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Pocket EMERGENCY

Tool3rd Edition


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Pocket EMERGENCY Tool

iPart 1 Part 2 Part 3POLICIES ANDPROCEDURES

PROGRAM GUIDELINESAND TECHNICAL NOTES

REFERENCE NOTES, TOOLSAND SAMPLE

CONTENTS

Acknowledgements .......................................................................viiIntroduction .....................................................................................1Abbreviations and Acronyms ..........................................................3

Policies and Procedures ......................................................5Overview of Health Emergency Management ...............................7

Vision and Mission of the Health Emergency Management Staff(HEMS) ...........................................................................................7General Functions of HEMS ............................................................7T.R.A.I.T of a Health Emergency Manager/Coordinator ....................9Role of Hospitals in Health Emergency Management .....................10Role of Centers for Health Development in EmergencyManagement ................................................................................10

Cluster Approach............................................................................13Aims of the Cluster Approach .......................................................13Levels of Operation .......................................................................13Current Work of the Global Health Cluster ...................................14Cluster Approach in the Philippine Disaster Management System ..16Roles and Functions of Government Cluster Lead Agencies ...........17

Program Guidelines and Technical Notes ........................21EMERGENCY PREPAREDNESS.............................................................23

Health Emergency Management Planning...................................23Components of the Health Emergency Preparedness, Response,


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ii Part 1POLICIES ANDPROCEDURES

Part 2PROGRAM GUIDELINESAND TECHNICAL NOTES

Part 3REFERENCE NOTES, TOOLSAND SAMPLE

Recovery Plan ...............................................................................23Emergency Preparedness (10 Ps) ...................................................24Emergency Planning Process .........................................................27

Coordinating with Other Agencies ...............................................29Establishing Good Working Relationships with Other Groups ........29

5 Ps of Facilitation ........................................................................30Organizing Response Teams ..........................................................31Further Deployment of Response Teams ........................................34

Safe Hospitals .................................................................................36Objectives .....................................................................................36

Basic Facts ....................................................................................36

EMERGENCY RESPONSE .....................................................................39Response Phase ..............................................................................39

Steps In Responding To Emergencies .............................................39Response Plan ...............................................................................41

Emergency Operations Center ......................................................42General Attributes ........................................................................42Functions of HEMS-OPCEN ...........................................................44

Integrated Code Alert System .......................................................46

General Guidelines .......................................................................46Conditions for Code Alert Activation ............................................47Human Resource Requirements for Code Response .......................49


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iiiPart 1 Part 2 Part 3POLICIES ANDPROCEDURES



Rapid Health Assessment ...............................................................53Key Questions ...............................................................................53Situation Report Outline ...............................................................53

Epidemiology and Surveillance .....................................................57Epidemiologic Methods of Emergency Management .....................57

Surveillance System Development .................................................58

Mass Casualty Management ..........................................................61Mass Casualty Incident .................................................................61Components of Field Management ...............................................62Triage and Stabilization .................................................................68

Transfer Organization and Evacuation ...........................................75Incident Management System .......................................................76Critical Incident Management .......................................................80

Management of Temporary Settlements ......................................84Overview of Temporary Settlements ..............................................84

Settlement Planning ......................................................................86Organizing the Affected Population .............................................87Determining Settlement Needs .....................................................88Establishing Health Services ..........................................................88Reporting, Documentation and Coordination ................................89

Prevention and Control of Communicable Diseases ....................90Vaccine Preventable Diseases ........................................................90Food and Water-borne Diseases ....................................................91Vector-borne Diseases ...................................................................91


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Respiratory Diseases ......................................................................92Zoonotic Diseases .........................................................................92Treatment Protocol for Selected Diseases .......................................93Preventive Measures for Common Diseases ...................................96

Nutrition in Emergency................................................................100

Key Concepts .............................................................................100Nutrition Preparedness ................................................................102Nutritional Assessment and Surveillance ......................................109Nutrition Activities and Key Services During Disaster....................112Post-Disaster Nutrition Activities ..................................................116

Water Supply, Sanitation and Hygiene (Wash) .........................118Hygiene Promotion .....................................................................118Water Supply ..............................................................................120Excreta Disposal ..........................................................................130Vector Control ............................................................................133Solid Waste Management ...........................................................137

Drainage .....................................................................................141

Mental Health and Psychosocial Support ...................................142Domains and Minimum Responses in Emergencies ......................142Steps in Promoting MHPSS..........................................................147Early Social Interventions for Children and Families ......................150

Guidelines for Delivering Psychological First Aid ..........................153Psychosocial Concerns for Disaster Workers ................................154

Management of the Dead and the Missing Persons ..................156


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Search and Recovery Operation ...................................................156Identication of the Dead Operation ...........................................157Final Arrangement for the Dead ..................................................158Management of the Missing Persons Operation ..........................159Management of the Bereaved Families ........................................160Other Concerns in Cases of Mass Fatalities .................................161

Logistics and Supplies Management ...........................................168Basic Principles in Logistics Management ....................................168Supplies and Equipment .............................................................169Transportation ............................................................................170Communication ..........................................................................171

Security and Well-Being ..............................................................171Donations ...................................................................................172

Risk Communication ....................................................................176Principles of Risk Communication ...............................................176Elements of Risk Communication ................................................177

Steps in Communicating Risks ....................................................179Media Management ...................................................................181

Recovery and Reconstruction ......................................................185Response to Development Goals .................................................188

Reference Notes, Tools and Samples .............................189Emergency Manager Deployment Checklist...............................191Rapid Health Assessment Forms ..................................................192

HEMS Form 1 .............................................................................192


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Rapid Health Assessment .............................................................. 192Rapid Health Assessment for Mass Casualty Incident ................... 195Rapid Health Assessment for Outbreaks ......................................197HEMS Form A .............................................................................199

Reference Values for Rapid Health Assessment and

Contingency Planning ..................................................................200Estimating Population Size ..........................................................200Emergency Food Requirements ...................................................200Basic Needs ................................................................................201Examples of Rations for General Food Distribution ......................202Essential Primary Health Care (PHC) Activities ..............................203

Vaccination .................................................................................203Health Personnel Requirements ...................................................203Health Supplies Requirements .....................................................204Cut-off Values for Emergency Warning .......................................204NCHS/WHO Normalized Reference Values for Weight-for-Length and Weight-for-Height by Sex (BOYS) ..............................205

NCHS/WHO Normalized Reference Values for Weight-for-Length and Weight-for-Height by Sex (GIRLS) ..............................208Decision Framework for Implementing Selective FeedingPrograms ....................................................................................213Supplementary Feeding Program Admission Criteria ....................216Classication of Acute Malnutrition ............................................216

Summary of Classication Systems for Food Crises and Famineswith Thresholds ..........................................................................217Summary Table on Projecting Psychosocial and Mental HealthAssistance ...................................................................................219


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Radio Procedures..........................................................................220Conversion Table ..........................................................................221Websites ........................................................................................224Emergency Call Number Directory ..............................................227Centers for Health Development ................................................228Metro Manila Hospitals ...............................................................230

Regional Hospitals........................................................................232References ....................................................................................237


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viii Part 1POLICIES ANDPROCEDURES



Acknowledgements

The third edition of the Pocket Emergency Tool is a projectof the Department of Health Emergency Management Staff(DOH-HEMS), with support from the World Health Organization Regional Ofce for the Western Pacic Region (WHO-WPRO).

Development of the third edition of the Pocket EmergencyTool was done through the collaborative efforts of Dr. Walter V.Laurel, under the technical supervision of Dr. Arturo M. Pesiganof the Emergency and Humanitarian Action (EHA) of the WHO-WPRO and Dr. Carmencita A. Banatin, DOH-HEMS director.Acknowledgment is mainly given to Dr. Marilyn V. Go, Dr.Gerardo P. Medina, Dr. Arnel Z. Rivera, Engr. Aida C. Barcelona,Ms. Susana G. Juangco, Ms. Florinda V. Panlilio, Dr. Lester SamA. Geroy, Ms. Glessie E. Salajog, and the rest of the DOH-HEMSstaff. Lay-out and cover design done by Mr. Zando F. Escultura.

The rst and second editions, which paved the way forthe development of the PET 3rd edition, were made possiblethrough the efforts of the following individuals: Dr. ArturoPesigan, Dr. Carmencita Banatin, Dr. Emmanuel Prudente, Dr.Marilyn Go, Dr. Teodoro Herbosa, Dr. Josephine Hipolito, Ms.Florinda Panlilio, Dr. Arnel Rivera, Dr. Edgardo Sarmiento, Dr.Xiangdong Wang, Mr. Zando Escultura, Engr. Russel Abrams,Sr. Shigeki Asahi, Dr. Agnes Beegas, Mr. Miguel Enriquez,Mrs. Guia Flores, Dr. Raquel Fortun, Dr. Camilla Habacon, Dr.


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ixPart 1 Part 2 Part 3POLICIES ANDPROCEDURES



Lourdes Ignacio, Mrs. Elizabeth Joven, Dr. Susan Mercado, Dr.Daniel Morales, Dr. Jean Marc Olive, Dr. Hitoshi Oshitani, Dr.Manuel Quirino, Dr. Lilia Reyes, Dr. Enrique Tayag, Dr. YoshiroTakashima, Mrs. Zen Delica Willison, Mr. Robin Willison, and Dr.Ladislao Yuchongco, Jr.


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1Part 1 Part 2 Part 3POLICIES ANDPROCEDURES



Introduction

Recurring disasters throughout the years have madeFilipinos realize that these emergencies are an integral part ofour lives. These are reinforced by occurrences of destructivetyphoons, killer earthquakes, massive ooding, devastatingvolcanic eruptions, as well as recent sea tragedies and ongoingarmed conicts. Amidst these crises, human survival and healthare among the common goals and measures of success of allhumanitarian endeavors.

The goal of the Department of Health (DOH) through theHealth Emergency Management Staff (HEMS) is to prevent orminimize the loss of lives and illnesses during emergencies anddisasters in collaboration with government, business and civilsociety groups. The main purpose of this pocket tool is to helpguide and prepare health sector professionals in the eld in theevent that an emergency occurs. For the third edition of thePocket Emergency Tool, recent policies and procedures fromthe World Health Organization, Department of Health, NationalDisaster Coordinating Council and other local and internationalorganizations involved in disasters and emergencies, as wellas latest updates from the 8th National Training Course onPublic Health and Emergency Management in Asia and Pacic(PHEMAP), have been added to make it more comprehensive andup-to-date for eld users, volunteers and health professionals.This booklet also aims to provide essential pointers and recent


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2 Part 1POLICIES ANDPROCEDURES



technical guidelines from emergency preparedness to responseto recovery in a user-friendly format that will come in handywhen faced with tragedy.

This pocket tool, however, neither provides nor claims tobe the denite and only guideline to follow in emergencies.

Thus, references to complementary documents and websites,where more details can be found, are provided in the booklet.Also, because every disaster is unique, some of the suggestedprocedures may need to be tailored to local conditions andparticular situations.

In summary, the third edition of the Pocket Emergency Toolwas conceived from lessons learned from recent disasters andemergencies that affected the country and the Western PacicRegion. Indeed, the success of this guide depends largely onthe dynamics of its use and the tireless efforts of its users toimprove it. It is our ultimate goal to impart lessons learned to

every individual who at some point had experienced adversityand that health emergency preparedness had become a way oflife.

We prevent disasters if we manage emergencies.


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Abbreviations and Acronyms

AO Administrative OrderBFAD Bureau of Food and DrugCD Centers for Disease Control and Prevention (USA)CHD Center for Health Development

CMR Crude Mortality RateCSR Communicable disease Surveillance and ResponseDFA Department of Foreign AffairsDN Department of National DefenseDOH-HEMS Department of Health-Health Emergency

Management Staff

DOTC Department of Transportation andCommunication

DPWH Department of Public Works and HighwaysDSWD Department of Social Works and DevelopmentEHA Emergency and Humanitarian UnitEMS Emergency Medical Services

EOC Emergency Operations CenterEPI Expanded Program of ImmunizationER Emergency RoomIASC Inter-Agency Standing CommitteeIEC Information, Education and CommunicationILO International Labor Organization

IOM Internal Organization for MigrationISDR International Strategy for Disaster ReductionHEICS Hospital Emergency Incident Command SystemLGU Local Government Unit


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MCI Mass Casualty IncidentMHPSS Mental Health and Psychosocial SupportMUAC Mid-Upper Arm CircumferenceNBI National Bureau of InvestigationNCDPC National Center for Disease Prevention and ControlNCHFD National Center for Health Facilities and Development

NCHP National Center for Health PromotionsNDCC National Disaster Coordinating CouncilNEC National Epidemiology CenterNEHK New Emergency Health KitNGO Nongovernmental organizationNNC National Nutrition Council

NPDEP Nutrition Preparedness in Disasters andEmergencies Plan

OCD Ofce of Central DefenseOpCen Operations CenterPHC Primary Health CarePNRC Philippine National Red Cross

RDCC Regional Disaster Coordinating CouncilSARS Severe Acute Respiratory SyndromeUN United NationsUNDP United Nations Development ProgramWASH Water, Sanitation and Hygiene PromotionWHO World Health Organization

WHO-WPRO World Health Organization Ofce for theWestern Pacic Region

WFP World Food ProgramWMD Weapons of Mass Destruction


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Part 1

Part 2 Part 3PROGRAM GUIDELINESAND TECHNICAL NOTES

REFERENCE NOTES, TOOLSAND SAMPLE 5

Part 1POLICIES ANDPROCEDURES

Policies andProcedures


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Overview of Health Emergency Management

Vision and Mission of the Health EmergencyManagement Staff (HEMS)

Vision : Asias model in health emergency managementsystem

Mission : Ensure a comprehensive and integrated health sectoremergency management system

General Functions of HEMS

1. To lead in the formulation of a comprehensive, integratedand coordinated health sector response to emergenciesand disasters

2. To ensure the development of competent, dynamic,committed and compassionate health emergencyprofessionals equipped with the most modern and state-of-the-art facilities comparable to world standard

3. To be the center of all health and health relatedinformation on emergencies and disasters


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HEMS Preparedness Division

Function : To develop policies, guidelines, protocols and plans,as well as to conduct monitoring, evaluation, and researchactivities to improve disaster management operation.

Policy Development Planning and Program Development Partnership and Coordination Advocacy and Human Resource Development Information and Management System Research and Best Practices

HEMS Response Division

Function : To monitor, integrate, and coordinate all healthresponses to emergencies and disasters, assist, augment and

provide logistical support, report, document, and serve as therepository of all data.

Operation Center Logistic Mobilization Information Management System

Coordination and Networking


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T.R.A.I.T of a Health Emergency Manager/Coordinator

Take the lead within the community in:

Health coordination and networking Rapid health assessment

Disease control and prevention Epidemiologic and nutrition surveillance Epidemic preparedness Essential medicines management Physical and psychosocial rehabilitation Health risk communication

Forensic concerns and management of mass casualties

Record and re-evaluate lessons learned to improve preparednessin the future

Assess and monitor health and nutrition needs so that they areimmediately dealt with

Improve health sector reform and capacity building bynetworking

Tend and protect the practice of humanitarian access, neutralityand protection of health systems in emergency situations


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Role of Hospitals in Health Emergency Management

1. Observe all requirements and standards (hospitalemergency plan, HEICS, Code Alert System, etc.) neededto respond to emergencies and disasters.

2. Ensure enhancement of their facilities to respond to the

needs of the communities especially during emergencies.3. Network with other hospitals in the area to optimize

resources and coordinate transferring of victims to theappropriate facility.

4. Report all health emergencies to the Operation Center,and document all incidents responded.

Role of Centers for Health Development inEmergency Management

(Based on DOH Administrative Order 168, s.2004)

1. Serve as the DOH Coordinating in their region.2. Maintain updates/hazard and vulnerability assessment of

their catchment areas.3. Observe all requirements and standards needed to

respond to emergencies (Regional Emergency Plan).4. Organize health sector in the region and provide

mechanism for coordination and collaboration.5. Maintain operation center as regional repository of events


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for the health sector. Identify an ofcial spokesperson toanswer concerns by the public and the media.

6. Report to the Central DOH (HEMS) for all emergenciesand disasters and any incident with the potential ofbecoming an emergency.

7. Document all health emergency events and conduct

researches to support policies and program development.

At the Center for Health Development (CHD) level:

The following information should be readily available for

reference and may be compiled in collaboration with otherpartners (government and non-government units). Thisinformation must be updated regularly:

Disaster prole of the region Population size and distribution

Topography and maps showing communication lines Epidemiologic prole of the region Location of health facilities and the services they provide Location of potential evacuation areas Location of stocks of food, medicine, health and water

treatment and other sanitation supplies in government

stores, commercial warehouses and international agenciesand major NGOs

Key people and organizations who would be responsiblefor/active relief (contact phone numbers and addresses)


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Individuals with special competencies and experience whomay be mobilized on secondment from their institutionsor as consultations in case of need (contact phonenumbers and addresses)

A roster of regular resource persons ready to translatetechnical information materials into local dialect (e.g.

traditional healers, indigenous health workers, barangaycaptain, etc.)

The following resources should be readily available for use atall times:

1. Vehicles2. Communications equipment3. Back-up power supplies4. Computer, printers, facsimile and photocopying machines5. Water testing sets

6. Food supplements7. Temporary shelter capacities8. Funding requirements9. Personal protective equipment


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Cluster Approach

The UN introduced the Cluster Approach in itsHumanitarian Reform Agenda and is envisioned tostrengthen system-wide preparedness and technicalcapacity to respond to humanitarian emergencies bydesignating global Cluster Leads.

Aims of the Cluster Approach

To improve the predictability, timeliness and effectivenessof humanitarian response

To strengthen preparedness and capacity to respond tohumanitarian emergencies by ensuring leadership andaccountability in key areas

At country level, the aim is to ensure a more coherentand effective response by mobilizing groups of agencies,organizations, and NGOs to coordinate, share informationand respond in strategic manner

Levels of Operation

1. Global level f Strengthen system-wide preparedness and technical

capacity to respond to humanitarian emergencies f Designate global cluster leads f Ensure predictable leadership and accountability in all


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the main sectors or areas of activity

2. Country level f Ensure more coherent and effective response f Mobilize groups of agencies, organizations and

NGOs to respond in strategic manner across all key

sectors or areas of activity each sector having clearly adesignated lead

f In support of existing government coordinationstructure and emergency response mechanisms

Current Work of the Global Health Cluster

1. Coordination and Management f Stakeholders analysis, strategic planning, joint action

plans, gap lling f Health aspects of the recovery phase

f Advocacy f Capacity Building of National Stakeholders

2. Information Management f Inter-cluster rapid assessment tool with

accompanying denitions and guidelinesf Comprehensive assessment tool with assessment,

monitoring, and tracking systems f Mainstreaming health information with larger

humanitarian IM system3. Rosters and Stockpiles


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f Selection, training and rostering of health cluster eldcoordinators

f Regional stockpiles of health supplies with necessarylogistic support

4. Capacity Building f Guidance to strengthen national capacity in

emergency preparedness, response and recovery

5. Operational Supportf Global working relations within the health cluster,

between global clusters, and with country clusters f Advocacy, resource mobilization, trainings f Benchmarks/indicators for and evaluations of the

impact of the cluster approach f A pocket book of simplied cluster guidance and

tools with annexes of full cluster documents/ndings f Library/database of emergency health documents


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Cluster Approach in the Philippine DisasterManagement System

In May 10, 2007, the National Disaster Coordinating Councilissued Circular No. 05, s-2007 entitled Institutionalization ofthe Cluster Approach in the Philippine Disaster Management

System, Designation of Cluster Leads and their Terms ofReference at the National, Regional and Provincial Level

Cluster Government Country TeamLEAD COUNTERPART

1. Nutrition DOH UNICEF2. WASH DOH UNICEF3. Health DOH WHO4. Emergency Shelter DSWD IFRC/UN Habitat5. Camp Management OCD/PDCC IOM6. Protection DSWD UNICEF

7. Early Recovery OCD UNDP8. Logistics OCD WFP9. Food DSWD WFP10. Agriculture DA FAO11. Livelihood DSWD ILO12. Psychosocial * DOH/DSWD IASC

* DSWD evacuation centersPNRC communityDEPED schools and children in evacuation centersDOH psychosocial assessment; referral system; local executives,military, responders, and victims; treatment of mental disorders


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Roles and Functions of Government Cluster LeadAgencies

Cluster Government Lead

Food and NFIs Department of Social Welfare andDevelopment (DSWD)

Camp/IDP Management, EmergencyShelter and Protection

DSWD

Permanent Shelter and Livelihood DSWD

WASH, Health, Nutrition, andPsychosocial Services

Department of Health (DOH)

Logistics and EmergencyTelecommunications

Ofce of Civil Defense/NDCCOperations Center

Education Department of Education

Agriculture Department of Agriculture

Early Recovery Ofce of Civil Defense

NDCC Memorandum No. 12, s. 2008 Amendment to the NDCC Circular Nos. 5, s. 2007and 4, s. 2008 re Institutionalization of the Cluster Approach in the Philippine DisasterManagement System, Designation of Cluster Leads and their Terms of Reference at theNational, Regional and Provincial Levels, October 6, 2008


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Roles and Responsibilities of Cluster Leads

1. National Levela. Inclusion of humanitarian partners in the cluster

taking stock of their mandates and program prioritiesb. Establishment and maintenance of appropriate

humanitarian coordination mechanisms at thenational level

c. Attention to priority cross-cutting issuesd. Needs assessment and analysise. Emergency preparednessf. Planning and strategy development

g. Application of standardsh. Monitoring and reportingi. Advocacy and resource mobilization

j. Training and capacity building

The NDCC Executive Ofcer and Administrator, OCD shall function as Chair of all Cluster Leads and may call ameeting of all Cluster Leads at the national level as maybenecessary. Furthermore, the NDCC Executive Ofcer and

Administrator shall represent the Government during theInter-Agency Standing Committee (IASC) Country TeamCluster Leads Meeting.


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2. Regional Level f The rst line of support to disaster-stricken provinces

(technical or operational) should come fromregional level ofces, which reect the roles andresponsibilities of national level cluster leads and addvalue to the delivery of emergency humanitarian

assistance to the affected areas. f The OCD Regional Ofce, as the principal

coordinating body at the regional level, should chaira regular cluster focal points meeting to discussoperational strategies and response plans based onguidance from the national level cluster leads.

3. Provincial Level f The national level cluster leads should serve as a

guide to Provincial Disaster Coordinating Council(PDCC) Chairpersons on how to organize provincialclusters and manage an impending or potential

disaster situation. f PDCCs should develop baseline databases of

provincial demography, sectoral data and other basicinformation to facilitate rapid needs assessmentsof affected areas, timely mobilization of neededresources, and delivery of urgent assistance to the

right beneciaries through the clusters.


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Part 2

Part 3REFERENCE NOTES, TOOLSAND SAMPLE 21

Part 1POLICIES ANDPROCEDURES


Program Guidelinesand Technical Notes


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23Part 2Part 1 Part 3POLICIES ANDPROCEDURES



EMERGENCY PREPAREDNESS

Health Emergency Management Planning

Components of the Health Emergency Preparedness,Response, Recovery Plan

A. BackgroundB. Plan Description/DenitionC. Goals and ObjectivesD. Planning GroupE. Risk Reduction Plan

f Hazards prevention plan f Vulnerabilities reduction plan f Emergency preparedness plan

F. Management StructuresG. Roles and ResponsibilitiesH. Emergency Response Plan

f Policies, guidelines, protocols for the developedsystems

f Plan of action on the rst 2 hours, 2 to 12 hours, andafter 24 hours from the time of emergency

I. Recovery and Reconstruction PlanJ. Annexes

f Glossary


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f Abbreviations f Directory of contact persons f Inventory of resources/assets of the CHD and partner

agencies

Emergency Preparedness (10 Ps)

1. Policy Formulation and Development f Policy statement/implementing rules f Systems development (logistics management

system, information management system andcommunications system)

f Guidelines, protocols, procedures f Organizational structure f Roles and functions f Resource mobilization

2. Peoples Capability Building f Training needs assessment f Human resource development f Training of trainers f Database of experts f Tabletop drills and exercises

3. Physical Facilities Development f Establishment of Emergency Operations Centers

(infrastructure, manpower, technology) f Standardization/improvement/upgrading of ER,


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ambulance, operation center, hospitals f Procurements of supplies, communications and

equipment

4. Partnership Building f Organization of the health sector f Coordination and planning f Memorandum of agreement with stakeholders f Networking activities

5. Plan development f Vulnerability and hazard assessment f All-hazards emergency operations plan f Specialized planning for uncommon incidents (e.g.

SARS, WMD) f Communication plans f Hospital preparedness and response plans

6. Public Information and Health Promotion f Advocacy activities

f Development of IECs f Mass media management

7. Performance Response Operation f Monitoring and evaluation activities f Postmodern evaluation f Drills f Technical assistance


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8. Program Development f Nutrition in Emergencies f WASH in Emergencies f MHPSS in Emergencies f Chemical Emergency Program f Other programs

9. Peso and Logistics f Fund allocation for emergency management

operations f Prepositioning of logistics f Resource inventory and mapping

10. Proper Documentation and Research f Publications f Databanking f Accomplishment reports f Research studies f Lessons learned


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Emergency Planning Process

1. 1. Dene the plan f Aim, objectives, and scope f Tasks to be performed f Resources to be needed f Framework which emergencies will be managed

2. Review planning group f Key people and organizations f Appropriateness of existing group (authority,

representation, sufcient expertise, cooperation of

local experts and other sectors)

3. Analyze potential problem f Hazards (causes, preventive strategies, trigger events) f Vulnerabilities f Risks

4. Analyze resources f Resources required for response and recovery f Variation between requirement and availability f Person/organization responsible for the resources

5. Describe roles and responsibilities

6. Describe management structure


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f Command of individual organizations and controlacross organizations

7. Develop strategies and systems f Specic response and recovery strategies and systems

that will support strategies

For further details, please refer to:

Health Emergency Management Planning, 8th National Training Course onPublic Health and Emergency Management in Asia and Pacic, 2008.


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Coordinating with Other Agencies

Prepare internal arrangements within DOH and with otherpublic health related government entities, UN agencies, NGOs,and other institutions in the country whose expertise and/orservices may be called upon during emergencies (DND, NDCC,DSWD, DPWH, DOTC, PNRC, etc.)

Establishing Good Working Relationships with OtherGroups

1. Have a common goal2. Have a good and strong facilitator3. Dene parameters. With consensus on objectives,

strategies and plans4. Discuss needs and lines of action5. Identify strengths and capabilities before dividing work

and responsibilities6. Encourage member participation7. Clear range of services each agency can provide8. Document agreements and arrangements with

memoranda of understanding9. Build trust among members. Fix issues early on10. Regular communication among members11. Have operating guidelines12. Respect organizational mandates.13. Establish and maintain effective communications.


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14. Take nal decisions in plenary15. Provide mechanisms for timely action, especially during

crises.16. Priority to the whole group. Each agency is vital17. Clear and attainable mission statements18. Support from top management

19. Awareness of partners on policies and protocols20. Adopt responsibilities of what was agreed upon21. Be exible and adjust to changes22. Adequate incentives23. Have a product showing teams efforts and share to have

sense of accomplishment. Celebrate.

5 Ps of Facilitation

1. Purpose f Explains the overall aim of the session f Have ground rules, a clear agenda, and desired

outcomes

2. Product f Describes the sessions deliverables in specic outputs f Discuss needs and lines of action f Reach a consensus on objectives, strategies and plans

3. Participants f Push the issues f Know their perspectives and concerns


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f Designated experienced chairperson should practicefacilitative behavior such as listening, encouragingparticipation, not defensive, asking open-endedquestions, and optimistic yet realistic

4. Probable Issues f Give an idea of the potential roadblocks f Sort issues by categories and types f Approve agenda before starting the meeting

5. Process f Detailed set of steps that will be taken to create the

product f Circulate information among partners f Preliminary word clarication and denition,

brainstorming, rank order of issues according toimportance to the group

f Have group memory by using ip charts or handouts

Organizing Response Teams

1. Time of occurrence of the emergencyf Immediately after the emergency

f After 24 hour or 72 hours, etc

2. Assessment/situation report is of signicance as basis ofcreating teams

f Data about the incident


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NOI (causative and additional hazards, projectedevolution)

Affected area Affected population

3. Health impact f Direct impact (causes/rates of morbidity, mortality,

malnutrition, etc.) f Other reasons (trauma, burn, disease outbreak, etc) f Projected evolution of health situation

4. Expressed needs from the affected area

5. Other impacts in the community f Lack of safe water

f Environmental sanitation f Health facilities and services

6. Magnitude and size of affected population

7. Existing response capacities


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Response Teams for Immediate Deployment

LogisticsManagement

Team

Teams forDeployment

EMSTeam

Security andSafety Team

Search andRescue Team

Public HealthTeam

TraumaTeam

MedicalTeam


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Further Deployment of Response Teams

1. Need to establish health system2. Need to support the treatment of injuries3. Need to support the medical cases4. Provision of public health services to include disease

surveillance5. Support for resource management6. Support risk communication7. Provide protection and safety of victims and responders


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Response Teams for Further Deployment

ResponseAssessment First Aid

Search and RescueEMS (Transport andLogistics) Evacuation

Center

EMSTeam

EvacuationCenter Team

ICS SupportTeam

First AidTeam

SARTeam

RHA Team


Health Emergency Management Planning, 8th National Training Course onPublic Health and Emergency Management in Asia and Pacic, 2008.


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Safe Hospitals

Objectives

The World Disaster Reduction Campaign on Hospitals Safe fromDisasters aims to raise awareness and effect change that will:

Protect the lives of patients and health workers byensuring the structural resilience of health facilities;

Make sure health facilities and health services are able tofunction in the aftermath of emergencies and disasters,when they are most needed, and

Improve the risk reduction capacity of health workers andinstitutions, including emergency management

Basic Facts

1. Many factors put hospitals and health facilities at risk:buildings, patients, the health workforce, equipment, andbasic lifelines and services.

2. Components of a hospital or health facility are typically

Hospitals Safe from Disasters:

Reduce Risk, Protect Health Facilities, Save Lives


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divided into two categories: Structural elements and non-structural elements.

3. Functional collapse, not structural damage, is the usualreason for hospitals being put out of service duringemergencies.

4. Hospitals and health facilities can be built to different

levels of protection: life safety, investment protection andoperations protection.

5. Making new hospitals and health facilities safe fromdisasters is not costly. It has been estimated that theincorporation of mitigation measures into the design andconstruction of a new hospital will account for less than

4% of the total initial investment.6. Field hospitals are extremely expensive and not necessarily

the best solution to compensate for the loss of a hospitalor health facility.

7. A check consultant is vital for ensuring the disaster safetyof critical facilities such as hospitals.

8. Building codes are of utmost importance.9. Creating safe hospitals is as much about having vision and

commitment as it is about actual resources.10. The most costly hospital is the one that fails!


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Hospitals Safe from Disaster Information Kit, World Disaster ReductionCampaign 2008-2009, UN/ISDR/WHO

www.unisdr.org.wdrc-2008-2009 www.who.int/hac/techguidance/safehospitals


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EMERGENCY RESPONSE

Response Phase

Steps In Responding To Emergencies

(Adapted from CDCs Public Health Emergency Response Guide)

Hours 0-2Immediate Response:1. Assess the situation2. Contact key health personnel3. Develop initial health response objectives and establish an

action plan4. Establish communication and maintain close coordination

with the EOC5. Ensure that the site safety and health plan is established,

reviewed, and followed6. Establish communication with other key health and

medical organizations.7. Assign and deploy resources and assets to achieve

established initial health response objectives8. Address health-related requests for assistance and

information from other agencies, organization and thepublic

9. Initiate risk communications activities10. Document all response activities


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Hours 2-12Immediate Response:1. Verify that health surveillance systems are operational2. Ensure that laboratories likely to be used during the

response are operational and verify their analyticalcapacity

3. Ensure that the needs of special populations (e.g., children,disabled persons, elderly, etc.) are being addressed

4. Manage health-related volunteers and donations5. Update emergency risk communications messages6. Collect and analyze data that are becoming available

through health surveillance and laboratory systems

7. Periodically assess health resource needs and acquire asnecessary

Hours 12-24Extended Response:1. Address psychosocial and mental health concerns

2. Prepare for transition to extended operations or responsedisengagement

3. Address risks related to the environment4. Continue health surveillance/epidemiologic services5. Ensure that local health systems are preserved and access

to health care, including essential drugs and vaccines, is

guaranteed


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Response Plan

A. Activation of Code Alert SystemB. Activation of the PlanC. Activation of the ICSD. Activation of the Operation Center

E. Implementation of the RESPONSE StandardOperating Procedures/ Protocols for Emergencies

F. Implementation of existing Standard OperatingProcedures/Guidelines for systems developed

G. Initiation and Maintenance of Coordination andnetworking for referrals of cases

H. Initiation and Maintenance of Mental Health andPsychosocial Support Services for casualties, patients,hospital staff and other responders, and bereaved

I. Management of InformationJ. Activation of plan in the event of complete isolation

of hospital/CHD/community for auxiliary power,water and food rationing, medication/ dressingrationing, waste and garbage disposal, staff andpatient morale

K. Provision of the Public Health ServicesL. Management of the Dead


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Emergency Operations Center

An emergency operations center (EOC) is a centralcommand and control facility which function to collect,gather and analyze data; make decisions that protect lifeand property, maintain the continuity of the organizationwithin the scope of applicable laws; and disseminatethose decisions to all concerned agencies and individuals,with the emergency manager as in-charge.

At the national level, there should be a permanentOperation Center

At the lower levels, the Centers for Health Developmentand Hospitals should have an Operation Center with twooptions, a permanent or a non-permanent type

General Attributes

1. Safe from hazards2. Adequate electrical, water and sewage systems3. Sufcient space for all functions (a mix of open and closed

work spaces) f Secured storage area f Secured space for staging materials and human

resources pending deployment (optional) f Open work space for management, operations,

logistics, and planning functions f Closed work space available for teleconferences,


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break-out groups, policy group meeting (can belocated in nearby rooms)

f Controllable space for media briengs (nearby oroff-site)

f Staff rest area with food preparation and storage,clean-up and eating areas

4. Data telephone and electrical connections5. Adequate wall space for big whiteboards or its equivalent6. Adequate lighting, ventilation, heating and cooling

capacity7. Equipped with:

f Floor plans, mapping the work stations and wiring f Well posted re evacuation plans and assembly areas f With available EOC protocol plans/owcharts (hard

and soft copies) f Staff roles and Standard Operating Procedures

8. Toilet/personal hygiene area9. Appropriate location

f Accessible by public transportation f Reasonably close to partners, supporting and

cooperating agencies f Has adequate parking f Has access to all entrances, exits, and windows easily

secured


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Functions of HEMS-OPCEN

1. Operates on 24/7 to monitor all national events, massgatherings and other events which may have impact onhealth resulting in a mass casualty incident.

2. Serves as the center of command, control andcoordination for the Department of Health and the HealthSector during emergencies and disasters.

3. Issues appropriate warning advisories and facilitate itsdissemination to the DOH Regional Ofces and Hospitals,other health facilities and stakeholders in anticipation ofimpending hazards.

4. Mobilizes technical experts and medical teams neededduring emergencies and disasters both locally andinternationally.

5. Mobilizes all logistical requirement of the Department of

EOC Minimum Requirements:

9 At least tw(2) TV sets 9 Telephone; fax machine 9 Computer with printer and internet connection 9 Maps 9 Whiteboard

9 Transistor radio 9 Directories 9 Tables and chairs 9 Ofce supplies and equipment 9 Conference area for brieng


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Health needed in the affected regions.6. Coordinates and network with all agencies of the NDCC

family, other partners in health emergencies, members ofthe Health Sector and the Health Clusters responding toemergencies/disasters as well as to facilitate movement ofall resources.

7. Prepares reports needed and disseminate to all concernedofces and agencies.

8. Document all emergencies and disasters responded to bythe DOH.


Emergency Operations Center, 8th National Training Course on PublicHealth and Emergency Management in Asia and Pacic, 2008.


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Integrated Code Alert System

In July 7, 2008, the Department of Health releasedAdministrative Order No. 2008-0024 which is the Adoptionand Institutionalization of an Integrated Code Alert Systemwithin the Health Sector.

General Guidelines

Code Declaration/Suspension Dissemination

ExternalEmergencies

Internal Emergencies

HEMSCentralOfce

HEMS Director or Division Chief(Response/Preparedness)

Telephonebrigade

Ofce order (c/oAdmin Ofce)

DOHHospitals

Secretaryof Health

HEMSDirector

Chief of Hospitals/Medical Center Chiefs*

HHEMS Coordinator Head of the Disaster

Committee

Proceduresc/o hospitalconcerned

Centerfor HealthDevelopment

Regional Director* RHEMS Coordinator

Proceduresc/o regionconcerned

DOH CentralOfces

DOH Sec upon recommendation of HEMSDirector (for national emergencies) ORDirectors of NEC and NCDPC (for epidemics/reemerging diseases)

Dept. Memo Telephone

brigade byHEMS OpCen


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*Automatic declaration of Code White during national events, especially with potential of amass casualty incident (MCI)

Conditions for Code Alert Activation

Code White Code Blue Code Red

H E M S C e n t r a

l O

f c e

Strong possibilityof militaryoperation (e.g.,coup attempt,armed conict)

Mass action ordemonstration

Forecast typhoons(signal 2 up)

National or localelections

National event/holidays withpotential for MCI

Emergency w/potential 10-50casualties

Terrorist attack Unconrmed

report ofreemergingdiseases (SARS/bird u)

Any hazard thatmay result toemergency

Any condition inCode White plus 2below: Mobilization of

DOH resources 30-50% health

facilities affectedIncapability of LGUto respond

Geographiccoverage andaffected population>30%

MCI with 50-100casualties

High case fatalityrate for epidemics

Conrmedhuman-humantransmission ofAvian u/SARS

Any natural,manmade,technological orsocietal disorder, withall present: Declaration of

disaster in area 100 casualties in

1 area Regional health

personnelincapable ofhandling entireoperation

Mobilization ofhealth sectorneeded

Mobilization ofDOH key ofces

Uncontrolledhuman-humantransmission ofAvian u/SARS


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D O H H o s p i t a

l s Conditions similar toHEMS Central Ofceplus: 20-50 casualties

(red tags) brought

to the hospital Internal emergency

in hospital bringingdown operatingcapacity to 50%and evacuation ofpatients to a FieldHospital

Conditions similar toHEMS Central Ofceplus: >50% (red tag)

casualties brought

to the hospital Hosp services

paralyzed due to50% manpowerare victims

Hosp damagedstructurallyrequiring patientevacuation

C e n t e r

f o r H e a

l t h D e v e l o p m e n t Conditions similar to

HEMS Central Ofceplus: Presence of

evacuation centers

>1 week w/ publichealth implications

Condition requiringmobilization ofentire region

Conditions similar toDOH Hospitals plus: Event resulting to

mass dead andmissing

Disaster declaredin 2 provincesor 30% of MetroManila cities

Uncontrolledepidemic or outbreak

D O H C e n t r a

l

O f c e s

Conditions similar toHEMS Central Ofce

Conditions similar toHEMS Central Ofce


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Human Resource Requirements for Code Response


H E M S C e n t r a

l O

f c e Emergency Ofcer

on Duty (EOD)1 & 2

Driver and securityguard to assist atOpCen

Reliever of EODs 1and 2 on stand by

Response DivisionChief (to serve

as MCI MedicalController)

HEMS Director orResponse Div Chiefpresent at OpCen

EOD 1 and 2 Driver and security

guard assist at OpCen Incoming EOD on call Logistics 1 DOH rep to go

on duty at NDCC if

requested

HEMS divided into3 teams going 24 hrduty every 3 days. Each team with: Team leader 2 Data Collector/

Encoder Logistics Communication Admin Ofcer

Support staff Driver 1 staff on 24 hr

duty OCD OpCen


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D O H H o s p i t a

l s 1st Response Team(ready for dispatch): 2 Doctors (pref.

Surgeon, Internist,Anes) 2 Nurses

First aider/ EMT Driver

2nd Response Team(on call) On stand-by: Gen surgeons Orthopedic Anes Internists OR nurses Ophtha ENT Infectious

specialists

ER, Nursing & Adminstaff residing at hospdorm on call

HEMS Coordinatorpresent at hospital

On-scene responseteam

ER and OR ofcer in

charge All Ortho & Anes

residents All 3rd & 4th year

residents Post duty & on duty

surgical team Mental health

professionals Toxicologists & chem.

experts for poisoning Admin Ofcer Nursing supervisor All OR Nurses Social workers Dietary CSR supplies ofcer Entire security force Institutional workers

on duty

All personnelenumerated underCode Blue

All medical internsand clerks

All nurses All nursing

attendants All institutional

workers All admin staff


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D O

H C e n t r a

l O

f c e s Concerned directors or designates on stand by

(for code white) or present at respective ofces(for code blue): Material Management Division Finance Service

Administrative Service Procurement and Logistics NEC NCHP Media Relations Unit NCDPC NCHFD Bureau of Quarantine & International Health

Surveillance BFAD

All servicesshould ensure theavailability of staff for 24 hours toaddress all requests

for technical andlogistical support


Adoption and Institutionalization of an Integrated Code Alert Systemwithin the Health Sector, DOH AO No. 2008-0024, 2008.

If there is a strong possibility that there would be a need to change the alert status from code white to blue to red,the Chief of Hospital is authorized to:

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

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

3. Take other steps necessary to respond to theemergency situation (e.g. cancel elective surgeries, etc.)


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Rapid Health Assessment

The following critical information required should be madeavailable for reference within 24 hours from the event.

Key Questions

Is there an emergency or not? (If so, indicate type, date, timeand place of emergency, magnitude and size of affected areaand population)

What is the main health problem?

What health facilities or services have been/may be affected?

What is the existing response capacity? (actions taken by thelocal authorities, by DOH-HEMS)

What decisions need to be made?

What information is needed to make these decisions?

Situation Report Outline

A. Executive SummaryB. Main Issue

1. Nature of the emergency (causative and additional


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hazards, projected evolution)2. Affected area (administrative division, access)3. Affected health facilities4. Affected population (sex/age breakdown)

C. Health Impact

1. Direct impact: reasons for alert (3 main causes ofmorbidity/mortality, CMR, under-5 mortality rate,acute malnutrition rate)

2. Other reasons for concern (e.g., trauma, reports/ rumors of outbreak)

3. Indirect health impact (e.g., damage to critical

infrastructures/lifelines)4. Pre-emergency baseline morbidity and mortality

(when available)5. Projected evolution of health situation: main causes

of concern if the emergency will be protracted

D. Vital Needs: current situation1. Water2. Waste disposal3. Food4. Shelter and environment on site5. Fuel, electricity, and communication

6. Other vital needs (e.g., clothing and blankets)

E. Critical Constraints1. Security: coordinate with the safety ofcer to identify


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hazards or unsafe conditions associated with theincident

2. Transport and logistics3. Social/political and geographical limits4. Other constraints

F. Response Capacity: functioning resources1. Activities already underway2. National protocols, contingency plans3. Operational support (command post, regional unit

and referral system, external assistance, state ofcommunications)

4. Operational coordination (lead agencies, mechanisms,ow of information)

5. Strategic coordination (local/internationalrelationships)

G. Conclusions

1. Are the current levels of mortality and morbidityabove-average for this area and this time of the year?

2. Are the current levels or morbidity, mortality,nutrition, water, sanitation, shelter and health careacceptable by international standards?

3. Is a further increase in mortality expected in the next

2 weeks?

H. Recommendations for Immediate Action1. What must be put in place as soon as possible to


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reduce avoidable mortality and morbidity?2. Which activities must be implemented for this to

happen?3. What are the risks to be monitored?4. How can they be monitored?5. Which inputs are needed to implement all these?

6. Who will be doing what?

I. Emergency Contacts: local donor representatives, DOHcounterparts and neighboring regional directors.

J. Annexes: include all detailed information that are

relevant


Health Assessments, 8th National Training Course on Public Health andEmergency Management in Asia and Pacic, 2008.

Page 192 for sample of Rapid Health Assessment Forms

Be honest in the conclusions and practical in therecommendations. Recommendations that cannot be

put into practice quickly are useless. Prioritize the health problems (in terms of magnitude and severity and of

feasibility of health interventions.


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Epidemiology and Surveillance

Epidemiologic Methods of Emergency Management

Objectives

Assess the urgent needs of human populations Match available resources to needs Prevent further adverse health effects Monitor and evaluate program effectiveness Improve contingency planning Optimize each component of emergency management

Application

Hazard mapping Analysis of vulnerability Assessment of the exibility of the existing local system

for emergency Assessment of needs and damages Monitoring health problems Implementation of disease-control strategies Assessment of the use and distribution of health services Etiological research on the cause of mortality and

morbidity Follow-up long-term impacts of health, etc.


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Surveillance System Development

1. Establish Objectives f Detect epidemics

f Monitor changes in the population Numbers

Health status including nutritional conditions Security

Access to food Access to water Shelter and sanitation Access to health services

f Facilitate the management of relief

2. Develop Case Denitions (Request NEC) f Standard case denitions of health conditions simplify

reporting and analysis

3. Choose the Indicators f Indicators must:

Illustrate the status of the population (ex. deathrates)

Measure the effectiveness of relief (ex.immunization coverage)

4. Determine Data Sources


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f Data can come from health-care facilities (passivesurveillance) and from surveys in the community(active surveillance)

f Involve those who provide health care f Health surveillance in an emergency requires input

from all sectors

5. Develop Data Collection Tools and Flows f Use pre-existing local formats and/or international

standards f Use formats the facilitate data entry (EpiInfo) f Utilize existing process ows

6. Field-Test and Conduct Training f Can these data produce the information required? f Training eld workers will improve data facility and

local analysis

7. Develop and Test the Strategy of Data Analysis f Data analysis should cover:

Hazards and impact on the populationshealth

Quality and quantity of services provided Impact of services on populations health

Relation between services provided to differentgroups (evacuees and hosts)

Deployment and utilization of resources


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f Major operations may require a centralepidemiological unit

8. Develop Mechanisms for Disseminating Information (RiskCommunication)

f Who will receive the information? f For the information to be useful, it must be

disseminated widely and in a timely fashion: Feedback will sustain data collection and the

performance of eld workers Health information is important for the activities

of other sectors.

f Sharing information is good coordination f Share information to authorities who manage the

cases and the incident

9. Monitor and Assess Usefulness of the Systemf Is everybody reporting on time? Which data are

missing? f Lack of information in areas or programs that have

problems f Is the system useful? f Is the information generated by the system being

used for decision making? f If not, readjust the system


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Mass Casualty Management

Mass Casualty Incident

Any event resulting in a number of victims large enough todisrupt the normal course of emergency and health care services

Different Approaches to Mass Casualty Incident (MCI):

1. Scoop and Run Approach f Most common f Does not require specic technical ability from

rescuers f Justied for small numbers occurring near a hospital f May just transfer problem to the hospital

2. Classical Approach f First responders are trained (basic triage and eld

care) f Disregard the receiving hospitals from the eld f Quickly result to chaos

3. Mass Casualty Management Approach f Most sophisticated approach includes pre-established

procedures for resource mobilization, eldmanagement, and hospital reception

f Training of various level of responders


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f Incorporates links between eld and health carefacilities

f Includes setting up a command post and dealing withmulti-sectoral response

f Dependent on the availability of large amounts ofhuman & material resources

Components of Field Management

Field Organization Checklist

Situation Assessment

Report to Central Level Work Areas Pre-identication Safety Primary Area: Impact Zone Secondary Area Units: CP/AMP/EVAC/TRANSFER Radio Communications

Crowd and Trafc Control Search and Rescue Triage and Stabilization Controlled Evacuation

Field Management

Encompass procedures used to organize the disaster areain order to facilitate the management of victims

Components: Alerting process, Pre-identication of eld


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areas, Safety/security, Command post, Search and rescue,Field care, Evacuation, Management Center (EMC)

Alerting Process

Sequence of activities implemented to achieve the

efcient mobilization of adequate resources Aims to conrm the initial warning, evaluate the extent of

the problems, and ensure that appropriate resources areinformed and mobilized

Dispatch center: f Core of the alerting process (Operation/

Communication Center) f Functions to receive all warning messages (radio/

phone) and mobilize a small assessment team (FlyingTeam) from police, re or ambulance services

Initial Assessment

Precise location of the event Time and type of the event Estimated number of casualties Added potential risk Exposed population

Resources needed


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Pre-identication of Affected Areas

Impact zone Command post Collecting area in unstable location Advance medical post area (3-T Principle)

Evacuation area VIP and press area (Information ofcer) Access roads (geographical presentations if available) Check point for resources (Staging area)

Safety/Security

Best practice technique to protect victims, responders andexposed population: immediate/potential risk

Direct action measures:f Risk reduction - re ghting

f Contain hazardous material f Evacuation of exposed population

Preventive actions: establish eld areas f Primary - Impact zone f Secondary - Rescue/ICP/AMP f Tertiary-buffer zone; tri-media

Personnel safety: re services; specialized units hazardousmaterials and explosives (bio-nuclear and radioactivematerials) experts, etc., airport manager and chemical


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plant experts Security measure for non-interference of external

elements: crowd/trafc control Contribute to safety:

f Protect workers from external inuence; additionalstress

f Free ow: victims/resources f Protect general public from risk exposure (ensured

by police ofcers/special units or security in airports,buildings, hospitals, establishments, etc.)

Command Post (CP/ICP)

Multi-sectoral control unit to: f Coordinate sectors involved in eld/scene

management f Linked with back-up system: provide information and

mobilization resources f Supervise victim management

Requisite: Radio communication network (for maincriterion to be effective)

Purpose: Coordination and communication hub of peoplewho dont work routinely (pre-hospital setting)

Location: External boundary of restricted area (impactzone) close to AMP/ Evacuation Area; accessible andeasily identied; and can accommodate visuals, maps andboards


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Personnel: f High ranking ofcer (government police, re, health,

defense) f Identied by name/position, coordinator/commander f May depend on what type of incident f Must be familiar with each others roles during

previous meetings, drills, simulation exercises andpolicies

f Core group cooperates with volunteer organizations

Method: The communication and coordination hub of thepre-hospital organization. By constant re-assessment, CP

will identify needs to increase or decrease resources: f Organize timely rotation of rescue workers

exposed to stressful/exhausting conditions in closecoordination with back-up system

f Ensure adequate supply of equipment / manpower f Ensure welfare / comfort of rescue workers f Provide information to back-up system, other

ofcials, and tri-media thru an Information Ofcer f Release as soon as situation allows emergency staff

and reestablish normal operations f Determine termination of eld operations

Search and Rescue Team

Locate victims Remove victims from unsafe locations collecting area


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Assess victims status (on-site triage) Provide rst aid, if necessary (no CPR on-site in MC Event) Transfer victims to AMP thru entry triage (medical triage) Under supervision of the CP/IC/or Commander/

Coordinator May require trained medical personnel in special situations

Stabilize/resuscitate/amputate (trapped) victim beforeextrication

Field Care

Pre-established capabilities/inventory: Pre-planning

Integrated community plan: Practiced with policy support The Golden Hour Principle Establish advance medical post with skilled and disaster

trained eld medical teams capable of good triage/ stabilization, and with efcient (radio) communicationsbetween the eld scene and medical facility


Mass Casualty Management, 8th National Training Course on Public Healthand Emergency Management in Asia and Pacic, 2008.


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Triage and Stabilization

Triage

Objective: to quickly identify victims needing immediatestabilization or transport, and the level of care needed

by these victims by assessing airway, breathing, andcirculation (ABCs)

Basis:f Urgency (victims status)

f Survival (chance or likelihood) f Care resource availability and capability

On-Site Triage (where they lie )

1. Acute2. Non-acute

Medical Triage (at Advance Medical Post)

1. Priority One (Highest Priority)

Red Tag

Immediate care and transportation Patients receive treatment at the scene for life-threatening

injuries


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First to be sent to available medical facilities

2. Priority Two (Intermediate Priority)

Yellow Tag

Urgent care May delay treatment and transport up to one hour

3. Priority Three (Delayed or Low Priority)

Green Tag

Walking-wounded May delay treatment and transport up to 3 hours

4. Priority Four (Lowest Priority)

Black Tag

No care required; patient is dead or near-death

Hardest priority to deal with emotionally Necessary for others to survive


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Evacuation Triage (for transport)

1. Red Tag

Transferred as soon as possible to tertiary to tertiaryfacilities in an equipped ambulance with medical escort

2. Yellow Tag

After evacuation of red tagged patients; without life-threatening problem

3. Green TagTo AS/OPD

4. Black Tag

To morgue, forensic services, public health and

psychosocial interventions for relatives and kin


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Start TriageAll walkingwounded

RespirationMinor

> 30 min < 30 min Position Airway

Yes No

Yes

ImmediateImmediateImmediate

Immediate

Deceased

No

Perfusion

Radial pulseabsent

Controlbleeding

MentalStatus

Can followsingle commandCannot followsingle command

Capillary Refill

Over2 secs

Under2 secs

Radial pulsepresent

ImmediateImmediate Delayed


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Patient Assessment

Respiration Greater than 30/min > Red Tag (priority one) Less than 30/min > move on to assessing pulse If not breathing:

f Quickly make sure mouth is clear f Open airway with head tilt method f If patient does not start to breath with simple airway

maneuvers > Black Tag (priority four)

Circulation

Check pulse rate and quality (radial area) no more than 5seconds

If pulse is strong, move on to assess mental status If pulse is weak/irregular > Red Tag (priority one) If no pulse > Black Tag (priority four)

Mental Status

Have patient respond to simple commands such as openyour eyes or squeeze my hand

If patient can perform this function, is breathing and has apulse > Yellow Tag (priority two)

If patient is unresponsive and cannot follow simplecommands > Red Tag (priority one)


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Role:f Provide entry medical triagef Effective stabilization for victims of a MCI/Situation

(capable of doing intubation, tracheostomy, chestdrainage, shock management, analgesia, fractureimmobilization, fasciotomy, control external bleeding

and dressing)f Convert red to yellow category as maybe possible

f Organize patient transfer to designated care facility/ ties

f AMP 3-T principle: Tag Treat Transfer

Personnel:f ER (A&ED), physicians/ nurses (trained & skilled)

f Support: Anesthetists, surgeons, EMTs, nurses,aiders, etc.


Triage, 8th National Training Course on Public Health and EmergencyManagement in Asia and Pacic, 2008.


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Transfer Organization and Evacuation

Procedures used to ensure that victims of an MC situationis safely, quickly, and efciently transferred by appropriatevehicles to the appropriate and prepared facility.

Preparation for Evacuation:

1. Single Reception Facility2. Multiple Reception Facilities

f Type of vehicle and escort required f Type of escort required

Transport and Evacuation Procedures

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