental conditions and health services in a standardised format in order to detect major health problems.

c) Data review – The health information system data, and changes in the disaster affected population, are regularly reviewed and analysed for decision-making and appropriate response.

d) Monitoring and evaluation – Data collected is used to evaluate the effectiveness of interventions in controlling diseases and in preserving health.

e) Participation – The disaster-affected population has the opportunity to participate in the design and implementation of the assistance programme.

2. Control of Communicable Diseasesa) Monitoring – The occurrence of communicable disease is monitored.b) Investigation and control – Diseases of epidemic potential are investigated and

controlled according to internationally accepted norms and standardsc) Measles Control – Measles vaccination campaigns should be assigned the

highest priority at the earliest time in emergency situations

3. Health Care Servicesa) Appropriate medical care – Emergency health care for disaster-affected

populations is based on an initial assessment and data from an onging health information system and serves to reduce excess mortality and morbidity through appropriate medical care.

b) Reduction of morbidity and mortality – Health care in emergencies follows primary health care principles and targets health problems that cause excess morbidity and mortality.



4. Human Resource Capacity and Traininga) Competence – Health interventions are implemented by staff who have

appropriate qualifi cations and experience for the duties involved and who are adequately managed and supported.

b) Support – Members of the disaster affected population receive support to enable them to adjust to their new environment and to make optimal use of the assistance provided to them

c) Local capacity – Local capacity and skills are used and enhanced by emergency health interventions.

3.3 Recovery in Health Emergencies:Health Emergency or Disaster Recovery is “the phase of the emergency management cycle that begins with stabilization of the incident and ends when the community has recovered from the disaster’s impacts (Lindell et al., 2006). Recovery actions begin almost concurrently with response activities and are directed to:

a. restore public health, medical, and social service systems to meet the needs of the impacted populations

b. support safety, psychosocial well-being, and social connectionsc. develop strategies and identify needed resources for addressing critical

issues likely to arise early in the recovery phase that can impede the progress of recovery and impact health/quality of life for survivors

d. identify opportunities to build resilience, mitigate hazards, address unmet needs, promote health during long-term recovery"

Recovery is provided in the following phases:

Short-term Medium-term Long-terma. address health and safety

needs;b. assess the scope of damages

and needs;c. restore basic infrastructure;

andd. mobilize recovery orga-

nizations and resources, including restarting and/or restoring essential services.

The short-term recovery phase should begin immediately after a disaster, running parallel to response activities.

Return individuals, families, critical infrastructure, and essential government or commercial services to a functional, if not pre-disaster, state.

a. redevelop and revitalize the impacted area;

b. rebuild or relocate dam-aged or destroyed social, economic, natural, and environments; and

c. transit to self-suffi cien-cy, sustainability, and resilience.

Long-term recovery may continue for months or years after the event.



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ctim

s acc

ordi

ng to

thei

r inj

urie

s an

d co

lor t

agge

d –

can

be tr

eate

d at

si

te, c

an w

ait f

or tr

ansp

orta

tion,

nee

ds

imm

edia

te re

ferr

als &

tran

spor

tatio

n an

d D

ead

Col

or ta

gs

Tr

aini

ng

Te

chni

cal p

roto

cols

for

Tagg

ing

at si

te, d

istri

ct,

regi

onal

and

nat

iona

l ho

spita

ls.

Supp

ly o

f Tra

inin

g an

d ad

voca

cy m

ater

ials

Ref

erra

l pro

toco

ls

Firs

t res

pond

er/H

A/

RRT

Trea

tmen

t at B

HU

Stab

ilize

thos

e w

ho a

re in

jure

d/tra

u-m

atiz

ed

O

nce

Tria

ge is

don

e, m

ove

patie

nts

to th

e pr

oper

trea

tmen

t are

a

U

se ta

ps, c

ones

, fl a

gs, t

o m

ark

area

s

C

ontro

l acc

ess t

o ar

eas

Dru

gs.

Med

ical

equ

ipm

ent

Ref

erra

l pro

toco

ls

M

anag

emen

t pro

toco

l

Tr

aini

ng a

nd a

dvoc

acy

mat

eria

ls

HA



Tran

spor

tatio

n of

ca

sual

ties t

o d

esig

nate

d h

ospi

tals

Am

bula

nces

repo

rt to

stag

ing

area

Tran

spor

tatio

n O

ffi ce

r ass

igns

pat

ient

s to

ambu

-la

nces

Bro

adca

st th

e “A

ll Im

med

iate

Tra

nspo

rted”

Hos

pita

ls to

be

notifi

ed.

Adv

ice

on e

n-ro

ute

care

/cap

abili

ty o

f the

hos

pita

l

A

ctiv

ate

disa

ster

pla

n at

hos

pita

l lev

el

U

pdat

e co

ntro

l are

a/EM

S di

spat

ch a

s sta

tus

chan

ges

Afte

r arr

ivin

g ho

spita

l, pe

rfor

m re

-tria

ge a

nd p

ro-

vide

med

ical

car

e as

per

nee

d. A

t all

stag

es o

f the

ho

spita

l’s re

spon

se a

ctiv

ities

, pat

ient

man

agem

ent

syst

ems,

and

proc

edur

es sh

ould

be

docu

men

ted

Trai

ning

.

A

mbu

lanc

e

C

omm

unic

atio

n eq

uip-

men

t

St

anda

rd te

chni

cal p

ro-

toco

ls fo

r Tag

ging

at s

ite

and

in h

ospi

tals

.

R

efer

ral p

roto

col

Patie

nt m

anag

emen

t pr

otoc

ol

HH

C

Esta

blis

h fi l

ed

hosp

ital a

nd

com

man

d po

st

Iden

tify

and

area

for e

stab

lishm

ent o

f co

mm

and

post

Sele

ct a

n ar

eas o

r zon

es to

be

used

for

fi rst

-leve

l cla

ssifi

catio

n (tr

iagi

ng) a

nd

do ta

ggin

g of

the

casu

altie

s prio

r to

thei

r tra

nsfe

r med

ical

car

e ce

nter

Ass

ign

crew

s spe

cifi c

task

s

Initi

ate

asse

ssm

ent a

nd tr

eatm

ent

SOP

delin

eatin

g fu

nctio

n of

Dis

trict

and

MO

H

emer

genc

y co

ntro

l ro

oms.

Job

actio

n sh

eet



Sear

ch &

Res

cue

Sear

ch th

e vi

ctim

s who

may

be

trapp

ed u

nder

the

ruin

s of b

uild

-in

gs th

at h

ave

colla

psed

, bur

ied

unde

r mud

or l

ands

lides

, cut

of

f by fl o

ods o

r the

blo

ckag

e of

co

mm

unic

atio

n ro

utes

Sear

ch a

nd R

escu

e ar

e sp

ecia

lized

are

as. P

ublic

Hea

lth p

erso

nnel

are

not

tr

aine

d fo

r se

arch

& r

escu

e. A

s suc

h, th

ese

oper

atio

ns a

re b

eyon

d th

e co

mpe

tenc

y of

Min

istr

y of

Hea

lth

Whe

n th

e di

sast

er re

sults

in

a la

rge

num

ber o

f dea

ths,

the

com

mun

ity sh

ould

org

aniz

e:

Tr

ansp

ort o

f the

dea

d bo

dies

,

Pl

ace

to p

ut th

em b

efor

e th

eir c

rem

atio

n

C

ertifi

cat

ion/

iden

tifi c

a-tio

n of

dea

d in

hos

pita

l

Form

for l

istin

g of

dea

ths,

inju

red

and

refe

rral

supp

ort

and

drug

s for

pre

serv

ing

dead

bod

ies

Tech

nica

l pro

toco

l for

m

anag

emen

t of d

ead

bodi

es

at si

te, d

istri

ct, r

egio

nal a

nd

natio

nal h

ospi

tals

Faci

litat

e ar

rang

ing

Fo-

rens

ic S

peci

alis

t/Ass

ista

nt

Fore

nsic

Spe

cial

ist/

MO

to

the

affe

cted

site

s

Tr

aini

ng a

nd a

dvoc

acy

mat

eria

ls.

BH

U/H

ospi

tal



Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rce

Req

uire

dA

ctio

nsW

hat

By

Who

mD

isea

se su

rvei

l-la

nce

and

early

w

arni

ng sy

stem

Early

war

ning

syst

em fo

r dis

ease

ou

tbre

ak

Sy

stem

of o

utbr

eak

inve

stig

atio

n an

d ru

mor

inve

stig

atio

n

W

eekl

y/m

onth

ly e

pide

mio

logi

cal

anal

ysis

Early

war

ning

for d

isea

se o

utbr

eak.

List

ing

of n

otifi

able

dis

ease

s

Tech

nica

l pro

toco

ls fo

r ear

ly w

arni

ng

agai

nst p

oten

tial d

isea

se o

utbr

eaks

at

site

, dis

trict

, reg

iona

l and

nat

iona

l le

vels

Dis

ease

man

agem

ent p

roto

col

Not

ifi ab

le d

isea

se e

mer

genc

y re

porti

ng

form

s.

Su

pply

of t

rain

ing

and

advo

cacy

mate

rials.

Stat

ione

ry a

nd fo

rms

DoP

H, R

CD

C

Dis

ease

pre

-ve

ntio

n S

yste

m o

f org

aniz

ing

activ

e di

seas

e su

rvei

llanc

e on

a

shor

t not

ice.

M

echa

nism

to e

xpan

d th

e ro

utin

e im

mun

izat

ion

func

-tio

ns w

ithin

a sh

ort p

erio

d. M

echa

nism

to q

uick

ly m

obi-

lize

the

emer

genc

y im

mun

i-za

tion

in th

e co

mm

unity

Tech

nica

l pro

toco

ls fo

r und

erta

king

pr

even

tive

publ

ic h

ealth

mea

sure

s at

Site

s

In

vest

igat

ion

team

Va

ccin

e an

d im

mun

izat

ion

faci

litie

s

Fu

nd

Sp

rayi

ng m

achi

ne, i

nsec

ticid

es, b

ed-

nets

,

Tr

aini

ng a

nd a

dvoc

acy

mat

eria

ls.

DoP

H,

RC

DC

, V

BC

P,

HPD

Tabl

e 13

: Em

erge

ncy

Prep

ared

ness

Act

ion

for D

ispl

aced

/Iso

late

d Po

pula

tion



Dis

ease

C

onta

inm

ent

M

echa

nism

to e

xpan

d th

e m

edic

al

treat

men

t fac

ilitie

s on

a sh

ort n

otic

e. A

vaila

bilit

y of

func

tiona

l pat

ient

s’ is

o-la

tion

faci

lity

on a

shor

t not

ice.

E

xist

ing

arra

ngem

ents

for e

xpan

ding

th

e m

edic

atio

n fa

cilit

ies a

t the

com

mu-

nity

leve

l. A

ddre

ssin

g da

y-to

-day

illn

esse

s. M

eetin

g th

e ro

ad-s

ide/

hom

e ac

cide

nts

– Fi

rst-a

id a

nd re

ferr

al a

rran

gem

ents

. M

edic

al su

pply

inve

ntor

y, st

orag

e,

repl

enis

hmen

t arr

ange

men

ts

Tech

nica

l pro

toco

ls fo

r Dis

ease

co

ntai

nmen

t in

case

of a

ny o

ut-

brea

k at

the

affe

cted

site

, dis

trict

, re

gion

al a

nd n

atio

nal l

evel

s

Fa

cilit

y pr

ovis

ion

for p

atie

nt is

o-la

tion,

fi rs

t aid

equ

ipm

ent,

form

at

for m

edic

al su

pply

inve

ntor

y,

spac

e fo

r med

ical

supp

ly st

orag

e,

Pres

crip

tions

and

oth

er fo

rms

Trai

ning

and

adv

ocac

y m

ater

ials

.

DM

S,

DoP

H,

RC

DC

Hea

lth

prom

otio

n D

istri

bute

adv

ocac

y m

ater

ials

to th

e af

fect

ed si

tes.

C

arry

out

adv

ocac

y on

hea

lth ri

sk a

nd

heal

th se

rvic

es

Tech

nica

l pro

toco

ls fo

r und

erta

k-in

g he

alth

pro

mot

ion

activ

ities

in

the

vuln

erab

le/h

igh-

risk

BH

U, a

t si

te d

istri

ct, r

egio

nal a

nd n

atio

nal

leve

ls.

Trai

ning

and

adv

ocac

y m

ater

ials

DoP

H(H

PD)



Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rces

Req

uire

dA

ctio

nW

hat

B y

Who

mD

isea

se

outb

reak

re

spon

se

Sent

inel

site

of e

arly

war

ning

syst

em

of e

pide

mic

pro

ne d

isea

ses,

outb

reak

re

spon

se (N

EWA

RS)

Dia

gnos

is a

nd tr

eatm

ent o

f com

mun

i-ca

ble

dise

ase.

Ref

er su

spec

ted

TB c

ases

Tech

nica

l pro

toco

ls fo

r Ear

ly W

arni

ng

agai

nst p

oten

tial d

isea

se o

utbr

eaks

at s

ite

dist

rict,

regi

onal

and

nat

iona

l lev

els.

Dis

ease

man

agem

ent p

roto

col

Trai

ning

and

adv

ocac

y m

ater

ials

.

Ve

ctor

con

trol (

IEC

+ im

preg

nate

d be

d ne

ts +

in/o

ut d

oor

IEC

on

loca

lly p

riorit

y di

seas

es (e

.g. T

B

self-

refe

rral

, mal

aria

self-

refe

rral

, oth

ers)

DoP

H,

RC

DC

Chi

ld

heal

th:

EPI:

rout

ine

imm

uniz

atio

n ag

ains

t all

natio

nal t

arge

t dis

ease

s and

ade

quat

e co

ld c

hain

in p

lace

Und

er 5

clin

ic c

ondu

cted

by

IMN

CI-

train

ed h

ealth

staf

f

H

ome-

base

d tre

atm

ent o

f: fe

ver/m

a-la

ria, A

RI/p

neum

onia

, deh

ydra

tion

due

to a

cute

dia

rrhe

a

C

omm

unity

mob

iliza

tion

for a

nd su

p-po

rt to

mas

s vac

cina

tion

cam

paig

ns

and/

or m

ass d

rug

adm

inist

ratio

n/tre

atmen

ts

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “C

hild

-hea

lth”

activ

ities

at s

ite, B

HU

, di

stric

t, re

gion

al a

nd n

atio

nal l

evel

s.

IM

NCI

IEC

mat

eria

ls fo

cus o

n ch

ild h

ealth

pl

us ac

tive c

ase fi

ndi

ngs

Bas

ic d

rugs

Tran

spor

tatio

n,

Add

ition

al H

R, v

acci

nes,

drug

s

Va

ccin

es e

quip

men

t

D

rugs

/col

d ch

ain/

stat

ione

ries

Wei

ghin

g sc

ale/

tape

/sta

tione

ries

Ref

erra

l sup

port

DoP

H, A

RI/

CD

D

Prog

ram

, EPI

Pr

ogra

m

Tabl

e 14

: Em

erge

ncy

Res

pons

e Act

ion

for D

ispl

aced

/Iso

late

d Po

pula

tion



VC

T fo

r HIV

Ant

iretro

vira

l tre

atm

ent (

ART

Parti

cipa

te w

ith th

e de

partm

ent,

agen

-ci

es in

volv

ed w

ith “

STI &

HIV

/AID

S”

activ

ities

.

Safe

del

iver

y ki

ts/IE

C m

ater

ial

Dru

gs/c

ontra

cept

ive

Dru

gs, I

EC m

ater

ials

Resu

scita

tion

set,

heat

ing,

O2,

Em

erge

ncy

drug

s/tra

inin

g

D

eliv

ery

set

Dru

gs/R

efre

sher

cour

se/st

aff/e

quip

men

t/gu

idel

ines

Trai

ning

and

advo

cacy

mat

eria

ls.M

ater

nal

& n

ewbo

rn

heal

th

Cle

an h

ome

deliv

ery,

incl

udin

g di

stri-

butio

n of

cle

an d

eliv

ery

kits

to v

isib

ly

preg

nant

wom

en, I

EC a

nd b

ehav

iora

l ch

ange

com

mun

icat

ion,

kno

wle

dge

of

dang

er si

gns a

nd w

here

/whe

n to

go

for

help

, sup

port

brea

st fe

edin

g

Fa

mily

pla

nnin

g

A

nten

atal

car

e: a

sses

s pre

gnan

cy, b

irth

and

plan

resp

ond

to p

robl

ems (

obse

rved

an

d/or

repo

rted)

, adv

ise/

coun

sel o

n nu

tritio

n &

bre

astfe

edin

g, se

lf-ca

re a

nd

fam

ily p

lann

ing,

pre

vent

ive

treat

men

t(s)

as a

ppro

pria

te

Sk

illed

car

e du

ring

child

birth

for c

lean

an

d sa

fe n

orm

al d

eliv

ery

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “M

a-te

rnal

& N

ewbo

rn”

activ

ities

at s

ite, B

HU

, di

stric

t, re

gion

al a

nd n

atio

nal l

evel

s.

Tr

aini

ng a

nd a

dvoc

acy

mat

eria

ls.

Safe

del

iver

y ki

ts/IE

C m

ater

ial

Dru

gs/c

ontra

cept

ive

Res

usci

tatio

n se

t, he

atin

g, O

2, E

mer

genc

y dr

ugs/

train

ing

Del

iver

y se

t

D

rugs

/Ref

resh

er c

ours

e/st

aff/e

quip

men

t/gu

idel

ines

Dru

gs/R

efre

sher

cou

rse/

staf

f/equ

ipm

ent/

guid

elin

e

R

efer

ral s

uppo

rt

DoP

H,

RH

Pr

ogra

m



Nut

ritio

n

Sc

reen

ing

of m

alnut

ritio

n/se

vere

maln

utrit

ion

Wei

ght&

age

MU

AC

Follo

w u

p of

chi

ldre

n en

rolle

d in

su

pple

men

tary

/ther

apeu

tic fe

edin

g (tr

ace

defa

ulte

rs)

Com

mun

ity th

erap

eutic

car

e of

seve

re

mal

nutri

tion

Man

agem

ent o

f mal

nutri

tion

(mod

erat

e an

d se

vere

)

Pa

rtici

pate

with

the

depa

rtmen

t; ag

enci

es

invo

lved

with

“N

utrit

ion

and

Food

Sec

-to

r” a

ctiv

ities

.

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “N

utrit

ion”

act

iviti

es a

t site

, BH

U, d

is-

trict

, reg

iona

l and

nat

iona

l lev

els.

Trai

ning

.

R

epor

ting

form

at.

MC

H h

andb

ook.

Wei

ghin

g sc

ale

Reg

iste

r

R

efer

ral s

uppo

rt

Su

pply

of T

rain

ing

and

advo

cacy

mat

eria

ls

DoP

H,

Nut

ri- tion

Prog

ram

STI &

HIV

/A

IDS

Com

mun

ity le

ader

s adv

ocac

y on

STI

/ H

IV

IE

C o

n pr

even

tion

of S

TI/H

IV in

fect

ions

an

d be

havi

oral

cha

nge

com

mun

icat

ion

Ensu

re a

cces

s to

free

con

dom

s

Sy

ndro

mic

man

agem

ent o

f sex

ually

tra

nsm

itted

infe

ctio

ns

St

anda

rd p

reca

utio

ns: d

ispo

sabl

e ne

edle

s &

syrin

ges,

safe

ty sh

arp

disp

osal

con

-ta

iner

s, Pe

rson

al P

rote

ctiv

e Eq

uipm

ent

(PPE

), st

erili

zer

Avai

labi

lity

of fr

ee c

ondo

ms

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “S

TI

& H

IV/A

IDS”

rela

ted

activ

ities

at si

te,

BHU

, dist

rict,

regi

onal

and

natio

nal l

evel

s

ST

I & H

IV/A

IDS

man

agem

ent p

roto

col

GM

C/S

cale

/chi

ld h

andb

ook

Fund

IEC

mat

eria

ls, f

und,

man

pow

er

Su

pply

of c

ondo

ms

Dru

gs a

nd o

ther

requ

ired

supp

ly

Sa

fety

box

,

PP

E, st

erili

zer,

auto

clav

e

C

ondo

m, B

ox

C

ouns

elin

g sk

ills &

Kno

wle

dge

DoP

H,

HIV

Pr

ogra

m



Esse

ntia

l new

born

care

: bas

ic n

ewbo

rn re

susc

itatio

n +

war

mth

(rec

omm

ende

d m

etho

d: K

anga

roo

Mot

her

Care

- K

MC)

+ ey

e pro

phyl

axis

+ cl

ean

cord

care

+

early

and

excl

usiv

e bre

ast f

eedi

ng 2

4/24

& 7

/7

Ba

sic em

erge

ncy

obste

tric c

are (

BEm

OC)

: pre

nata

l an

tibio

tics +

oxy

toci

c / an

ti-co

nvul

sions

dru

gs +

m

anua

l rem

oval

of p

lace

nta +

rem

oval

of r

etai

ned

prod

ucts

+ as

siste

d va

gina

l del

iver

y 24

/24

& 7

/7

Po

st-p

artu

m c

are:

exa

min

atio

n of

mot

her a

nd n

ew-

born

(up

to 6

wee

ks),

resp

ond

to o

bser

ved

sign

s, su

ppor

t bre

ast f

eedi

ng, p

rom

ote

fam

ily p

lann

ing

Com

preh

ensiv

e abo

rtion

care

: Man

agem

ent o

f pos

t ab

ortio

n ca

re, u

terin

e eva

cuat

ion

usin

g M

VA o

r m

edic

al m

etho

ds, a

ntib

iotic

pro

phyl

axis,

trea

tmen

t of

abor

tion

com

plic

atio

ns, c

ouns

elin

g fo

r abo

rtion

and

post-

abor

tion

cont

race

ptio

n

Pa

rtici

pate

with

the d

epar

tmen

t/ ag

enci

es in

volv

ed

with

“Mat

erna

l & N

ewbo

rn” r

elat

ed ac

tiviti

es.

Dev

elop

Man

agem

ent p

roto

col

Sexu

al

viol

ence

Clin

ical

man

agem

ent o

f rap

e su

rviv

ors (

incl

udin

g ps

ycho

logi

cal s

uppo

rt)

Em

erge

ncy

cont

race

ptio

n

Pa

rtici

pate

with

Pol

ice

and

othe

r dep

artm

ents

, in

volv

ed w

ith “

Sexu

al V

iole

nce

rela

ted

activ

ities

”.

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “S

exua

l Vio

lenc

e” a

ctiv

ities

at s

ite, B

HU

, di

stric

t, re

gion

al a

nd n

atio

nal l

evel

s

M

anag

emen

t pro

toco

l for

rape

surv

ivor

s

Re

porti

ng a

nd in

vesti

gatio

n te

am

Re

ferra

l sup

port

EC p

ills

Supp

ly o

f Tra

inin

g an

d ad

voca

cy

m

ater

ials.

DoP

H (R

H,

Ado

lesc

ent

and

Men

tal

Hea

lth

Prog

ram

, HPD

)



Phys

ical

ly

hand

icap

ped,

Ps

ycho

-soc

ial

& m

enta

l he

alth

Prom

otio

n of

self-

care

, pro

visi

on o

f ba

sic

heal

th c

are

and

psyc

hoso

cial

sup-

port,

iden

tifi c

atio

n an

d re

ferr

als o

f sev

ere

case

s for

trea

tmen

t, pr

ovis

ion

of n

eede

d fo

llow

-up

to p

eopl

e di

scha

rged

by

faci

l-ity

-bas

ed h

ealth

and

soci

al se

rvic

es fo

r pe

ople

with

chr

onic

hea

lth c

ondi

tions

, di

sabi

litie

s and

men

tal h

ealth

pro

blem

s

M

enta

l hea

lth c

are:

supp

ort o

f acu

te d

is-

tress

and

anx

iety

, fro

nt li

ne m

anag

emen

t of

seve

re a

nd c

omm

on m

enta

l dis

orde

rs

Pa

rtici

pate

with

the

depa

rtmen

t, ag

enci

es

invo

lved

with

“ph

ysic

ally

han

dica

pped

, Ps

ycho

soci

al &

men

tal h

ealth

” ac

tiviti

es.

Dev

elop

Man

agem

ent p

roto

col

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “P

hysic

ally

han

dica

pped

, psy

cho-

soci

al

& m

enta

l hea

lth” a

ctiv

ities

at si

te, B

HU

, di

stric

t, re

gion

al an

d na

tiona

l lev

els.

Trai

ning

and

advo

cacy

mat

eria

ls.

D

rugs

Dia

gnos

tic k

its

Re

ferra

l sup

port

Gen

eral

Psy

chos

ocia

l Int

erve

ntio

n

Sp

ecifi

c Psy

chos

ocia

l int

erve

ntio

n

Id

entifi

cat

ion

of m

enta

l pro

blem

s and

re

ferra

l

DoP

H

(Men

tal

Hea

lth,

CB

RP)

Non

com

-m

unic

able

di

seas

es,

inju

ries

Inju

ry c

are

and

mas

s cas

ualty

man

age-

men

t

H

yper

tens

ion

treat

men

t

D

iabe

tes t

reat

men

t

Pa

rtici

pate

with

the

depa

rtmen

t, ag

en-

cies

invo

lved

with

“N

on-c

omm

unic

able

di

seas

es &

Inju

ries r

elat

ed S

ecto

rs”

activ

ities

.

D

evel

op m

anag

emen

t pro

toco

l

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “N

on-c

omm

unic

able

dis

ease

s &in

jurie

s re

late

d” a

ctiv

ities

at s

ite, B

HU

, dis

trict

, re

gion

al a

nd n

atio

nal l

evel

s

Tr

aini

ng a

nd a

dvoc

acy

mat

eria

ls

D

rugs

Am

bula

nce

Com

mun

icat

ion

supp

ort

Add

ition

al m

anpo

wer

supp

ort

Dru

gs

B

asic

equ

ipm

ent l

ike

BP

inst

rum

ent e

tc.

Ref

erra

l sup

port

DoP

H

(NC

D,

CB

R)



Envi

ronm

en-

tal h

ealth

(W

ater

+

sani

tatio

n +

hygi

ene)

Safe

was

te d

ispo

sal

Cle

an d

rinki

ng w

ater

sup

ply

Prop

er sa

nita

tion

IEC

on

hygi

ene

prom

otio

n

C

omm

unity

mob

iliza

tion

for c

lean

up c

ampa

igns

and

/or

oth

er sa

nita

tion

activ

ities

Des

ign

stan

dard

s for

toile

t co

nstru

ctio

n an

d m

inim

um

num

bers

of t

oile

ts a

t site

s)

Pa

rtici

pate

with

the

depa

rt-m

ent,

agen

cies

invo

lved

w

ith “

Envi

ronm

enta

l hea

th

(Wat

er +

San

itatio

n +

Hy-

gien

e)”

rela

ted

activ

ities

.

Tech

nica

l pro

toco

ls fo

r the

iden

tifi e

d “E

nviro

n-m

enta

l hea

th (W

ater

+ S

anita

tion

+ H

ygie

ne)”

ac-

tiviti

es at

site

, BH

U, d

istric

t, re

gion

al an

d na

tiona

l le

vels.

Min

imum

wat

er su

pply

qua

ntity

and

qual

ity S

tan-

dard

s

En

viro

nmen

tal h

ealth

man

agem

ent p

roto

col

Trai

ning

and

advo

cacy

mat

eria

ls.

Su

pply

of W

aste

disp

osal

pit/

buck

ets (

3 co

lors

)

M

anpo

wer

supp

ort

Broo

m/d

eter

gent

s/dus

t col

lect

or/sa

nita

ry g

love

s

IE

C m

ater

ials/

wat

er te

sting

kits

Clos

e Lin

kage

s with

dist

rict w

ater

, san

itatio

n

an

d hy

gien

e tea

m

Te

sting

kits

WCT

trai

ning

CDH

Fiel

d La

trine

equi

pmen

t

Su

bsid

ized

bin

s

W

aste

disp

osal

pit/

buck

ets (

3 co

lors

)

M

anpo

wer

Broo

m/d

eter

gent

s/dus

t col

lect

or/sa

nita

ry g

love

s

IE

C m

ater

ials/

wat

er te

sting

kits

C

lose

Lin

kage

s with

loca

l wat

er, s

anita

tion

and

hygi

ene t

eam

Envi

ronm

enta

l Pr

ogra

m,

PHED



Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rces

Req

uire

dA

ctio

nsW

hat

By

Who

mH

azar

d M

appi

ng a

nd

Vul

nera

bilit

y A

naly

sis

Prep

are

Dis

trict

-wis

e na

tiona

l hea

lth

rela

ted

emer

genc

y m

ap –

BH

U w

ise

– ha

zard

zon

ing

and

epid

emio

logi

cal

profi

le b

ased

on

haza

rds

Earth

quak

e

Fl

ood/

GLO

F

La

ndsl

ides

Fire

Win

d-St

orm

Acc

iden

t

A

Bas

ed o

n di

seas

e ep

idem

iolo

gy

B

ased

on

avai

labi

lity

Hea

lth fa

cilit

ies

Haz

ard

asse

ssm

ent f

orm

Tech

nica

l cap

acity

on

haza

rd

ass

essm

ent

Map

of h

ealth

faci

litie

s

EMSD

, D

HO

Dev

elop

ing

a di

stric

t D

isas

ter C

ontin

genc

y Pl

an

Dev

elop

haz

ard

asse

ssm

ent f

orm

Dev

elop

Con

tinge

ncy

plan

ning

pro

-ce

ss fo

rmat

Haz

ard

Profi

le

H

azar

d as

sess

men

t for

m

Fo

rm fo

r con

tinge

ncy

plan

ning

Bud

get,

equi

pmen

t, dr

ugs

EMSD

, D

HO

Esta

blis

hmen

t of E

mer

-ge

ncy

Con

trol R

oom

in

DH

O o

ffi ce

Lay

dow

n Em

erge

ncy

com

mun

icat

ion-

guid

elin

es a

nd p

roce

dure

Dev

elop

repo

rting

form

at

Iden

tify

spac

e fo

r EC

room

Com

pute

r with

prin

ter,

fax

Rep

ortin

g fo

rmat

Lay

dow

n Em

erge

ncy

com

-m

unic

atio

n gu

idel

ines

and

pr

oced

ure

EMSD

, D

HO

Tabl

e 15

: Em

erge

ncy

Prep

ared

ness

Act

ions

at D

zong

khag

Lev

el



Hea

lth S

ecto

rA

dmin

istra

tive

and fi n

anci

al a

r-ra

ngem

ent

Dec

entra

lized

adm

inis

trativ

e an

d fi n

anci

al a

utho

ritie

s

A

dvan

ce F

inan

cial

nee

d as

sess

men

t fo

r em

erge

ncy

prep

ared

ness

and

re

spon

se

Ex

ecut

ive

orde

r.

R

espo

nsib

ility

iden

tifi c

atio

n.

M

onito

ring

proc

ess.

Emer

genc

y fu

nds f

or T

A/D

A

Ass

ess t

he b

udge

t req

uire

men

t and

pr

ovid

e fu

nd.

Del

egat

ion

of a

dmin

istra

tive

and fi -

nanc

ial a

utho

ritie

s to

wor

k in

em

er-

genc

ies w

ith m

inim

um p

roce

dure

un

der o

vera

ll gu

idan

ce a

nd su

perv

i-si

on o

f the

des

igna

ted

offi c

ials

Bud

get p

rovi

sion

for a

ny u

nfor

e-se

en e

xpen

ditu

re w

ith d

ecen

traliz

ed

fi nan

cial

aut

horit

yTr

ansp

ort a

nd p

atie

nt re

ferr

al

D

evel

op a

SO

P fo

r am

bula

nce

and

trans

port

requ

irem

ents

.

Ti

e-up

with

nea

rby

Hos

pita

l for

am

bula

nce

serv

ices

as p

art o

f ref

erra

l su

ppor

t

A

dvan

ce E

mer

genc

y tra

nspo

rt ne

eds

asse

ssm

ent t

o be

dep

loye

d at

the

time

of e

mer

genc

y

Ass

ess a

mbu

lanc

e an

d ot

her t

rans

port

requ

irem

ents

Esta

blis

h lin

kage

s with

am

bula

nce

proj

ect.

Driv

er d

eplo

ymen

t with

tran

spor

t, du

ty-r

oast

er a

nd re

lief d

river

.

B

udge

t for

fuel

, ove

r-tim

e et

c.

EMSD

, H

HC

Plan

ning

for S

kill

deve

lopm

ent

Dev

elop

trai

ning

mod

ules

Prov

ide

train

ing

of tr

aine

r

In

stitu

tiona

lizat

ion

of h

ealth

sect

or

emer

genc

y pr

epar

edne

ss tr

aini

ng in

pu

blic

hea

lth, P

ara-

med

ical

and

med

i-ca

l cur

ricul

a

Bud

get

Trai

ning

mat

eria

lsD

MS,

M

SD,

DH

O



Dev

elop

ing

train

ing

prog

ram

for t

he

com

mun

ity le

vel

heal

th w

orke

rs

Prep

are

dist

rict i

nven

tory

of r

equi

rem

ents

–

equi

pmen

t, tra

inin

g m

ater

ials

, mon

ey

alon

g-w

ith d

eleg

atio

n of

adm

inis

trativ

e an

d fi n

anci

al a

utho

ritie

s.

Ti

me-

fram

e fo

r tra

inin

g to

BH

U a

nd d

istri

ct

publ

ic h

ealth

wor

kers

Trai

ning

and

adv

ocac

y m

ater

ials

.

Fa

cilit

ate

and

mon

itor s

imul

atio

n ex

erci

ses

Trai

ning

mod

ules

Trai

ning

equ

ipm

ent

Mon

ey a

nd a

dvoc

acy

mat

eria

ls

DM

S/O

PH,

DH

O

Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rces

Req

uire

dA

ctio

nW

hat

By

Who

mEm

erge

ncy

Rel

ated

R

epor

ting

& M

onito

ring

of

emer

genc

y si

tuat

ion

Dev

elop

Rep

ortin

g fo

rm

St

anda

rd g

uide

lines

on

esta

blis

hing

com

man

d an

d co

ntro

l pos

t

Es

tablis

hmen

t of D

istric

t con

trol &

com

man

d sy

stem

Con

stitu

te h

ealth

sect

or c

oord

inat

ion

com

mitt

ee

Rep

ortin

g fo

rms

Gui

delin

es o

n es

tabl

ishi

ng c

omm

and

post

EMSD

, D

HO

Ass

essm

ent o

f the

im

pact

Dev

elop

and

mak

e av

aila

ble

asse

ssm

ent f

orm

Dist

rict h

ealth

sect

or A

sses

smen

t tea

mA

sses

smen

t for

mEM

SD,

DH

OD

istri

ct H

ealth

sec-

tor C

oord

inat

ion

• C

onst

itutio

n of

Hea

lth S

ecto

r Em

erge

ncy/

disa

s-te

r Coo

rdin

atio

n Co

mm

ittee

• D

raw

job

actio

n sh

eet f

or sp

ecifi

c ta

sk

Gui

delin

es, f

und,

SO

PEM

SD,

DH

O

Tabl

e 16

: Em

erge

ncy

Res

pons

e Act

ion

at D

zong

khag

Lev

el



Adm

inis

trativ

e Su

ppor

t for

fi el

d le

vel a

ctiv

ities

E

mer

genc

y Pl

anni

ng fo

r

Med

ical

Sup

ply

need

s

Em

erge

ncy

Plan

ning

for

Tran

spor

tatio

n fa

cilit

ies

E

mer

genc

y pl

anni

ng fo

r

m

edic

al su

pply

E

mer

genc

y Pl

anni

ng fo

r

hu

man

reso

urce

s to

mob

i-liz

e at

a sh

ort n

otic

e

Car

ry o

ut su

pply

nee

d as

sess

men

t

C

arry

out

tran

spor

t nee

d as

sess

men

t

M

edic

al S

uppl

y ne

eds a

sses

smen

t

Su

rge

capa

city

ass

essm

ent

Gui

delin

es o

n su

pply

nee

d

a

sses

smen

t

G

uide

lines

and

SOPs

on

tran

spor

t nee

d as

sess

men

t

M

edic

al su

pply

nee

d

as

sess

men

t for

m

G

uide

lines

and

form

s on

man

pow

er n

eed

asse

ssm

ent

Med

icin

es, v

ehic

les,

HR,

F

und

EMSD

, D

HO

Tech

nica

l Sup

port

to B

HU

and

V

illag

e le

vel a

ctiv

ities

thro

ugh

Rap

id R

espo

nse

Team

Form

atio

n of

rapi

d re

spon

se te

am

Pr

ovid

e Fi

rst-a

id &

Tre

atm

ent

Prov

ide

Out

patie

nt se

rvic

es

Pr

ovid

e ba

sic

labo

rato

ry se

rvic

es

Enha

nced

BH

U a

nd h

ospi

tal a

dmis

-si

on c

apac

ity

St

reng

then

ed re

ferr

al c

apac

ity

Firs

t aid

kits

& e

quip

men

t

M

edic

al su

pplie

s, re

-ag

ents

/che

mic

als

&

equi

pmen

t

D

rugs

, bed

s, lin

ens,

othe

r su

pplie

s

A

mbu

lanc

es, h

ands

ets,

mob

ile

R

efer

ral p

roce

dure

s, m

eans

of c

omm

unic

atio

n an

d tra

nspo

rtatio

n

BH

U,

DH

O



Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rces

Req

uire

dA

ctio

nsW

hat

By

Who

mH

ospi

tal v

ulne

rabi

lity

asse

ssm

ent

Iden

tifi c

atio

n of

the

vario

us ty

pes o

f vu

lner

abili

ties t

hat m

ust b

e co

nsid

-er

ed in

hos

pita

l set

tings

Stru

ctur

al v

ulne

rabi

litie

s

N

on-s

truct

ural

vul

nera

bilit

ies

Func

tiona

l vul

nera

bilit

y; A

dmin

istra

-tiv

e an

d or

gani

satio

nal v

ulne

rabi

litie

s

Trai

ning

Fund

Adm

Offi

cer/

DH

O/

Mai

nten

ance

Uni

t

Med

ical

Sup

plie

s

Su

pplie

s inv

ento

ry a

nd S

tora

ge sp

ace

Dru

gs a

nd e

quip

men

tD

HO

, C

MO

Hum

an re

sour

ces

Link

ed u

p w

ith n

earb

y ho

spita

l for

bac

k up

serv

ices

Ope

ratio

nal p

lan

for

back

up

serv

ices

Adm

Offi

cer/D

HO

Inte

rnal

Com

mun

ica-

tion

Set u

p ho

spita

l

Com

mun

icat

ion

syst

em

H

R, E

quip

men

t’s-

Hot

line,

fax,

tele

, w

alki

e-ta

lkie

and

pr

ovis

ion

for f

ree

vouc

her

Adm

Offi

cer/C

MO

Tech

nica

l com

pone

nts

o Pl

an fo

r sta

ffs +

stoc

k, m

obili

zatio

n fr

om th

e ne

arby

Hea

lth c

ente

r

H. R

esou

rce

S

uppl

ies.

Adm

Offi

cer/C

MO

Tabl

e 17

: Hos

pita

l Em

erge

ncy

Prep

ared

ness

in H

ospi

tal



Mai

nten

ance

pro

ce-

dure

s (ba

ck-u

p fo

r w

ater

, pow

er, e

tc.)

Link

ed u

p ex

istin

g st

aff,

dept

. of

pow

er, d

istri

ct e

ngin

eerin

g an

d

m

unic

ipal

Mai

nten

ance

staf

f, el

ectri

cian

, plu

mbe

rs,

clea

ner a

nd su

pplie

s

Adm

Offi

cer/C

MO

/M

aint

enan

ce U

nit

Emer

genc

y R

espo

nse

Plan

Set u

p Em

erge

ncy

med

ical

te

am –

Rap

id R

espo

nse

Team

Hum

an re

sour

ce, s

up-

plie

s of m

edic

ine

and

equi

pmen

t, tra

nspo

r-ta

tion

and

com

mun

i-ca

tion

Adm

Offi

cer/C

MO

SOPs

Dev

elop

SO

Ps fo

r em

erge

ncy

O

pera

tion

Gui

delin

es a

nd tr

ain-

ing

mat

eria

l, fi n

ance

, hu

man

reso

urce

and

lo

gist

ic su

ppor

t

Adm

Offi

cer/C

MO

Secu

rity

D

evel

op se

curit

y pl

an

Se

curit

y pe

rson

nel,

budg

et a

nd lo

gist

ics

Adm

Offi

cer/C

MO

Exte

rnal

Vul

nera

bilit

ies

Acc

ess t

o ro

ad

Lin

ked

up w

ith D

OR

and

pol

ice

Hum

an re

sour

ce,

trans

port

and

com

mu-

nica

tion

equi

pmen

t

Adm

Offi

cer/C

MO

/D

HO

Elec

trica

l and

wat

er su

p-pl

y &

com

mun

icat

ion

L

inke

d up

with

Pow

er, m

unic

ipal

and

tel

ecom

Pow

er, m

unic

ipal

and

te

leco

mA

dm O

ffi ce

r/CM

O/

DH

O



Geo

grap

hica

l loc

atio

n an

d bu

ildin

g st

ruct

ure

vuln

erab

le to

ear

th-

quak

e, fl

oods

, sto

rm,

land

slid

e et

c

HID

P (H

ospi

tal I

nfra

stru

ctur

e D

evel

-op

men

t Pro

ject

), Pl

anne

r

H

R a

nd fi

nanc

e

Tr

aini

ngA

dm O

ffi ce

r/CM

O/

DH

O

Func

tiona

l Vul

nera

bili-

ties

Dev

elop

men

t of s

yste

ms t

hat c

an

rem

ain

oper

atio

nal d

urin

g a

disa

ster

or

reco

ver t

heir

func

tiona

l cap

acity

in

a re

lativ

ely

shor

t tim

e

Hos

pita

l rap

id

re

spon

se te

am (H

R,

supp

lies,

e

quip

men

t)

Tr

aini

ng

Adm

Offi

cer/

CM

O/D

HO

Hos

pita

l Sur

ge C

apac

-ity

L

istin

g of

nea

rby

hosp

itals

, ava

il-ab

lebe

d ca

paci

ty, N

umbe

r of s

taff

(tota

l / d

octo

rs /

nurs

es /

allie

d m

edic

al

/ sup

port

/ oth

ers)

, ava

ilabl

e Sp

ecia

lty,

depa

rtmen

ts, E

mer

genc

y de

partm

ent

capa

city

Fund

Adm

Offi

cer/

CM

O/D

HO

Polic

ies a

nd p

roce

dure

s

Writ

ten

hosp

ital-w

ide

prep

ared

ness

pl

an

Tra

inin

g pr

ogra

m fo

r the

staf

f on

disa

ster

pre

pare

dnes

s

Ess

entia

l inf

rast

ruct

ure

need

ed fo

r m

itiga

tion

and

resp

onse

dur

ing

a di

sast

er

Rev

iew

and

eva

luat

ion

of th

e pr

e-pa

redn

ess p

rogr

am

Fund

Adm

Offi

cer/

CM

O/D

HO



Hos

pita

l Em

erge

ncy

Prep

ared

ness

pla

n

C

onst

itute

hos

pita

l Em

erge

ncy

com

-m

ittee

C

lear

ly d

escr

ibe

role

of e

ach

pers

on-

nel a

nd a

ctio

n ca

rds

F

und

Adm

Offi

cer/

CM

O/

DH

O

Plan

for m

obili

zing

dr

ugs a

nd m

edic

al te

am

from

out

side

E

stab

lish

unde

rsta

ndin

g w

ith o

ther

ne

arby

hos

pita

l to

mob

ilize

dru

gs a

nd

med

ical

team

from

thei

r hos

pita

l

F

und

and

trans

porta

-tio

n fa

cilit

ies

Adm

Offi

cer/

CM

O/D

HO

/MO

H

Exer

cise

/moc

k dr

ill

M

ock

drill

pro

toco

l and

scen

ario

ch

eckl

ist

HR

/tech

nica

l exp

er-

tise/

Fina

ncia

l sup

port/

equi

pmen

t

Adm

Offi

cer/

CM

O/D

HO

/MO

H

Dea

ling

with

med

ia

Des

igna

te m

edia

foca

l per

son

T

imel

y an

d ac

cura

te

info

rmat

ion

feed

ing

Adm

Offi

cer/

CM

O/D

HO

Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rces

Req

uire

dA

ctio

nsW

hat

By

Who

mH

ospi

tal E

mer

genc

y C

ontro

l Roo

m

Es

tabl

ish

and

activ

ate

EOC

in th

e ho

spita

l

Act

ivat

e Em

erge

ncy

Res

pons

e Te

am–

Emer

genc

y re

spon

d te

am

Hum

an re

sour

ces

Am

bula

nces

/ com

mu-

nica

tion

Equi

pmen

t an

d ot

hers

Adm

Offi

cer/

CM

O

Tabl

e 18

: Em

erge

ncy

Res

pons

e in

Hos

pita

l



repo

rt pr

ompt

ly to

ass

ess t

he

disa

ster

's m

agni

tude

and

the

num

ber,

loca

tion,

and

urg

ent r

equi

rem

ents

of

casu

altie

s. M

My

Cal

lE

Exac

t Loc

atio

nT

Type

of I

ncid

ent

H H

azar

dsA

A

cces

sN

Num

ber o

f Cas

ualty

E Em

erge

ncy

Serv

ice

Adm

Offi

cer/

CM

O

Man

agem

ent

Prio

ritie

s:H

ospi

tal C

omm

and

Post

Esta

blis

h a

com

man

d po

st to

:

C

oord

inat

e em

erge

ncy

rela

ted

activ

ities

insi

de th

e ho

spita

l

M

onito

r the

util

izat

ion

of

a

vaila

ble

reso

urce

s

Pr

even

t rol

e co

nfl ic

ts.

Hum

an re

sour

ce

H

ospi

tal e

mer

genc

y pl

an a

nd c

omm

unic

a-tio

n eq

uipm

ent

Adm

Offi

cer/

CM

O

Secu

rity

and

traffi

c - S

afet

y &

Se

curit

y of

Hos

pita

l to

man

age

pa-

tient

s car

e w

ithou

t any

hin

dran

ces

also

to p

reve

nt se

cond

disa

ster i

n ho

spita

l com

plex

cau

sed

by in

ten-

tiona

l/uni

nten

tiona

l mot

ives

.

Mak

e C

ontin

genc

y fu

nd

a

vaila

ble

Act

ivat

e th

e lin

ked

esta

blis

hed

with

pol

ice,

Des

uups

and

vol

unte

ers

Hum

an R

esou

rce

(PR

O, S

ecur

ity p

erso

n-ne

l, po

lice,

Des

uups

, vo

lunt

eers

), C

CTV

ne

twor

k

Em

erge

ncy

aler

t ala

rm

Adm

Offi

cer/

CM

O



Hos

pita

l com

mun

icat

ion

cent

er /

EOC

Esta

blis

hing

line

s of c

omm

unic

a-tio

n w

ith re

gion

al h

ospi

tals

or

sate

llite

uni

ts to

ale

rt th

em o

f the

ne

ed to

act

ivat

e an

d im

plem

ent

thei

r res

pect

ive

emer

genc

y pl

ans

for m

ass c

are

of th

e w

ound

ed

and

emer

genc

y ca

ll to

ess

entia

l ho

spita

l sta

ffs

Rec

eptio

nist

/War

d/Te

l O

pera

tor/D

HO

Adm

Offi

cer/

CM

O

Rec

eptio

n an

d re

gist

ratio

n of

in

com

ing

casu

altie

s:

N

ame

Age

Add

ress

Tele

phon

e nu

mbe

r

Lo

catio

n et

c

Stan

dard

form

s on

patie

nt re

gis-

tratio

nH

R (r

ecep

tioni

st, M

RO

) C

ompu

ters

, Reg

istra

tion

form

Adm

Offi

cer/

CM

O

Publ

ic in

form

atio

n

Id

entif

y an

d es

tabl

ish

Publ

ic

info

rmat

ion

cent

er

PR

O,P

ublic

add

ress

sy

stem

/ Pub

lic in

for-

mat

ion

boar

d

Adm

Offi

cer/

CM

O

Tria

ge

A

ctiv

atin

g se

lect

ed a

n ar

ea o

r zo

ne to

be

used

for H

ospi

tal l

evel

cl

assifi

cat

ion

(tria

ge) a

nd id

entifi

-ca

tion

(tagg

ing)

of c

asua

lties

prio

r to

thei

r rem

oval

to d

iffer

ent w

ards

or

to o

ther

med

ical

car

e ce

nter

Hum

an re

sour

ces

(EM

T. T

riage

nur

se

etc.

), Eq

uipm

ent

Emer

genc

y dr

ugs

Tria

ge a

reas

– sp

ace

cord

oned

of

Adm

Offi

cer/

CM

O



Dec

onta

min

atio

n ar

ea in

cas

e of

ch

emic

al le

akag

e

Id

entif

y de

cont

amin

atio

n ar

ea

D

econ

tam

inat

ion

Equi

pmen

t + sp

ace

Adm

Offi

cer/

CM

OR

esus

cita

tion

& T

reat

men

t Are

a

A

dmin

iste

ring fi r

st a

id to

the

wou

nded

, inc

ludi

ng st

abili

zatio

n,

hem

orrh

age

cont

rol,

clea

ring

air

pass

ages

, and

, in

som

e ca

ses,

bloo

d-vo

lum

e re

plac

emen

ts. I

n ad

min

iste

ring fi r

st a

id, t

he p

riori-

ties a

ssig

ned

in th

e tri

age

area

m

ust b

e ob

serv

ed

Hum

an re

sour

ce

(EM

T, N

urse

s, do

ctor

s an

d ot

her s

uppo

rting

st

aff)

Emer

genc

y su

pplie

s

B

lood

don

ors

Emer

genc

y m

edic

al

equi

pmen

t’s –

list

to b

e pr

epar

ed

Adm

Offi

cer/

CM

O

Tran

spor

tatio

n ar

rang

emen

t of

patie

nts t

o di

ffere

nt lo

catio

n in

ho

spita

l-IC

U, C

CU

, OT

etc

Act

ivat

e in

tern

al p

lan

on tr

ans-

porta

tion

arra

ngem

ent t

o di

ffer-

ent u

nits

Hum

an re

sour

ces

(EM

Ts, S

uppo

rting

st

affs

etc

)

St

retc

her/w

heel

cha

ir

A

dequ

ate

ambu

lanc

e w

ell e

quip

ped

with

life

su

ppor

t sys

tem

s

Adm

Offi

cer/

CM

O

Rad

iolo

gy d

epar

tmen

t and

labo

-ra

torie

sK

eep

stock

of r

eage

nts,

alte

rnat

ive

pow

er su

pply

and

func

tiona

l X-ra

y an

d po

rtabl

e U

SG

Equi

pmen

t

R

eage

nts

Bac

kup

pow

er su

pply

USG

and

X-r

ay m

a-ch

ines

Adm

Offi

cer/

CM

O



Ope

ratio

n R

oom

s

Fo

rm e

mer

genc

y op

erat

ion

team

Equi

p fa

cilit

ies w

ith n

eces

sary

eq

uipm

ent

Hum

an R

esou

rces

,

Eq

uipm

ent

Adm

Offi

cer/

CM

O

Blo

od B

ank

Kee

p lis

t of v

olun

tary

blo

od

dono

r

B

lood

ban

k

Vo

lunt

ary

bloo

d do

-no

rs

Adm

Offi

cer/

CM

O

Fore

nsic

exp

ertis

e an

d te

mpo

rary

m

orgu

e to

acc

omm

odat

e la

rge

num

ber o

f dea

d

Iden

tify

enou

gh sp

ace

for d

ead

bodi

es, f

oren

sic

spec

ialis

t

H

uman

reso

urce

s and

eq

uipm

ent

Mor

tuar

y, te

mpo

rary

m

ortu

arie

s

Tr

ansp

ort f

or d

ead

bodi

es

Adm

Offi

cer/

CM

O

Evac

uatio

n pl

an to

shift

serio

us

patie

nts i

n ca

se o

f stru

ctur

al/n

on-

stru

ctur

al d

amag

e ho

spita

ls.

Det

aile

d ev

acua

tion

plan

, hum

an

reso

urce

s, Su

pplie

s and

tran

spor

-ta

tion

Hum

an re

sour

ces (

hosp

ital

team

/loca

l vol

unte

ers/a

rm

forc

es)

Adm

Offi

cer/

CM

O

Doc

umen

tatio

n of

min

imum

dat

a se

ts

Pr

e-ho

spita

l car

e re

port

Patie

nt re

fusa

l rep

ort

Inci

dent

repo

rt

Repo

rting

form

sA

dm O

ffi ce

r/C

MO

Ass

essm

ent o

f hos

pita

l dam

age

Form

hos

pita

l dam

age

asse

ss-

men

t tea

m

A

sses

smen

t for

mA

dm O

ffi ce

r/C

MO

Mas

s med

ia m

anag

emen

t

D

evel

op P

olic

y an

d gu

idel

ines

on

deal

ing

with

mas

s med

ia

Po

licy

and

guid

elin

es

on d

ealin

g w

ith m

ass

med

ia

Adm

Offi

cer/

CM

O



Tran

spor

t man

agem

ent

Alte

rnat

ive

trans

port

arra

nge-

men

t

A

mbu

lanc

es/P

ool

vehi

cle

Adm

Offi

cer/

CM

OEn

viro

nmen

tal h

ealth

man

age-

men

t

G

uide

lines

on

envi

ronm

enta

l he

alth

man

agem

ent

H

R (E

nviro

nmen

tal

heal

th o

ffi ce

r, m

unic

i-pa

l per

sonn

el/fi

nanc

e/Eq

uipm

ent

Adm

Offi

cer/

CM

O

Men

tal h

ealth

man

agem

ent

Gui

delin

es o

n de

aling

with

psy

cho-

socia

l iss

ues

P

sych

iatri

c w

ard,

psy

-ch

olog

ist

Adm

Offi

cer/

CM

O

Dea

d bo

dy m

anag

emen

t

G

uide

lines

on

dead

bod

y m

an-

agem

ent

M

orgu

e, p

rese

rvat

ives

(f

orm

alde

hyde

)A

dm O

ffi ce

r/C

MO

Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rces

Req

uire

dA

ctio

nsW

hat

By

Who

mEs

tabl

ish

HEO

C

Id

entif

y th

e sp

ace

Equi

pped

the o

pera

ting

cent

er w

ith co

m-

mun

icat

ion

line,

com

pute

r and

prin

ter

Nam

e an

d nu

mbe

rs o

f hea

lth se

ctor

co

ordi

nato

r at d

iffer

ent l

evel

Com

pute

r, pr

inte

rs,

Fax

and

com

mun

ica-

tion

faci

litie

s

EMSD

Emer

genc

y Pr

epar

ed-

ness

and

Res

pons

e gu

idel

ines

and

SO

Ps

Faci

litat

e re

leva

nt p

rogr

am to

com

e up

with

gui

delin

es a

nd S

OPs

R

evie

w a

nd e

ndor

se g

uide

lines

and

SO

Ps b

y TA

C

Tech

nica

l exp

ertis

e

G

uida

nce

from

TA

CA

ll Pr

ogra

ms

Tabl

e 19

: Em

erge

ncy

Prep

ared

ness

Act

ion

at N

atio

nal L

evel



Tech

nica

l Sup

port

to th

e D

zong

-kh

ag H

ospi

tals

Prov

ide

supp

ort i

n H

azar

d m

ap-

ping

, vul

nera

bilit

y an

d ca

paci

ty

asse

ssm

ent o

f Dzo

ngkh

ag h

ospi

-ta

ls

Tech

nica

l exp

ertis

e

G

uida

nce

from

TA

CEM

SD

Nee

d A

sses

smen

t

Li

st d

own

the

publ

ic h

ealth

risk

of

kno

wn

haza

rd

Li

st th

e re

sour

ces r

equi

red

for

resp

onse

Nee

d as

sess

men

t for

mEM

SD

Nat

iona

l Inv

ento

ry o

f sup

plie

s

Pr

epar

e na

tiona

l inv

ento

ry o

f su

pplie

s req

uire

d

Inve

ntor

y fo

rmM

SVU

and

D

oMSH

I

Esta

blis

h H

EOC

Id

entif

y th

e sp

ace,

Set

up

com

-m

unic

atio

n ch

anne

l, lis

t of h

eath

se

ctor

coo

rdin

ator

, TV,

Spa

ce fo

r pr

ess r

elea

se

Hum

an re

sour

ces,

Equi

pmen

t and

SOP

for o

pera

ting

HEO

C

EMSD

Stan

dard

repo

rting

Trai

ning

on

how

to u

se re

porti

ng

form

S

tand

ard

repo

rting

fo

rmC

oord

inat

ion

mec

hani

sm

Id

entif

y ro

les a

t diff

eren

t lev

el

and fi x

resp

onsi

bilit

ies

D

evel

oped

con

tinge

ncy

plan

Adv

ocac

y an

d aw

aren

ess

Hea

lth p

rom

otio

n m

ater

ial o

n ris

k of

diff

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t haz

ards

Stra

tegi

es o

n he

alth

pro

mot

ion

for d

ispl

ace

popu

latio

n

P

amph

lets

, pos

ters

HPD



Esta

blis

h Ea

rly w

arni

ng sy

stem

Prov

ide w

eath

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ater

, and

clim

ate

data

, for

ecas

ts an

d w

arni

ngs

Prov

ide a

dequ

ate,

relia

ble a

nd

timel

y G

laci

er L

ake O

utbu

rst F

lood

(G

LOF)

war

ning

s to

safe

guar

d lif

e an

d pr

oper

ty d

owns

tream

.

GLO

F Ea

rly W

arni

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Syst

emD

epar

tmen

t of

Hyd

ro-

Met

Ser

vice

s (D

HM

S)

Ensu

re st

ockp

ile o

f em

erge

ncy

supp

lies a

nd e

quip

men

t

C

ondu

ct n

eed

asse

ssm

ent

Esta

blis

h m

echa

nism

for s

tock

-pi

ling

emer

genc

y su

pplie

s and

eq

uipm

ent

Dev

elop

gui

delin

es o

n m

obili

zatio

n an

d sto

ck-

pilin

g of

em

erge

ncy

supp

ly a

nd e

quip

men

t

DoM

SHI

Esta

blis

h co

ordi

natio

n w

ith In

ter-

natio

nal o

rgan

izat

ion

Esta

blish

coo

rdin

atio

n m

echa

nism

w

ith In

tern

atio

nal o

rgan

izat

ion

Form

hea

lth c

lust

er

TOR

with

inte

rnat

iona

l or

gani

zatio

nEM

SD/M

OH

Tran

spor

tatio

n fa

cilit

ies

Plan

tran

spor

tatio

n fa

cilit

ies s

pe-

cial

ly d

urin

g th

e in

acce

ssib

ility

Am

bula

nces

, Hel

icop

-te

r dur

ing

inac

cess

ibil-

ity, t

ruck

for l

ogis

tic

supp

ly

HH

C/

EMSD

/MSD

Dev

elop

men

t of p

olic

y, p

lan

guid

elin

es a

nd p

roto

cols

Fa

cilit

ate

deve

lopm

ent o

f pol

icy,

pl

an g

uide

lines

, pro

toco

ls b

y pr

ogra

ms t

o su

ppor

t fi e

ld le

vel

activ

ities

Tech

nica

l exp

ertis

e to

de

velo

p po

licy,

pla

n gu

idel

ines

, pro

toco

ls b

y pr

ogra

ms t

o su

ppor

t fi e

ld

leve

l act

iviti

esFu

nd

EMSD



Dzo

ngkh

ag H

ealth

Sec

tor E

mer

-ge

ncy

Con

tinge

ncy

Plan

Faci

litat

e de

velo

pmen

t of

Dzo

ngkh

ag H

ealth

Sec

tor E

mer

-ge

ncy

Con

tinge

ncy

Plan

Fund

Tec

hnic

al su

ppor

tEM

SD

Rep

ortin

g m

echa

nism

and

dis

-se

min

atio

n

La

y do

wn

proc

edur

es fo

r get

ting

emer

genc

y re

late

d fr

om c

omm

u-ni

ty, d

istri

ct, p

olic

e, fi

re o

n da

ily

basi

s

Fund

for l

ayin

g do

wn

proc

edur

esEM

SD

Skill

dev

elop

men

t

D

evel

op tr

aini

ng c

urric

ulum

in

UM

SB

Pr

ovid

e tra

inin

g to

dis

trict

and

B

HU

staf

fs

Fund

ing

Act

iviti

esD

etai

led

Inte

rven

tion

Are

asR

esou

rces

Req

uire

dA

ctio

nsW

hat

By

Who

mB

ack

up su

ppor

t

Act

ivat

e N

atio

nal R

RT

Act

ivat

e su

pply

cha

in m

echa

nism

A

ctiv

ate

ambu

lanc

e m

obili

zatio

n an

d ba

ck u

p m

echa

nism

Hum

an re

sour

ces,

Stoc

k of

logi

stic

sA

mbu

lanc

es p

ool

EMSD

/HH

C

HEO

C

Act

ivat

ion

HEO

C w

hich

incl

ude

repo

rt-in

g an

d co

ordi

natio

n m

echa

nism

E

stabl

ish co

mm

and

cent

er an

d id

entif

y H

ealth

Sec

tor c

oord

inat

or at

diff

eren

t lev

el

Tele

phon

e lin

esFa

xW

alki

e-ta

lkie

Rep

ortin

g fo

rm

EMSD

Tabl

e 20

: Em

erge

ncy

Res

pons

e Act

ion

at N

atio

nal L

evel



Ensu

re c

ontin

uous

an

d ad

equa

te su

pply

of

dru

gs, e

quip

men

t an

d ot

her l

ogis

tics

A

ctiv

ate

the

supp

ly m

echa

nism

Stoc

k of

dru

gs, e

quip

men

t and

oth

er lo

gist

ic

requ

ired

MSQ

U/D

OM

SHI

Mob

ilize

inte

rnat

iona

l su

ppor

t if r

equi

red

A

ctiv

ate

MO

U w

ith in

tern

atio

nal o

rga-

niza

tion

TOR

with

inte

rnat

iona

l or

gani

zatio

nEM

SD



Chapter 4. Role and Responsibilities

4.1 Disaster Management Act 2013As per the DMAB 2013, the health offi cials are represented in the following overall disaster management committees that make easy coordination among different sectors:

a. NDMA under the chairperson ship of the Honorable Prime Minister is being represented by the Secretary of Health who shall update and coordinate regarding health sector response in emergencies and disasters.

b. Dzongkhag Disaster Management Committee under the chairperson ship of the Dasho Dzongda is being represented by the DHO as co-opted member who will in turn update and coordinate health sector response in emergencies and disasters.

c. The Dzongkhag Disaster Management Committee may,if it considers necessary, constitute a sub-committee at the Dungkhag, Thromde or Gewog level wherein health offi cials (Dungkhag Health Offi cer/Medical Offi cer/HA) will represent and coordinate health sector response in emergencies and disasters.

4.2 HealthEmergency Management CommitteeHealth Emergency Management Committee(HEMC)shall bethe highest decision making body in the Health Ministry in any disasters, emergencies and disease outbreaks.

Composition of HEMC

1. Honorable Secretary as the Ex-offi cio Charperson2. Director General/Director, DMS as the Ex-offi cio member3. Director General/Director, DoPH as the Ex-offi cio member4. Director General/Director, DoTM as the Ex-offi cio member



5. Director General/Director, DoMSHI as the Ex-offi cio member6. Chief Planning Offi cer, PPD as the Ex-offi cio member7. Chief Administrative Offi cer, AFD as the Ex-offi cio member8. Chief Human Resource Offi cer, HRD as the Ex-offi cio member9. Medical Superintendent, JDWNRH as the Ex-offi cio member10. Chief Program Offi cer, EMSD as the Ex-offi cio Member

Secretary

Responsibilities of HEMCThe HEMC shall:

a. Advise and update the National Disaster Management Authority on the emergencies situation

b. Directs relevant departments and Regional Hospitals within Health Ministry for responses.

c. Direct Health Ministry for resources mobilizations and allocations.

d. Coordinate with Department of Disaster Management to mobilize resources (technical & fi nancial support) from national and international partners.

e. Approve and endorse Plan, policies, guidelines and SOP son health emergencies as recommended by Technical Advisory Committee (TAC).

Honorable Secretary will act as Incident Commander for any health emergencies.

Director of DoMS and Director of DoPH will serve as Operation Chief.

Director of DoMSHI- Logistic Chief CAO of AFD, MoH – Administration and Finance CPO, PPD, MoH – Public Information and Media

4.3 Technical Advisory Committee (TAC) TAC will comprise of following technical personnel in providing technical assistance to HEOC:



Composition of TAC1. Director General/Director, DMS as an Ex-offi cio Chairperson2. Director General/Director, DoMSHI as an Ex-offi cio member3. Chief Program Offi cer, CDD as an Ex-offi cio member4. Chief Program Offi cer, NCD as an Ex-offi cio member5. Head, RCDC, DoPH as an Ex-offi cio member6. Chief Program Offi cer, Health Promotion Division as an

Ex-offi cio member7. Chief Program Offi cer, EMTD as an Ex-offi cio member8. Chief Engineer, PHED, DoPH as an Ex-offi cio member9. Head, ED, JDWNRH as an Ex-offi cio member10. Chief Executive Offi cer, HHC, EMSD as an Ex-offi cio member11. Program Offi cer, EMSD as an Ex-offi cio member secretary12. Other member may be co-opted as per the need

Responsibilities of TAC TAC shall:

a. Review and recommend health emergency and disaster policy, guidelines, plans, SOPs and job responsibilities.

b. Provide technical assistance to the HEOC on preparedness and response for emergency, disaster and disease outbreaks.

c. Provide ongoing scientifi c advice, direction, feedbacks and technical backstopping to the HEMC.

d. Standardize emergency equipment, medicines and fi rst aid kit for hospitals, BHUs, ambulances and fi rst responders.

4.4 Health Rapid Response Team (RRT) at National levelComposition of RRT:For Disease Outbreak (Communicable disease outbreak &outbreak after Disaster)

For disaster(Both natural man-made Disaster)

1. Program Offi cer, EMSD 1.Program Offi cer, EMSD2. Epidemiologist, MoH 2. Engineer, PHED3. Head, RCDC 3.Engineer, HIDD* Other member may be co-opted in accordance with nature of the disaster or situation (DoPH, DoMSHI, PHED, DHOs and other relevant stakeholders)



Responsibilities of RRTRRT shall:a. Review available information about the events and affected

areas.b. Carry out rapid needs assessments in cooperation with

local authority at the site.c. Assess the immediate needs of the affected community

using standard assessment tools.d. Evaluate health information and assess potential public

health risks for the population.e. Gather and rapidly disseminate necessary public health

information.f. Provide technical backup in disaster-affected areas.

4.5 Health Rapid Response Team at District Level1. District Health Offi cer2. Medical Offi cer/Clinical Offi cer3. Medical Laboratory Technologist/Technician4. Other member may be co-opted as per the need

Responsibilitiesa. Review available information about the events and

affected areas.b. Cooperate with local authority in carrying out rapid needs

assessments in the health sector in order to coordinate the response.

c. Assess the immediate needs of the affected community using standard asessment tools.

d. Evaluate health information and assess potential public health risks for the population.

e. Advise the health sector in carrying out immediate interventions.

f. Gather and disseminate necessary public health information.g. Provide technical backup in disaster-affected areas.



4.6 Emergency Medical Services Division (EMSD)EMSD under DMS is the nodal division for coordinating, facilitating and supporting Dzongkhag to the Community in disaster management activities in all phases of disaster management cycle (before, during and after the disaster). EMSD shall:

a. Facilitate other allied programs to come up with guidelines and SOPSs for emergencies.

b. Build capacity of health workers on emergency and disaster management

c. Assist district health sector to come up with emergency and disaster contingency plan

d. Provide emergency-related direction and advice to the affected sites.

e. Ensure provision of continuous curative services to both OPD and IPD before, during and aftermath of disaster.

f. Institute coordination mechanism and mobilize back-up services (human resources, medical supply fi nancial and transportation) to the disaster areas.

g. Recommend priorities for allocation of resources.h. Manage Health Emergency Operating Centre.i. Provide national treatment & management Protocols as

per the standard treatment guidelines and Emergency Medical and Trauma Care manuals.

j. Delegate authorization to mobilize manpower from the non-affected areas.

k. Provide skill &capacity development in collaboration with training institutes.

l. Received early warning system from RCDC, DHMS and Districts and activate HEOC.

m. Conduct simulations and mock drills on different types of disasters and emergencies’ contingency plans.



4.7 Health Help CenterHHC under EMSD shall have following responsibilities:

a. Mobilize ambulances to the disaster affected areas and arrange back up ambulance services from nearest unaffected areas.

b. Timely communication of emergencies and disasters to the nodal agencies.

c. Provide health advice and counseling through toll free number 112.

d. Ensure toll free number is functioning at all times.

4.8 Department of Medical Supply and Health Infrastructurea. Develop guidelines for mobilization of Medical Supplies

(drugs, equipment and transportation).b. Ensure availability and timely supply of adequate medical

supplyc. Develop standard for building disaster resilent infrastructure

4.9 Department of Public Health Public Health emergencies especially those events caused by outbreaks of emerging diseases (SARS, H1N1, H5 N1, H7N9, MeRS-CoV, Ebola, Zika virus) pose serious threat to national and international health security. Effective preparedness can ensure rapid Public Health emergency response and minimize negative health, economic and social impacts of communicable diseases.In the event of large-scale natural disasters like earthquake, there are probabilities of secondary disaster like disease epidemics. Therefore, Public Health should play lead role in disease prevention and containment through the following responsibilities:

Emergency Preparedness a. Conduct communicable disease risk mapping to reduce

the risk of diseasesb. Strengthen early detection of outbreaks of diseases and

public health emergencies through event based and indicator surveillances.



c. Strengthen rapid response to diseases by developing SOPS and guidelines for surveillance, reporting and outbreak response

d. Build capacity for disease outbreak response in coordination with EMSD, DMS.

e. Strengthen effective preparedness for responding to disease outbreaks by Mapping out resources for responding to emergencies.

f. Build sustainable partnerships within and outside the country.

Emergency Responsea. Coordinate with EMSD to assess the public health risk of

the disaster affected areab. Prevent communicable diseases & non-communicable

conditions in the disaster-affected area.c. Mobilize back up resources (fi nancial, human, supplies &

equipment).d. Guide and coordinate among Public Health Programs in

executing the response actions.

4.10 Dzongkhag Health Sector Preparedness phase

a. Develop Health Sector Dzongkhag Hazard Maps including hazard mapping in terms of geographical impact of past emergencies, disease epidemiology and mapping of health facilities.

b. Develop a Dzongkhag Disaster Contingency Plan.c. Develop guidelines/instructions for fi eld level support activities.d. Establish Emergency Control Room in DHO's offi ce.e. Liaise with HHC for ambulance services.f. Plan for surge capacity (manpower, resource, etc.).g. Plan for fi nancial and logistics mobilization.h. Tie-up with nearby hospital for backup services.i. Conduct advance emergency transport needs assessment.

Response Phasea. Activate Dzongkhag health sector emergency contingency

plan.



b. Coordinate with Dzongkhag Disaster Management Committee.c. Emergency Related Reporting & Monitoring of emergency

situation.d. Assess impact of emergency by District HRRT.e. Activate DHRRT to support BHU and community.f. Report and monitor emergency situationg. Provide technical Support to BHU and Village level

activities through Rapid Response Team

4.11 HospitalsPreparedness

a. Conduct hospital vulnerability assessmentb. Conduct capacity assessment c. Maintain supply inventory and storaged. Develop Hospital Emergency Contingency plan including

security plan and SOP for emergency operatione. Establish line of communicationf. Plan for staffs + stock, mobilization from the nearby Health

centerg. Link existing staff, dept. of power, dzongkhag engineering

and municipalh. Set up Emergency Medical Team – Rapid Response Teami. Review required logisticsj. Monitor ongoing emergency response operationsk. Exercise and mock drill

Response Phasea. Activate hospital emergency contingency plan in emergencies

and disasters b. Monitor utilization of the available resources and prevent

confl ict of rolec. Activate the hospital control roomd. Activate selected area or zone to be used for Hospital

level classifi cation (triage) and identifi cation (tagging) of casualties prior to their removal to different wards or to other medical care center



e. Administer medical care including stabilization, hemorrhage control, clearing air passages, and blood transfusion as per triaging system.

4.12 BHUs:Preparedness Phase

a. Identify the disaster riskb. Develop BHU Emergency Contingency plan including

BHU safety levelc. Build human resource capacity for communitiesd. Request for necessary medical supplies and logistic supporte. Strengthen the patient referral systems from community

BHU to dzongkhag hospitalsf. Strengthen line of communication with nearest BHUS

and hospitals

Response Phasea. Immediate notifi cation/ reporting of the event to concern

DHO and hospitalsb. Health needs assessmentc. Select an area or zone to be used for fi rst-level classifi cation

(triage) and identify (tagging) of casualties prior to their transfer to medical care centers

d. Provide fi rst aid at sitese. Transport disaster patients/causlaties to the nearest BHU

and hospitals f. Identify site for fi eld hospital and establish Incident command

postg. Coordinate with Search & Rescue, security personnel and

other sectors h. Mobilize additional resources including community

support if requiredi. Verify rumor and report j. Establish and conduct active disease surveillance and

report the incident to DHO/MoH



CHAPTER 5: COORDINATION, RESOURCE MOBILIZATION AND MONITORING

5.1 Coordination and Communication Mechanism The response operation for disasters type II and III will be directed by NDMA. NDMA will have 24 hours National Emergency Operating Center (NEOC) based in Thimphu. In relation to epidemics, health sector will trace early warnings and take necessary actions through HEOC. HEOC is expected to work in close collaboration with NEOC. In the small-scale disasters or disaster type I, the local authorities will meet the basic needs.

The coordination and channel of communication between the agencies and among the health sector and other relevant partners are given in the fi gure number 3.

5.1.1 Health Emergency Operation Centre (HEOC)a. HEOC is a central command, control and coordination center

for the effective administration of emergency preparedness and disaster management in any emergency situation.

b. HEOC will be managed and operated by EMSD under the directives of Health Emergency Management Committee (HEMC) during the times of emergencies and disasters

c. The Honorable Secretary being the Chairperson of the HEMC will take matter which requires higher intervention to the NDMA.

d. HEOC will host necessary resources and data for effective coordination and response during emergencies. During the emergency, the centre will function 24/7 with trained and dedicated staff.

e. HEOC will be equipped with communication material such as telephone, mobile, internet, satellite phones, etc. In addition, it will consist of all information technology



for communicating and coordinating with NEOC, Central Referral Hospitals, Regional hospitals, etc. so that HEOC can update data regularly and coordinate disaster response appropriately.

f. HEOC will also play a pivotal role in maintaining operational linkages between health sector preparedness and response mechanism and the existing and emerging institutions/mechanisms of community, district, regional and the central level disaster risk management initiatives.

Figure 3: Coordination and Communication Mechanism



5.1.2 Emergency Medical Service Divisiona. At the national level, EMSD shall coordinate with HHC,

Dzongkhag Health Sectors, Gewogs, DDM and establish mechanism for network with police, fi re, Desuups, volunteers. Similarly, coordination mechanism shall be established at Dzongkhag level by DHO and Gewog level by Health Assistant

b. Facilitate establishment of similar facilities at Dzongkhag levels in a phase manner to facilitate appropriate, adequate and timely health sector emergency/disaster response and relief operations.

c. Assist operation center at different levels for timely fl ow of information from the disaster-affected areas.

d. EMSD shall dispatch Rapid Response Team (RRT) from national level if the disaster is beyond the coping capacity of the Dzongkhag.

e. Dzongkhag shall dispatch rapid response team from Dzongkhag level if the disaster is beyond the coping capacity of the Drungkhag or Gewog concerned.

5.1.3 Media focal pointa. The Chief Planning Offi cer (CPO), Policy and Planning

Division of the ministry shall be the media spokesperson for disaster and emergency at the national level.Media spokesperson shall appoint relevant person to talk on the technical aspect of the emergencies and disasters if required.

b. DHO shall act as media spokesperson for the Dzongkhag Health Sector.

c. EMSD shall provide information received through HEOC to CPO from time to time.

5.2 Financial and Resource Mobilization at National Levela. NDMA and Ministry of Finance shall ensure adequate fi nancial arrangement to response to health emergencies and disasters as empoweredby the DM Act, 2013 (Chapter 8, Section 80-91).



b. Based on nature of disaster, relevant department (DoPH/DoMS) will prepare budgeted plan and EMSD will put it up to HEMC for fund mobilization from national or international level.

c. Further, MoH shall:• Mobilize resources from nearby health facilities as per

the approved mechanism and guidelines.• Assist affected Dzongkhag for additional drugs and supplies.• Establish mechanism on resource mobilization with

national, international and non-governmental organization• Secure SEARHEF (WHO) budget allocated for disaster

and emergency.• Any kind of materials (in-kind) and fi nancial aid related

to health will be taken over by the ministry through DDM with an information to the GNHC and MoF.

5.3 International Emergency Relief Any foreign health relief assistance by international organisations or countries will be routed through MoH. International emergency relief should complement, not duplicate the measures taken health sector in the country.

Donors will be informed about what is needed. This is as critical as giving specifi cations for requirement. Guidelines will be circulated to all the potential suppliers of assistance, diplomatic and consular representatives abroad to prevent ineffective contributions and coordination.

5.4 National Assistance to Disaster Affected Countries AbroadThe ministry shall form a team known as Bhutan Medical Assistance Team (BMAT) to be dispatched to other countries in case of disasters as part of Bhutan’s humanitarian initiatives and support. The criteria and terms of reference for selection of health professionals for the BMAT shall be developed accordingly.



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District health Offi cer (DHO) shall be responsible to establish Emergency Incident Command System in the districts and at the site during Epidemic and Disasters.Sl. No Districts Name of the DHO Contact Numbers

1 Mongar DekiPhuntsho 176735792 Lhuntse UgyenDorji 176687193 Trashigang Gang Dorji 176669244 Trashiyantse SingyeDorji 178123535 Pemagatshel JigmeKelzang 176063066 SamdrupJongkhar PemaTshewang 178123537 Sarpang TsheringPenjor 179197798 Chukha GopalHingmang 176058249 Tsirang TashiDawa 1715167610 Paro Dechenmo 1772003111 Thimphu GyemboDorji 1760058212 Bumthang KingaGyeltshen 1768644013 Trongsa DolleyTshering 1760995414 Wangdiphodrang NamgayDawa 7762914515 Punakha TashiNorbu 1716378316 Haa Samten 7722449517 Samtse ThinlayChoden 1770895818 Dagana DorjiWangchuk 1762312119 Gasa RinchenDorji 1768410020 Zhemgang Karchung 17652070

*All DHO should update their latest workplace and contact num-ber information annually



Table 23: Incident Report Template (Could be used by VHW or any fi rst responder during response)Date: Place of Occurrence:

Name of the fi rst Responder: Designation:

Sl. No.

Actions

1 SituationWhat has occurred? How many Affected? How many died and injured?What are the sources of the emergency?( contaminated water, rain, broken dam etc)

2 ResponseWhat has been done? By whom?

3 What are the gaps?



Table 24: Situation Report Template(to be fi lled by BHU level - HA/GNM)Date: Place of Occurrence:

Name of the Responder: Designation:

Sl. No.

Actions

1 Highlights: What are the main highlights? (# of people dead, missing, in-jured etc.)Current Situation: Are there any updates on the situation?

2 Response: What is the main response? Who is respond-ing, and in what area? What are the resources on the ground?

3 Gaps: What are the main gaps in response? What are the plans to fi ll the gaps?

4 Next Steps: What are the next steps envisioned?



REFERENCES

1. Department of Disaster Management. Disaster Management Act of Bhutan. 2013.

2. Department of Disaster Management. Draft Contingency Planning Guide for Bhutan. 2014.

3. IFRC. Contingency Planning guide. 2012. http://www.ifrc.org Acessedn20 September 2015.

4. IFRC. Disaster Response and Contingency Planning guide. 2007. http://www.ifrc.org Accessed 20 September 2015.

5. IASC. Guidance note on using the cluster approach to strengthen humanitarian response. 2006.

6. MoH. National Health Policy Bhutan. 2010.7. MoH. Health Sector Emergency Preparedness and

Disaster Response Plan Nepal. 2003.8. WHO. Mass Casualty Management System. Strategies

and guidelines for building health sector capacity. 2007.9. UNHCR. Contingency Planning. 2011.10. WHO. Guidance for health sector assessment to support

the post disaster recovery process. 2010.11. MOH. Emergency Health Contingency Plan Lebanon.

2012.12. WHO. Global Assessment of National Health Sector

Emergency Preparedness and Response. 2008.13. WHO. Health Emergency Risk Management Framework

and Improving Public Health Preparedness. 2012.14. WHO. Emergency and Humanitarian Action. Country

Report. (na).15. UNDP. Situation Report. Earthquake in Bhutan. 200916. WHO. Global Assessment of National Health Sector

Emergency Preparedness and Response. 2008.



17. SEARO. Initial Seismic Vulnerability Assessment of Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. 2012.

18. SEARO. Initial Seismic Vulnerability Assessment of Trashigang District Hospital Trashigang, Bhutan. 2013.

19. Lavonne M. Adams. Exploring the Concept of Surge Capacity. The Online Journal of issues in Nursing. 2009. http://www.nursingworld.org/ Accessed 8 May 2016.

20. The Sphere Project. Humanitarian Charter and Minimum Standards in Humanitarian Response. 2011.

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