Adoption and Institutionalization of an Integrated Code Alert System within the Health Sector ( DOH Administrative Order No. 2008-0024 )

July 7, 2008

DOH ADMINISTRATIVE ORDER NO. 2008-0024

 

I. BACKGROUND AND RATIONALE:

Most emergencies and disasters are unpredictable but are not totally unexpected. Some events which trigger disasters, such as typhoons and volcanic eruptions, or threats of civil disorders, may be expected several hours before they occur. Others, such as earthquakes, may occur without warning. A stance of readiness to respond is assumed whenever potential emergencies are foreseen. Emergency management and control measures are usually indicated for those types of emergencies. Preventing measures, preparedness program are likewise helpful in mitigating or preventing the effects of such emergencies and disasters. All emergencies and disasters is a health concern. Whenever there are lives lost, injuries sustained, movement of large populations and even psychosocial disturbances the Department of Health plays a very vital role. All health facilities must get ready to respond whenever emergencies/disasters are foreseen and/or declared. The organization of the medical care is unquestionably the focal point for coordinating for the health sector's response to this host of complex needs, since response and prompt care is critically important in saving lives.

With this concern, and in order to synchronize the efforts of the Department of Health leading the health sector and in anticipation of health emergencies, disasters, mass casualty incidents, epidemics, a Code Alert System must be in place specifically in the mobilization and deployment of its resources. This mechanism is adopted to describe the expected levels of preparation and the most suitable responses by all facilities in emergencies and disasters.

II. OBJECTIVES:

A. General

To implement the integrated code alert system in all health facilities to ensure a comprehensive and well coordinated response in emergencies and disasters.

B. Specific

1. To improve the effectiveness of DOH systems, structures and mechanisms in managing emergencies and disasters.

2. To strengthen links between field, hospitals and the DOH Central Office.

3. To guide health facilities in their response during emergencies and disasters. CAIaDT

4. To emphasize the role of each instrumentality of the Department of Health especially in command, control and coordination.

5. To guide the responding agencies in early and timely pre-positioning and mobilization of resources (logistics and manpower)

III. DEFINITION OF TERMS:

1. Code Alert System — an agreed system among offices as a tool to alert the department to prepare and respond during emergencies and disasters (internal and external) in terms of an organizational shift in management and mobilizing its resources (manpower and logistics).

2. Disaster — any event (natural/human generated) that may result to loss of lives and damage to property which may exceed the capability of the community to respond.

3. Emergency — any public health situation endangering the life or health of a significant number of people and demanding immediate action. An emergency situation may result from a natural, human generated, technological or societal hazard.

4. Hazard — any phenomenon which has the potential to cause disruption or damage to people, their properties, their services, their livelihood and their environment.

5. Mass Casualty Incident — an event in which the number of casualties (dead and injured) is of sufficient magnitude as to overwhelm the available resources of the facility or the community (= or > 10 persons involved).

6. Single Command System — a system whereby the incident is managed by a leader coming from a single response unit or agency. This is based on first arriving emergency unit. Initial Incident Commander begins assessment of incident. Deals with rescue, triage, treatment and transport.

7. Unified Command System — a system whereby the incident is managed by a group of individuals coming from several units or agencies with jurisdiction over the incident, and are involved in the decision making and planning process. Insures plan is communicated and supported by all resources. ITScAE

8. Coordination — the bringing together of organizations and elements in order to ensure effective counter-disaster response. It is primarily concerned with the systematic acquisition and application on resources (organization, manpower, and equipment) in accordance with the requirements imposed by the threat or impact of a disaster.

9. Red Tag — serious patients in life threatening situations who needs immediate attention such as patients with obstruction or damage to airway, disturbance of breathing, disturbance in circulation and those needing life saving measures and urgent hospital admission.

10. Emergency Officer on Duty (EOD) — personnel who goes on duty, 16 or 24 hours a day at the Operation Center and monitors health related events that would require DOH intervention.

IV. COVERAGE:

These regulations and procedures shall apply to all health facilities, whether public or private.

V. GENERAL GUIDELINES:

5.1 All DOH Central Offices, Centers for Health Development, DOH Hospitals, DOH attached agencies, and other health facilities shall incorporate the Integrated Code Alert System to their existing emergency preparedness, response and rehabilitation plan.

5.2 This Code Alert System shall be institutionalized in the Department of Health and in all health facilities. DOH shall ensure that this is properly disseminated to all personnel and corresponding procedures be developed for the implementation of this code alert.

5.3 All health personnel should receive a basic training for the implementation of this code alert.

5.4 All senior and middle managers should receive a basic training on the Incident Command System both for a Single Command as well as Unified Command System.

5.5 All DOH Offices should support HEMS in emergencies and disasters.

5.6 All facilities and identified Offices affected by the emergency shall appropriately organize to respond to the condition. It shall institute an Emergency Incident Command System based on the code. All other units, facilities, offices and attached agencies should support the affected facility.

5.7 All those responsible for the declaration of the code should know the criteria for raising, lowering and suspending the alert level. SDTIHA

5.8 When the Code Alert is activated, all DOH personnel mobilized shall be entitled to meal allowances during the entire activation period which is outside the ordinary subsistence allowance due to the unusual nature of the emergency situation or incident. These personnel are entitled to claim overtime pay and other allowable benefits due them. This shall be supported through the issuance of a pertinent Department Personnel Order/Regional Order/Hospital Order and which shall state funding of such overtime from savings of the Central Office, Regions or Hospitals, HEMS funds, or any other funds subject to the usual accounting and auditing rules and regulations.

5.9 DOH shall provide technical assistance to the Local Government Units and private sectors in the implementation of this code.

5.10 Strict compliance and enforcement, monitoring, evaluation and formulation of new policies and guidelines pertaining to the implementation of the Integrated Code Alert System shall be the responsibility of the Department of Health through the Health Emergency Management Staff (DOH-HEMS).

VI. IMPLEMENTING GUIDELINES:

A. HEMS CENTRAL OFFICE

1. CODE WHITE

1.1 Conditions for adopting Code White

• Strong possibility of a military operation e.g., coup attempt/armed conflict which have a national implication

• Any planned mass action or demonstration which have a national implication

• Forecast Typhoons (signal 2 up)

• National or local elections and other political exercises

• National events, holidays or celebrations with potential for MCI

• Any emergency with potentially 10-50 casualties (deaths, injuries) ScAIaT

• Notification of reliable information of terrorist/attack activities

• Any other hazard that may result to emergency

• Unconfirmed report of reemerging diseases e.g., bird flu, SARS

1.2 Human Resource requirements for responding to the Code

• Emergency Officer on Duty (EOD) 1 and 2

• Driver and Security Guard to assist at the Operation Center

• Reliever 1 and 2 (next day EOD's) on stand by

• Response Division Chief or alternate on continuous monitoring and will serve as Medical Controller for Mass Casualty Incident.

1.3 Other Requirements

• EOD 1 to check all medicines, supplies available

• EOD 1 & 2 to do proactive monitoring

• EOD to alert the region, hospitals and other facilities that might be affected or needed to respond or receive patients.

• Response Division Chief or HEMS Director to alert key officials as needed

• EOD to inform National Epidemiology Center regarding outbreaks for confirmatory report.

2. CODE BLUE

2.1 Conditions for Adopting Code Blue

• Any condition mentioned in Code White plus any of the two below:

• Mobilization of DOH resources is needed (manpower, materials, etc.) IDSaAH

• 30-50% health facilities in the areas affected or damaged

• No capability of the LGU and/or lack of resources of the Region to respond to the affected area

• Magnitude of the disaster based on geographic coverage and number of affected population (more than 30%)

• Any Mass Casualty Incident (MCI) with 50-100 casualties irrespective of color code

• High case fatality rate for epidemics

• Confirmed human to human for avian flu or SARS.

2.2 Human Resource requirements for responding to the Code:

• HEMS Director or Response Division Chief should be physically present at OPCEN

• EOD 1 and 2

• Driver and Security Guard to assist at the Operation Center

• Incoming EOD's on call for immediate mobilization

• Logistics Officer or alternate to go on duty

• At least one DOH representative to go on duty to NDCC if required and/or requested

2.3 Other Requirements:

• Coordinate with the following:

/ Implementing agencies (hospitals, region, central office) for possible dispatching of teams or experts

/ NDCC and other sectors for other concerns e.g., transportation, etc.

/ MMD regarding supplies available at DOH

/ Different DOH Central Offices for personnel augmentation to the Operation Center and for other technical support AHDcCT

• Prepare possible drugs and medicines needed for movement to affected area

• If needed drugs/medicines not available, prepare emergency purchase

• Check all possible means of transportation ex. with NDCC, air cargo, etc.

• Anticipate need of medical teams and other experts

• Prepare all needed reports and presentation required especially for emergency NDCC meetings

• Orient staff to be deployed to NDCC and those additional staff to augment the OPCEN

• In cases of long term emergencies, plan for support to the affected region

• Activate Code Blue for HEMS and prepare necessary documentation

• Initiate the conduct of coordinative meeting of the national clusters: Health, Nutrition and WASH

3. CODE RED

3.1 Conditions for Adopting Code Red:

Any natural, manmade, technological or societal disaster, where all of the following are present:

• Declaration of disaster to the affected area

• 100 or more casualties in one area

• Health personnel in the region not capable to handle entire operation

• Mobilization of the health sector needed

• Mobilization of key offices in DOH

• Uncontrolled human to human transmission of SARS/Avian Flu

3.2 Human Resource requirements for responding to the Code

The HEMS Office personnel and staff augmentation from other offices shall be divided into 3 teams to go on a 24 hour duty rotation every 3 days. The team is composed of the following: AcEIHC

• Team Leader

• 2 Data Collector/Encoder

• Logistics

• Communication

• Administrative Officer

• Support Staff/Clerk

• Driver

• At least 1 staff to be assigned at OCD OPCEN on 24 hours duty

3.3 Other Requirements

• HEMS to represent the Department of Health to NDCC and other agencies.

• Leads in the coordination with international partners in the Health, Nutrition and WASH Clusters.

• Leads in the coordination with all members of the health sectors.

• Leads in the coordination with donor agencies both international and local.

• Prepares updated reports for use of Secretary, and other partners.

• Assists in the preparation of the rehabilitation and recovery plan; represent the DOH in the national DANA team.

• HEMS-OPCEN to serve as DOH Command Post.

• Recommends the activation of the Crisis Committee who serves as the technical, operations arm and prepares recommendation to the Executive Committee of DOH to be chaired by the Undersecretary for Policy Development Team for Service Delivery and to be assisted by the Directors of HEMS, NEC, NCDPC, NCHFD, Finance, Administrative and MMD. cEaCAH

4. GUIDELINES IN IMPLEMENTING THE CODE ALERT

• The HEMS Code alert shall be declared by the HEMS Director or by the Division Chief (Response or Preparedness)

• Announced through telephone brigade

• Administrative Officer to prepare Office Order/Department Personnel Order

• HEMS Director or the Division Chief (Response or Preparedness) lifts the Code Alert and make necessary announcement

B. DOH HOSPITALS

1. CODE WHITE

1.1 Conditions for adopting Code White

• Strong possibility of a military operation within the area/region e.g., coup attempt

• Any planned mass action or demonstration within the catchment area

• Forecast Typhoons, (signal 2 up) the path of which will affect the area

• National or local elections and other political exercises

• National events, holidays, or celebrations in the area with potential for MCI

• Any emergency with potentially 10-50 casualties (deaths, injuries)

• Any other hazard that may result to emergency

• Unconfirmed report of reemerging diseases e.g., bird flu, SARS

1.2 Human Resource requirements for responding to the Code

• Manpower:

• First response team ready for dispatch to include the following: DCcHIS

/ 2 doctors preferably Surgeon, Internist, anesthesiologist, etc.

/ 2 nurses

/ First Aider/EMT

/ Driver

• Second response team should be on call

• The following should be available for immediate treatment of incoming patients:

/ General Surgeons

/ Orthopedic Surgeons

/ Anesthesiologists

/ Internists

/ O.R. Nurses

/ Ophthalmologists

/ Otorhinolaryngologists

/ Infectious Specialists

• Emergency service personnel, nursing personnel and administrative personnel residing at the hospital dormitory shall be placed on call status for immediate mobilization.

1.3 Other Requirements

• The Hospital's Operation Center should be activated. It should continuously report and coordinate with the Regional and DOH Central Operation Center IcAaEH

• Medicines and Supplies:

• Ensure that emergency medicines (especially for trauma needs) be made available at the emergency room

• Medicines and supplies in the operating rooms should likewise be reviewed and increased to meet sudden requirements

• Other needs such as x-ray plates, laboratory requirements, etc. should be made available and not required to be purchased by victims

• Personnel department to prepare for mobilization of additional staff

• Finance department to ensure availability of funds in cases of emergency purchases and the like

• Logistics department to coordinate with possible suppliers for additional requirements

• Dietary department to open and meet the need of the victims as well as the health personnel on duty

• Security force to institute measures and stricter rules in the hospital

• Activate Bird Flu Plan/SARS Plan etc.

• Enforce and monitor use of personal protective equipment (PPE) for all health personnel.

• Triage system should be activated.

2. CODE BLUE

2.1 Conditions for adopting Code Blue

• Any of the following conditions:

• When 20-50 casualties (red tags) are suddenly brought to the hospital

• Any internal emergency/disaster in the hospital which brings down their operating capacity (i.e., vital areas) to 50% or which would require evacuation of patients and setting up of a Field Hospital SATDHE

• For conditions other than MCI, the influx of patients is beyond the capacity of the hospital to handle.

• Confirmed/documented report of reemerging diseases (SARS, human to human avian flu) within the catchment area.

2.2 Human Resource requirements for responding to the Code

• HEMS Coordinator to be physically present at the hospital

• On-Scene Response Team

• Medical Officer in charge of the Emergency Room

• All residents of the Department of Orthopedics

• Medical Officer in charge of the Operating Room

• Surgical Team on duty for the day

• Surgical team on duty the previous day

• Mental health professionals

• All anesthesiology residents

• Toxicologist, chemical experts for poisoning and/or chemical cases (if available)

• All third and fourth year residents

• Administrative Officer or designate

• Nursing supervisor on duty

• All OR nurses

• Social workers

• Dietary personnel

• Officer in charge of supplies at the CSR

• The entire security force and

• Institutional workers on duty EAHDac

2.3 Other Requirements

All those mentioned in Code White plus:

• Activate Hospital Emergency Incident Command System (HEICS).

• Other needs of victims apart from medicines and supplies depending on the disaster should as much as possible be made available.

• The Chief of Hospital/Medical Center or his designate should make proper coordination with other hospitals for networking and/or possible transfer of patients.

• Incident Commander should assign a Safety Officer, Liaison Officer to coordinate with other agencies and Public Information Officer to serve as the spokesperson of the hospital.

• Social Service section should prepare assistance to victims in coordination with mental health professionals of the Hospital if available and the Department of Social Welfare; in addition they should lead in providing information to relatives of victims.

• Mortuary section should anticipate dead victims brought to the hospital for proper care and identification.

• The security team in anticipation of possible influx or patients, relatives, responders, police, press etc. should ensure smooth flow of traffic inside the compound especially for the ambulances.

• Should report regularly to HEMS OPCEN and as much as possible have a regular press release or briefing.

3. CODE RED

3.1 Conditions for adopting Code Red

Any of the following is present:

• When more than 50 (red tag) casualties are suddenly brought to the hospital

• An emergency wherein the services of the hospital is paralyzed due to 50% of the manpower are themselves victims of the disaster. cDCIHT

• Hospital is structurally damaged requiring evacuation and/or transfer of patients

• Conditions requiring mandatory quarantine of hospital and its personnel (e.g., SARS, avian flu); Uncontrolled human to human transmission of SARS/Avian Flu within the catchment area.

3.2 Human Resource requirements for responding to the Code

• All personnel enumerated under Code Blue

• All medical interns and clinical clerks

• All nurses

• All nursing attendants

• All institutional workers

• All administrative staff

3.3 Other Requirements

All those mentioned in Code Blue plus:

• The Chief of Hospital/Medical Center Chiefs can cancel all types of leaves and can order all personnel to report to the hospital

• The Chiefs of Hospital/Medical Center Chiefs can temporarily stop all elective admissions and surgeries and network with other hospitals

• The Chief of Hospital/Medical Center Chiefs should anticipate requests of additional manpower and specialists not available in his hospital. He is further authorized to accept medical volunteers and other professionals to augment its manpower resources rather than transferring patients based on some agreements.

• Networking with other hospitals for augmentation of resources and transfer of patients in special cases.

• Answers all queries of the media pertaining to patients in the hospital.

• Anticipate evacuation and/or use of field hospital; closure and/or quarantine of the hospital.

• The Chief of Hospital/Medical Center Chief to specifically be concerned with safety and security not only the patients but the personnel as well. SDaHEc

4. GUIDELINES IN IMPLEMENTING THE CODE ALERT

• The Hospital Code Alert shall be declared by the Secretary of Health or by the Director of HEMS for external emergencies and/or incidents affecting national security; by the Medical Center Chiefs, Chiefs of Hospital, HHEMS Coordinator, Head of the Disaster Committee of the Hospital for all emergencies within their catchments area.

• Chiefs of Hospital/Medical Center Chiefs to automatically declare Code White during national events and activities especially with the potential of an MCI.

• Each hospital shall prepare it's own procedures in declaring and lifting the Code.

• The alert level is raised, lowered or suspended by the Secretary of Health. Director of HEMS for external emergencies and national events: the respective Medical Center Chiefs/Chiefs of Hospital or their designates for emergencies within their catchment area.

• Conditions to raise or suspend the alert level depends on the threat whether it is increased or is no longer present.

• Arrival of patients in the hospitals warrants the raising of the alert level: likewise alert can be suspended when no significant incident is monitored and the hazard or condition (typhoon, election, bombing etc.) is finished and/or contained.

C. CENTER FOR HEALTH DEVELOPMENT

1. CODE WHITE

1.1 Conditions for adopting Code White

• Strong possibility of a military operation e.g., coup attempt within the region

• Presence of hazards that pose a public threat such as epidemics, chemical, biological and radiological threat, etc. acHITE

• Notification of on-going epidemic by LGU, with adequate measures by local health personnel.

• Any planned mass action or demonstration in the area

• Forecast Typhoons (signal 2 up) the path of which will affect the region

• National or local elections and other political exercises

• National events, holidays or celebrations with potential for MCI

• Any emergency with potential 10-50 casualties (deaths, injuries)

• Any other hazard that may result to emergency

• Unconfirmed report of reemerging diseases e.g., bird flu, SARS

1.2 Human Resource requirements for responding to the Code

• 2 Emergency Officers on Duty

• Driver

• Regional HEMS Coordinator on call and on proactive monitoring

• One Rapid Assessment Team ready for dispatch to include the following:

/ DOH Representative

/ Nurse

/ Driver

1.3 Other Requirements

• The Regional Operation Center should be activated on 24 hours and continuously report and coordinate with HEMS Operation Center ScHADI

• Do proactive monitoring for any development

• Report to HEMS-OPCEN daily and as necessary

• Require update from field as necessary

• Finance Division to ensure availability of funds in cases of emergency purchases and the like

• Supply section to coordinate with possible suppliers for additional requirements

• Transport section to ensure availability of vehicles

• Monitor and assess continuously for requirements of other teams (medical, surveillance, environmental, health promotion, psychosocial etc.). These teams are on standby/on call for immediate mobilization.

• Intensify IEC campaign through health advisories

• Coordinate regularly with affected LGUs

• Coordinate with Regional hospitals for back-up teams

• Monitor stock level of needed drugs/supplies, preposition as needed.

• Activate Bird Flu Plan.

• Mobilization of RESU team to conduct investigation for outbreaks.

2. CODE BLUE

2.1 Conditions for adopting Code Blue

• Any of the following conditions:

• 50-100 casualties irrespective of tags for MCI.

• Declaration of epidemic: confirmed/documented report of reemerging diseases (SARS, human to human avian flu) within the region TCcSDE

• Declaration of calamity in any province in the region

• Presence of evacuation centers estimated to last for more than a week which has public health implications

• Magnitude of the disaster based on geographic coverage and number of affected population (more than 30%)

• Any conditions that would require mobilization of resources of the entire region

2.2 Human Resource requirements for responding to the Code

• RHEMS Coordinator to be physically present at OPCEN

• Rapid Assessment Teams and other appropriate teams (RAT)

• Three (3) teams on standby (environmental/surveillance/medical)

• EOD 1 and 2

• Logistics Officer

• Finance Officer as necessary

• Health Promotions Officer as necessary

• Driver

• All other regional staff on standby for immediate mobilization

• All DOH REPS in the affected area should be available at the LGU

2.3 Other Requirements

All those mentioned in Code White plus:

• Activate the Regional Emergency Incident Command System (REICS).

• Operation Center on 24/7 with adequate personnel and logistical support to receive, evaluate, analyze all reports. ECDaAc

• Mobilize teams to affected areas for Rapid Assessment in coordination with the DOH Representative.

• Regional Director or his designate to make proper coordination with RDCC and other agencies like DSWD, DEPED etc. for networking and other requirements.

• Incident Commander should assign needed staff in Operations, Logistics, Planning and Administrative to assist affected LGU's.

• Public Information Officer to prepare and have regular media conference or press release.

• Continuous HEC campaign through health advisories especially in evacuation centers.

• May need to activate also a Field EOC as needed to coordinate health activities.

• Oversees operation of Management of Mass Dead together with the Health unit of the LGU concerned.

• Leads in coordinative meetings of the different clusters under the DOH: Health, Nutrition and WASH.

• Provides technical support to LGU's.

• Mobilize other requirements as needed such as psychosocial team etc.

• Regularly coordinate with DOH-HEMS OPCEN for reports and other needs.

3. CODE RED

3.1 Conditions for adopting Code Red

Any of the following is present:

• Conditions resulting to mass dead and missing

• Disaster declared in 2 or more provinces in the region or 30% of the cities in Metro Manila.

• Major facility or Hospital such as the Provincial/City/Hospital in area are not able to provide optimal services due to damages or 50% of staff are affected AECDHS

• Mobilization of entire regional resources not enough and thus require external support

• Uncontrolled epidemic/outbreak

• Uncontrolled human to human transmission of SARS/Avian Flu

3.2 Human Resource requirements for responding to the Code

• Mobilize all regional staff as needed on rotation basis

• Establish surveillance system in all evacuation centers

• All other teams deployed in affected area

3.3 Other Requirements

All those mentioned in Code Blue plus:

• The CHD Director can cancel all types of leaves and can order all personnel to report to the CHD.

• The CHD Director can stop all operations not related to the disaster.

• The CHD Director should anticipate request of additional manpower and specialists not available in his CHD. He is further authorized to accept volunteers and other professionals to augment its manpower based on some agreements.

• Continue networking with RDCC and its Clusters (Health, Nutrition, WASH).

• Public Information campaign.

• Handles queries from media.

• For reemerging diseases, to provide leadership together with the LGU in decisions like quarantine of the area and other decisions in preventing spread of the epidemic. HAaScT

• Provide updated report to HEMS Central OPCEN.

4. GUIDELINES IN IMPLEMENTING THE CODE ALERT

• The Regional Code Alert shall be declared by the Secretary of Health or Director of HEMS for emergencies with national implications; Regional Director and RHEMS Coordinator for internal (regional) emergencies

• Regional Directors to automatically declare Code White during national events and activities especially with the potential of an MCI

• The alert is raised, lowered or suspended by the Secretary of Health, HEMS Director for emergencies with national implications; by the respective Regional Director or RHEMS Coordinator for internal (regional) emergencies

• Each Region shall prepare it's own procedures in declaring and lifting the Code

• The conditions to raise or suspend the alert level depends on the threat whether it is increased or is no longer present.

D. DOH CENTRAL OFFICES

1. CODE WHITE

1.1 Conditions for adopting Code White

• Strong possibility of a military operation e.g., coup attempt/armed conflict which have a national implication

• Any planned mass action or demonstration which have a national implication

• Forecast typhoons (Signal 2 up)

• National or local elections and other political exercises

• National events, holidays or celebrations with potential for MCI

• Notification of reliable information of terrorist/attack activities

• Any other hazard that may result to emergency

• Unconfirmed report of reemerging diseases e.g., bird flu, SARS

1.2 Human Resource requirements for responding to the Code

• Concerned Directors or designates of the following Offices should be on stand by:

/ Material Management Division

/ Finance Service

/ Administrative Service

/ Procurement and Logistics Service

/ National Epidemiology Center

/ National Center for Health Promotions

/ Media Relations Unit HTSAEa

/ National Center for Disease Prevention and Control

/ National Center for Health Facilities and Development

/ Bureau of Quarantine & International Health Surveillance

/ Bureau of Food and Drugs

2. CODE BLUE

2.1 Conditions for adopting Code Blue

• Any condition mentioned in Code White plus any of the two below:

• Mobilization of DOH resources is needed (manpower, materials, etc.)

• 30-50% health facilities in the area affected or damaged

• No capability of the LGU and/or lack of resources of the Region to respond to the affected area

• Magnitude of the disaster based on geographic coverage and number of affected population (more than 30%)

• Any Mass Casualty Incident (MCI) with 50-100 casualties (mortalities plus injuries) irrespective of color code

• High case fatality rate for epidemic or confirmed/documented report of reemerging diseases (SARS, human to human Avian flu)

2.2 Human Resource requirements for responding to the Code

• Directors or designates to be present at their respective offices IHTaCE

/ Material Management Division

/ Finance Service

/ Administrative Service

/ Procurement and Logistics Service

/ National Epidemiology Center

/ National Center for Health Promotions

/ Media Relations Unit

/ National Center for Disease Prevention and Control

/ National Center for Health Facilities and Development

/ Bureau of Quarantine & International Health Surveillance THaCAI

/ Bureau of Food and Drugs

2.3 Other Requirements

Activate the following offices:

• Material Management Division

/ Ensure availability of staff to prepare all medicines and supplies needed

/ Ensure that the medicines and supplies be transferred to the affected area via NDCC arrangement or other means

/ Ensure the presence of the inspection team (DOH and BFAD Teams)

• Finance Service

/ All unit heads must be available to facilitate release of funds

/ Petty cash must be in place

/ Facilitate in the travel arrangements and other requirements in case of local or international teams to be sent

• Administrative Service

/ Should ensure availability of vehicles with drivers, gasoline/diesel etc.

/ Should ensure the provision of electricity/generator in all services responding to the emergency/disaster at the Central Office

/ Should ensure availability of other communication lines specially PABX

/ Security Force to institute measures and stricter rules at the DOH Compound

/ Assist MMD in the preparation of medicines and supplies and transfer of this to airports etc.

/ Facilitate arrangement with the airport for the travel of medical teams.

• National Epidemiology Center

/ Ready surveillance and outbreak investigation team and experts to be deployed as needed. ITCHSa

• Procurement Division

/ Should ensure the availability of list of qualified & responsible pharmaceutical companies and other suppliers for emergency procurement of drugs and medicines

/ Should facilitate procurement of emergency drugs/supplies as needed

• National Center for Health Promotion (NCHP) and Media

/ Should ensure their availability to assist and provide technical assistance to HEMS and Regional Offices in the conceptualization and development of behavioral messages and IEC materials

/ Should assist Regional Offices in the conduct of Health Education activities

/ Assist in documentation of events

• Media Relations Unit (MRU)

/ Anticipate any untoward media reports and recommend necessary response.

/ Prepare press releases and/or press statement.

/ Recommend and organize press conference and other media blitz like radio and television appearances.

/ Coordinate with HEMS/NCDPC and other offices for technical inputs.

• National Center for Disease Prevention and Control (NCDPC)

/ All Program Managers with concerns to disaster should be available for their technical support such as the communicable disease, environmental, nutrition, sanitation, psychosocial etc. ICaDHT

/ Provide treatment protocols as necessary.

/ Standby experts to be mobilized to affected area.

• National Center for Health Facilities Development

/ Technical support for hospitals should be readily available especially for infrastructure concerns

/ There should be protocols in the movement of blood requirements for emergencies especially for Mass Casualty Incidents. Blood intended for elective can be realigned for the use of victims

/ Provide technical support especially for hospital management

• Bureau of Food and Drugs

/ Ensure the presence of the inspection team to issue certificate of clearance for drugs and medicines.

/ Facilitate requirements and certification for donated medicines etc.

• Bureau of Quarantine & International Health Surveillance

/ Will only be activated in the presence of cases of reemerging diseases such as SARS and Avian Flu which needs an international surveillance in all ports of entry and other emergencies related to incoming and outgoing transportations. CaSAcH

All Offices and Bureaus to have regular coordination with DOH-HEMS

3. CODE RED

3.1 Conditions for adopting Code Red

Any natural, manmade, technological or societal disaster where all of the following are present:

• Declaration of disaster to the affected area

• 100 or more casualty in one area

• Health personnel in the region not capable to handle entire operation

• Mobilization of health sector needed

• Mobilization of key offices of Department of Health

• Uncontrolled human to human transmission of SARS/Avian Flu in any region

3.2 Human Resource requirements for responding to the Code

• All services should ensure the availability of staff for 24 hours to address all requests for technical as well as other logistical support

3.3 Other Requirements

• Each Office to deploy one personnel to augment HEMS Central Operation Center and NDCC Operation Center.

• DOH Crisis Committee to convene and provide overall support, direction and policy directions to affected regions. Likewise, they can call on any other office for technical and management support.

• All Directors or Designates (mentioned above) to report 24/7 to Operation Center until Code Red is activated.

• Other Offices/units shall be on call or required to report to OPCEN as identified or needed by the Crisis Committee. DaHISE

4. GUIDELINES IN IMPLEMENTING THE CODE ALERT

• The Central Code Alert shall be declared by the Secretary of Health upon the recommendation and evaluation of the Director of HEMS for natural and manmade emergencies with national implications; for epidemics and reemerging diseases by Directors of NEC and NCDPC.

• This will be disseminated through a Department Memorandum; HEMS OPCEN may call through a telephone brigade all Offices concerned; this will also be followed in lifting the Code.

VII. IMPLEMENTING MECHANISM: FUNCTIONS AND RESPONSIBILITIES OF RESPECTIVE DOH OFFICES:

These regulations shall be administered by the following:

1. The Undersecretary for Policy Development and Service Delivery shall oversee that these guidelines are implemented in the different offices of the Department during emergencies and disasters.

2. The Health Emergency Management Staff Director shall be responsible for monitoring and evaluating the enforcement and compliance of this order and subsequent recommendations for policy formulations and amendments.

3. The Service/Bureau Directors of DOH Central Office shall be responsible for the implementation and adoption of these guidelines for their Offices as required and appropriate in their response during emergencies and disasters.

4. The Center for Health Development Directors shall be responsible for the implementation and adoption of these guidelines within their Region and provide feedback, suggestions and policy recommendations to the Secretary of Health through the Field Implementation and Management Office.

5. The Medical Center Chiefs/Chief of Hospitals shall administer these regulations and support all the policies and guidelines mentioned in this Order. He/she shall lead in the dissemination of these guidelines and integration in the hospital. He/she shall ensure availability of personnel and funds to support all the needed training, and responses. He shall submit reports to the CHD Directors except in Metro Manila hospitals who reports directly to the Office of Special Concern. ASHaTc

6. The HEMS Coordinators of the hospitals/regions shall directly oversee the implementation of these guidelines in their respective hospitals/regions. He/she shall report to the Chief of Hospital/Medical Center Chief, CHD Director and the Director of the Health Emergency Management Staff.

7. The Local Government Unit and Private Health Sector shall adopt these guidelines in their locality and provide feedback and report to the Director of the Center for Health Development.

VIII. APPLICABILITY CLAUSE:

This Administrative Order shall supersede other Orders related to this and shall take effect upon signing. ASHaTc

(SGD.) FRANCISCO T. DUQUE III, MD, MSc.Secretary of Health