Hospital Emergency Preparedness: Philippines

Hospital Emergency
Preparedness: Philippines
CARMENCITA A. BANATIN, MD, MHA

Director III
Health Emergency Management Staff
Department Of Health
Outline of Presentation
I Introduction
II Philippine’s Initiative – 10 P’s

I. INTRODUCTION
Philippines is an archipelago of 7,107 islands

Lies along the path of turbulent typhoons
Within the Circum Pacific Ring of Fire
300 volcanoes, 22 are active
On top of two tectonic plates ( Eurasian and
Pacific
Country with the most number of natural
disasters in the last decade (1990–1999) CRED
Human generated disasters increasing
1972 – Presidential Decree 1566 – organizational
structure for disaster management from national to
local
In 1992 the Local Government Code was passed
In 1994 - program STOP DEATH and DMU
In 2000 – institutionalization – HEMS
Health Emergency Management Staff – 15 staff
Main function is to coordinate health sector’s response
to emergencies and disasters; covers preparedness,
response and rehabilitation
Typhoon
Philippine Hazards and
Vulnerabilities
Volcanic Eruption
Philippines is located along typhoon belt
Light structured houses in the provinces
Average of 22 typhoons occur in a year
Earthquake
300 volcanoes, 22 of which are active Located along the earthquake belt
Philippines within the Pacific Ring of Fire Active faults and trenches
Most houses are not seismically prepared
Region 1
Region CAR
Region 2
Region 3
Region NCR
Region 4 A & B
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
Region Caraga
Region 11
Region 12
Region ARMM
SITUATIONER – PHILIPPINE HOSPITALS
Sector Category Number
Government DOH 72
LGU Owned 592
Military 30
Others 1
Private
Level 4 55
Level 3 113
Level 2 397
Level 1 465
TOTAL 1,725
SITUATIONER – PHILIPPINE HOSPITALS
Government Private
695 hospitals 1,030 hospitals
43,670 beds 42,860 beds
(24,362) BEDS - DOH

HEMS - OPERATION CENTER MONITORING REPORT
CY 2005 (Jan-Dec) to 2006 (Jan.- Dec.)
462
500
450
379
400
350
300 236 257
250
200
150
100
21 18 3 14
50
0
# of Events Monitored # of Minor Emergencies # of Major Emergencies # of Disasters
CY2005 (Jan-Dec) 379 236 21 3

CY 2006 (Jan-Dec.) 462 257 18 14
II - Hospital Emergency Preparedness
Initiatives of DOH
10 P’s
1. Policies
2. Plans
3. Protocols, Guidelines and Procedures
4. People
5. Promotion and Advocacy
6. Partnership Building
7. Physical (Facility Enhancement)
8. Program Development
9. Practices
10. Peso and Logistics
1. Policies:
AO168 - “National Policy on Emergencies

and Disasters”
AO 155 – “Implementing Guidelines for
Managing MCI during Emergencies and
Disasters”
AO 182 – “Code Alert System for DOH
Hospitals during Emergencies and Disasters
Dept. Circular FAE – 64-A - “HEARS
Reporting “
Organizational Policies
Institutionalized Hospital HEMS unit

directly under the hospital director
Designated Hospital HEMS
coordinators and response teams
Organizational shift during
emergencies
HEICS practiced in all hospitals
2. PLANS
Hospital Emergency Preparedness,

Response and Rehabilitation Plan
(HEPRRP) a requirement in licensing of
all hospitals (Multi hazard)
Developed “Easy Guide for HEPRRP
Development”
Included in all strategic planning
3. Procedures, Protocols,
Guidelines
Manual of Operation for Hospitals (2nd

edition) includes: dispatching, alerting,
reporting, communication, MCI etc. )
Pocket Emergency Tool (2nd edition)
Manual of Treatment Protocols for
common diseases during emergencies
and disasters
4. People
Health Sector training agenda to include
management and skills
Training
1. BLS,ACLS, EMT, MCI-ICS
2. National PHEMAP
3. National HOPE
4. EMERGENCY ESSENTIAL SURGICAL
SKILLS FOR DISTRICT LEVEL
5. HOSPITAL BASED WMD
6. POWER AND RISK COMMUNICATION
5. Promotion and
Advocacy
July – National Disaster Consciousness
Month
December- Health Emergency Week
Compendium of Health Messages
Health Sector Drills and Exercises
Skills Benchmarking
Recognition Awards
6. Partnership Building
Organization of the Health Sector - 2001

Establishment of the Health Cluster- 2006
Establishment of Hospital Network to
include referral systems
TWG composition from members of the
Health Sector (policy, training & advocacy)
Networking activities especially during
special national events (APEC, ASEAN)
7. Physical -Facilities
Enhancement
Establishment and upgrading of especial
service units (Trauma ward, Burn Unit, etc.)
Upgrading of blood banks and laboratories
Provision of decontamination areas for the

BCRN hospitals including necessary PPE’s
Provision of negative pressure rooms for
selected hospitals
7. Physical- Facilities
Enhancement
Creation of Hospital Operation Center
(OPCEN) with communication system in
certain regions
Upgrading of ER, OR
Upgrading of Ambulance Service
Provision of triage areas
Identifying and upgrading alternate areas in
case of surge of victims during emergency
8. Program Development
Strengthen Toxicology Centers
Strengthen response to environmental
emergencies especially chemical events
WPRO Book on Assessment of Health
Facilities – role of DOH - HEMS
Embarking on a nationwide assessment of
capability of hospitals on their structural,
non-structural and functional capacity
Proactive in using licensing as a strategy for
hospital compliance
9. Practices
10 P’s as evaluation tools for all hospitals
Postmortem evaluation of major events and
disasters
Documentation of good practices compiled
into a book
Documentation of all health sector
proceedings
Clustering approach in disaster management
Providing leadership in all emergencies
9. Practices
MCM Survey of WPRO 2005 (VTN, PHIL,

SING and FIJI)
Framework of MCM covering the pre-
hospital and hospital role in MCI
Influenced our training agenda
Need to have a coordinated training
with all members of the Health Sector
(Police, military, fire and LGU)
9. Practices
WHO Project 2006 – evaluation for the physical
recovery and rehab of typhoon-damaged essential
health facilities: 18 facilities
Focused on architectural and engineering
evaluation, building safety assessment – hazards
(geotechnical, flood, structural, architectural,
electrical
Policy manual on the Design and Construction of
Health Facilities in Typhoon-Prone Areas
Retrofitting of Existing Health Facilities to mitigate
hazards of earthquake, fire, flooding and typhoons
in compliant of existing Codes
10. Peso and Logistics
Allocation of funding for Health Emergency

activities is gradually increasing
The National Disaster Coordinating Council
is recommending 5% of budget of facilities
be for preparedness activities
Availability of Quick Release Funds (QRF)
during emergencies
“Opportunities in times of Adversities”
CITY OF
METRO MANILA
Metro Manila
17 cities where all government activities are

Economic center of the Philippines and where all
embassies are located.
Saturated with 21 big DOH hospitals and other
private and military hospitals; all connected through
a good communication system
Hospital zoning – “receiving hospital and satellite
hospital” concept
Strong networking camaraderie among hospitals
with protocols depending on type of emergency
VGH
JNRMH
SLRWH EAMC*
PCMC
SLH, TMC PHC POC
DJFMH NKTI LCP
JRRMMC* LCP NCH
UP-PGH QMMC
NCMH ARMMC
RMC
LPDH TPDH
Legend:
Trauma hospital RITM

Poison Centers
Hosp. for Biological Emergency
Hosp. for Radio-nuclear Emergency
Special hospitals
DOH Hospitals in Metro Manila

LRT BOMBING
Dec. 31, 2000
22 deaths
115 injured
Ultra Stampede Incident
(Pasig City) February 4, 2006
1,059 Injured Victims

and
71 Deaths
Volcanic Eruption Typhoons: “Miolenyo, Paeng, Reming,
Senyang”
Bicol is located along typhoon belt

Most houses built of light materials
Commonly/yearly visited by typhoon
Mayon Volcano is an active volcano that Earthquake
erupts yearly
Hardest hit DOH Hospital:
Bicol Regional and Training

Hospital in Albay
Earthquake is very often to occur as it
precedes volcanic eruption
Impact in the Community
RHUs, BHS, hospitals were damaged

Houses and other infrastructures uprooted
Lifelines were broken down
Basic health services disrupted
Significant number of families were
displaced into the evacuation centers or
temporary shelters
NO. OF REPORTED TYPHOON-DAMAGED GOVERNMENT
HEALTH FACILITIES IN BICOL (TYPHOON REMING)
FACILITY NO. OF NO.OF

HEALTH TYPHOON-
FACILITY DAMAGED
HOSPITAL 52 33
RHU/CHO 133 58
BHS 1026 314
BRTTH
Blown-off roofs Dilapidated building Damaged roof framing,
BICOL REGIONAL TRAINING AND TEACHING HOSPITAL
Damaged roof and Damaged ceiling framing, Damaged electrical

ceiling eaves, fascia; broken window wires & wiring devices.
glazing;
Impact in the Hospital
Blown off roof making the 2nd floor non-

functional
Hospital personnel were victims (40%)
Hospital water, communication, and electrical
supply were down
Hospital equipment damaged
Some hospital areas non functional
Surge of victims ( 1008 patients with 450
admissions)
14 died mostly due to communicable; 2 trauma
Resiliency of the Hospital is not
just the structure but the
system developed, the policies,
guidelines, procedures and the
people that makes the
difference. Furthermore, if a
hospital ceases to function, the
ability of the network to cover
the gap is the most important
contingency plan.
THANK YOU

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Hospital Emergency

CARMENCITA A. BANATIN, MD, MHA

II Philippine’s Initiative – 10 P’s

Philippines is an archipelago of 7,107 islands

695 hospitals 1,030 hospitals

43,670 beds 42,860 beds

(24,362) BEDS - DOH

CY2005 (Jan-Dec) 379 236 21 3

AO168 - “National Policy on Emergencies

Institutionalized Hospital HEMS unit

Hospital Emergency Preparedness,

Manual of Operation for Hospitals (2nd

Organization of the Health Sector - 2001

Upgrading of blood banks and laboratories

Provision of decontamination areas for the

MCM Survey of WPRO 2005 (VTN, PHIL,

Allocation of funding for Health Emergency

17 cities where all government activities are

Trauma hospital RITM

DOH Hospitals in Metro Manila

1,059 Injured Victims

Bicol is located along typhoon belt

Hardest hit DOH Hospital:

Bicol Regional and Training

RHUs, BHS, hospitals were damaged

FACILITY NO. OF NO.OF

Blown-off roofs Dilapidated building Damaged roof framing,

BICOL REGIONAL TRAINING AND TEACHING HOSPITAL

Damaged roof and Damaged ceiling framing, Damaged electrical

Blown off roof making the 2nd floor non-

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