Pocket Emergency Tool 2005

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CONTENTS

Acknowledgements ....................................................................iii Introduction .................................................................................1 Abbreviations .............................................................................2 Roles and Responsibilities .........................................................3 PREPARING FOR EMERGENCIES ..........................................5 Coordinating with Other Agencies ............................................11 Drafting the Health Disaster Management Plan .......................15 RESPONDING TO EMERGENCIES .......................................16 Rapid Health Assessment ........................................................19 Critical Incident Management ...................................................22 Pre-Hospital Activities ...............................................................23 Hospital Activities .....................................................................25 Prevention and Control of Communicable Diseases ................29 Nutrition Concerns ...................................................................31 Environmental Health ...............................................................37 Water Supply ...........................................................................38 Sanitation and Waste Management .........................................43 Vector and Vermin Control .......................................................49 Epidemiology and Surveillance ................................................52 Psychosocial Care and Mental Health .....................................56 Management of Dead Bodies ..................................................63 Forensic Science Concerns in Mass Fatalities .........................65 Resource Management ............................................................71 Risk Communication ................................................................73 APPENDICES ..........................................................................77 Emergency Manager Deployment Checklist ............................78 Rapid Health Assessment Forms ............................................79 Reference Values for Rapid Health Assessment and

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CONTENTS

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Contingency Planning .........................................................85 Radio Procedures .....................................................................98 ConversionTable ......................................................................99 Websites ................................................................................101 References .............................................................................103 Emergency Call Number Directory .........................................105

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The review and revision for this second edition was done through the efforts of Dr. Emmanuel S. Prudente, under the technical supervision of Dr. Arturo M. Pesigan of Emergency and Humanitarian Action (EHA) of the WHO-WPRO. Acknowledgement is also given to Dr. Carmencita A. Banatin, Dr. Marilyn V. Go, Dr. Teodoro J. Herbosa, Dr. Josephine H. Hipolito, Ms. Florinda V. Panlilio, Dr. Arnel Z. Rivera, Dr. Edgardo Sarmiento and Dr. Xiangdong Wang, who reviewed the text and provided valuable comments. Lay-out and cover design was done by Mr. Zando Escultura.

ACKNOWLEDGEMENTS

This pocket tool is a project of the Department of HealthHealth Emergency Management Staff (DOH-HEMS), with support from the World Health Organization-Regional Office for the Western Pacific Region (WHO-WPRO).

The first edition was through the efforts of the following individuals: Engr. Russell Abrams; Dr. Shigeki Asahi ; Dr. Carmencita A. Banatin ; Dr. Agnes B. Beñegas ; Mr. Miguel C. Enriquez ; Mrs. Guia P. Flores ; Dr. Raquel dR. Fortun ; Dr. Camilla A. Habacon ; Dr. Lourdes L. Ignacio ; Mrs. Elizabeth M. Joven; Dr. Susan P. Mercado; Dr. Daniel T. Morales; Dr. JeanMarc Olivé; Dr. Hitoshi Oshitani; Dr. Arturo M. Pesigan; Dr. Manuel F. Quirino; Dr. Lilia M. Reyes; Dr. Arnel Z. Rivera; Dr. Edgardo Sarmiento; Dr. Enrique A. Tayag; Dr. Yoshihiro Takashima; Dr. Xiangdong Wang; Mrs. Zen Delica Willison; Mr. Robin Willison; and Dr. Ladislao N. Yuchongco, Jr.

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INTRODUCTION

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Human survival and health are the common objectives and measures of success of all humanitarian endeavors. The goal of the Department of Health (DOH) through the Health Emergency Management Staff (HEMS) is to prevent or minimize the loss of lives during emergencies and disasters in collaboration with government, business and civil society groups. The main purpose of this pocket tool is to help guide and prepare health sector professionals in the field in the event that an emergency occurs. A compendium of recent DOH, WHO and other international agencies' guidelines, checklists and standards, this booklet provides essential pointers on how to carry out rapid health assessment, networking and coordination, planning, and other necessary tools especially in times of tragedies and adversities. This pocket tool, however, neither provides nor claims to be the definite and only guideline to follow in emergencies. Thus, references to complementary documents and websites, where more detail can be found, are provided at the end of the booklet. Also, because every disaster is unique, some of the suggested procedures may need to be tailored to local conditions. Furthermore, this pocket tool is an evolving text; this 2nd edition was conceived from the lessons learned from the recent disasters that affected the country and the Western Pacific Region. Indeed, the success of this guide depends largely on the dynamics of its use and the tireless efforts of its users to improve it.

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DOTC DPWH DSWD EHA EMS EOC EPI ER IEC HEICS LGU MUAC NBI NDCC NEC NEHK NGO NNC NPDEP OpCen PHC PNRC RDCC SARS WHO-WPRO WMD

Centers for Disease Control and Prevention (USA) Center for Health Development Crude Mortality Rate Communicable disease Surveillance and Response Department of National Defense Department of Health-Health Emergency Management Staff Department of Transportation and Communication Department of Public Works and Highways Department of Social Welfare and Development Emergency and Humanitarian Unit Emergency Medical Services Emergency Operations Center Expanded Program of Immunization Emergency Room Information, Education and Communication Hospital Emergency Incident Command System Local Government Unit Mid-Upper Arm Circumference National Bureau of Investigation National Disaster Coordinating Council National Epidemiology Center New Emergency Health Kit Nongovernmental organization National Nutrition Council Nutrition Preparedness in Disasters and Emergencies Plan Operation Center Primary Health Care Philippine National Red Cross Regional Disaster Coordinating Council Severe Acute Respiratory Syndrome World Health Organization-Office for the Western Pacific Region Weapons of Mass Destruction

ABBREVIATIONS

CDC CHD CMR CSR DND DOH-HEMS

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ROLES AND RESPONSIBILITIES

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

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ake 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

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ecord and re-evaluate lessons learned to improve preparedness in the future

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ssess and monitor health and nutrition needs so that they are immediately dealt with

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mprove health sector reform and capacity building by networking end and protect the practice of humanitarian access, neutrality and protection of health systems in emergency situations

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1. Observe all requirements and standards (hospital emergency plan, HEICS, Code Alert System, etc.) needed to respond to emergencies and disasters. 2. Ensure enhancement of their facilities to respond to the needs of the communities especially during emergencies.

ROLES AND RESPONSIBILITIES

Roles of Hospitals in Health Emergency Management

3. Network with other hospitals in the area to optimize resources and coordinate transferring of victims to the appropriate facility. 4. Report all health emergencies to the Operation Center, and document all incidents responded.

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PREPARING FOR EMERGENCIES

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1. Policy Formulation and Development ! policy statement/implementing rules ! guidelines, protocols, procedures ! organizational structure ! roles and functions ! resource mobilization

PREPARING FOR EMERGENCIES

Steps in Preparing for Emergencies

2. Capability Building ! training needs assessment ! human resource development ! training of trainers ! database of experts ! tabletop drills and exercises 3. Facilities Development ! standardization/mprovement/upgrading of ER, ambulance, Operation Center, hospitals ! procurement of supplies, communications and equipment 4. Networking ! organization of the health sector ! coordination and planning ! memorandum of agreement with stakeholders ! networking activities 5. Disaster Planning ! vulnerability and hazard assessment ! all-hazards emergency operations plan ! specialized planning for uncommon incidents (e.g. SARS, POCKET EMERGENCY TOOL

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WMD) ! communication plans ! hospital preparedness and response plans 6. Public Information and Mass Media ! advocacy activities ! development of IEC's 7. Post-disaster Response Evaluation ! monitoring and evaluation activities ! postmortem evaluation 8. Systems Development ! Logistics Management System ! Management Information System ! Communication System 9. Establishment of Emergency Operation Centers ! Infrastructure, manpower, technology 10. Documentation and Research ! publications ! databanking ! accomplishment reports ! research studies ! lessons learned

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1. Serve as the DOH Coordinating Body in their region 2. Manintain updated hazard and vulnerability assessment of their catchment areas 3. Observe all requirements and standards needed to respond to emergencies (Regional Emergency Plan)

PREPARING FOR EMERGENCIES

Roles of Centers for Health Development in Emergency Management

4. Organize health sector in the region and provide mechanism for coordination and collaboration. Provide advice to the RDCC for health emergency concerns 5. Maintain operation center as regional repository of vents for the health sector. Identify an official spokesperson to answer concerns by the public and the media 6. Provide technical assistance and empower all LGUs in the area on health emergency management 7. Report to the Central DOH (HEMS) for all emergencies and disasters and any incident with the potential of becoming an emergency 8. Document all health emergency events and conduct researches to support policies and program development. (Based on DOH Administrative Order 168, s.2004)

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PREPARING FOR EMERGENCIES

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At the Center for Health Development (CHD) level… The following information should be readily available for reference and may be compiled in collaboration with other partners (government and non-government units). These information must be updated regularly: ! Disaster profile of the region ! Population size and distribution ! Topography and maps showing communication lines ! Epidemiologic profile 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 agencies and major NGOs ! Key people and organizations who would be responsible for/active in relief (contact phone numbers AND addresses) ! Individuals with special competencies and experience who may be mobilized on secondment from their institutions or as consultants in case of need (contact phone numbers AND addresses) ! A roster of regular resource persons ready to translate technical information materials into local dialect (i.e., traditional healers, indigenous health workers, barangay captain, etc.)

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1. Vehicles 2. Communications equipment 3. Back-up power supplies 4. Computers, printers, facsimiles and photocopying machines 5. Water testing sets 6. Food supplements 7. Temporary shelter capacities 8. Funding requirements 9. Personal protective equipment

PREPARING FOR EMERGENCIES

The following resources should be readily available for use AT ALL TIMES:

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COORDINATING WITH OTHER AGENCIES

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

Steps in Establishing Good Working Relationships with Other Groups or Entities 1. Have a common goal. 2. Designate a good and strong facilitator. 3. Define the parameters of the project. Reach a consensus on objectives, strategies and plans. 4. Discuss needs and lines of action. 5. Have operating guidelines. 6. Encourage member participation. 7. Build trust among members. Fix issues early on. 8. Maintain regular communication and correspondence among members. 9. Give priority to the whole group. Each agency is vital. 10. Develop clear and attainable mission statements from the beginning of the project. 11. Enlist and maintain the support of top-level-management. 12. Educate all members about the range of services each agency can provide. 13. Make partners aware of policies and protocols. 14. Adopt responsibilities in the context of what was agreed upon 15. Adjust to changes. Be flexible and be open to possibilities, unforeseen events and new opportunities.

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Health coordination must start as soon as possible, it should be regular and frequent. At the start of a crisis, changes are fast and many. To coordinate is to facilitate.

5 Ps of Facilitation:

COORDINATING WITH OTHER AGENCIES

16. For members to attend, allow adequate incentive. 17. Have a product or concrete result showing the team's effort and share among members so that there is a sense of accomplishment. Celebrate.

1. PURPOSE explains the overall aim of the session. ! Have ground rules, a clear agenda, and desired outcomes. 2. PRODUCT describes the session's deliverables in specific outputs. ! Discuss needs and lines of action. ! Reach a consensus on objectives, strategies, and plans. 3. PARTICIPANTS push the issues. Know their perspectives and concerns. A designated and experienced chairperson should practice facilitative behavior: listening, encouraging participation, not being defensive, asking open-ended questions, and optimistic but realistic 4. PROBABLE ISSUES give an idea of the potential POCKET EMERGENCY TOOL

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roadblocks. ! Sort issues by categories and types. ! Approve the agenda before starting the meeting. 5. PROCESS is the detailed set of steps that will be taken to create the product. ! Circulate information among partners. ! Preliminary word clarification and definition, brainstorming, rank order of issues according to importance to the group. ! Have group memory by using flip charts or handouts. The resulting consensus should be that everyone feels that he has been heard and that everyone agrees and is willing to support the decision.

Coordination is sharing information with other persons or organizations so they can work together in harmony without friction or overlapping - based on regular communication of relevant data.

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! ! ! ! ! ! ! !

Surprise: Is it true? Has it really happened? Lack of information: What is happening? Events escalate: It's getting worse but I don't know the details? Lack of control: I don't know therefore I cannot do. Siege mentality: Why is this happening to us? Panic: Will we ever recover from this? Short term reaction: Get everyone away from me

COORDINATING WITH OTHER AGENCIES

Disaster Reaction Sequence:

Common Communication Concerns: ! ! ! ! ! ! !

“I don't have the correct facts.” “I might upset other people with what I'll say.” “There might be a better spokesperson.” “There may be legal implications to what I say.” “I might risk my reputation.” “I might be asked something I cannot answer.” “I might sound stupid.”

If you do not tell, information will be gathered elsewhere, leading to misinformation, misunderstanding, and their consequences…

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DRAFTING THE DISASTER HEALTH MANAGEMENT PLAN

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You may follow the outline provided below; however, it is not meant to replace alternative outlines that you may deem more appropriate and useful. I. Background Present the following: ! geographic description ! disasters that have occurred ! gaps in response ! hazard maps ! vulnerabilities and risks II. Goals and Objectives III. Potential Problems Analysis IV. Resource Analysis V. Management Structure a. Explain the organization (an accompanying diagram is essential) b. Specify command, control, lead organization and coordination VI. Roles and Responsibilities VII. Strategies VIII. Annexes (i.e., glossary, abbreviations, directory of contact persons)

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RESPONDING TO EMERGENCIES

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RESPONDING TO EMERGENCIES

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Steps in Responding to Emergencies

Hours 0-2

Immediate Response: 1. Assess the situation 2. Contact key health personnel 3. Develop initial health response objectives and establish an action plan 4. Establish communication and maintain close coordination with the EOC 5. Ensure that the site safety and health plan is established, reviewed, and followed 6. Establish communication with other key health and medical organizations. 7. Assign and deploy resources and assets to achieve established initial health response objectives 8. Address health-related requests for assistance and information from other agencies, organizations and the public 9. Initiate risk communications activities 10.Document all response activities

Hours 2-12

Intermediate Response: 1. Verify that health surveillance systems are operational 2. Ensure that laboratories likely to be used during the response are operational and verify their analytical capacity 3. Ensure that the needs of special populations (e.g., children, disabled persons, elderly, etc.) are being addressed 4. Manage health-related volunteers and donations POCKET EMERGENCY TOOL

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Hours 12-24

Extended Response: 1. Address psychosocial and mental health concerns 2. Prepare for transition to extended operations or response disengagement 3. Address risks related to the environment 4. Continue health surveillance/epidemiologic services 5. Ensure that local health systems are preserved and access to health care, including essential drugs and vaccines, is guaranteed

RESPONDING TO EMERGENCIES

5. Update emergency risk communication messages 6. Collect and analyze data that are becoming available through health surveillance and laboratory systems 7. Periodically assess health resource needs and acquire as necessary

(Adapted from CDC's Public Health Emergency Response Guide.)

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RAPID HEALTH ASSESSMENT

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The following critical information required should be made available for reference within 24 hours from the event. Basically, the following key questions need to be answered: ! Is there an emergency or not? (If so, indicate type, date, time and place of emergency, magnitude and size of affected area and population) ! What is the main health problem? ! What health facilities or services have been or may be affected? ! What is the existing response capacity? (actions taken by the local authorities, by DOH-HEMS) ! What decisions need to be made? ! What information is needed to make these decisions? Situation Report Outline: 1. Executive Summary 2. Main Issue a. Nature of the emergency (causative and additional hazards, projected evolution) b. Affected area (administrative division, access) c. Affected health facilities d. Affected population (sex/age breakdown) 3. Health Impact a. Direct impact: reasons for alert (3 main causes of morbidity/mortality, CMR, under-5 mortality rate, acute malnutrition rate) b. Other reasons for concern (e.g., trauma, reports/rumors of outbreak)

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5.

6.

7.

RAPID HEALTH ASSESSMENT

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c. Indirect health impact (e.g., damage to critical infrastructures/lifelines) d. Pre-emergency baseline morbidity and mortality (when available) e. Projected evolution of health situation: main causes of concern if the emergency will be protracted Vital Needs: current situation a. Water b. Waste disposal c. Food d. Shelter and environment on site e. Fuel, electricity, and communication f. Other vital needs (e.g., clothing and blankets) Critical Constraints a. Security: coordinate with the safety officer to identify hazards or unsafe conditions associated with the incident b. Transport and logistics c. Social/political and geographical limits d. Other constraints Response Capacity: functioning resources a. Activities already underway b. National protocols, contingency plans c. Operational support (command post, regional unit and referral system, external assistance, state of communications) d. Operational coordination (lead agencies, mechanisms, flow of information) e. Strategic coordination (local/international relationships) Conclusions a. Are the current levels of mortality and morbidity aboveaverage for this area and this time of the year?

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b. Are the current levels of morbidity, mortality, nutrition, water, sanitation, shelter and health care acceptable by international standards? c. Is a further increase in mortality expected in the next 2 weeks? 8. Recommendations for Immediate Action a. What must be put in place as soon as possible to reduce avoidable mortality and morbidity? b. Which activities must be implemented for this to happen? c. What are the risks to be monitored? d. How can they be monitored? e. Which inputs are needed to implement all these? f. Who will be doing what? Be honest in the conclusions and practical in the recommendations. Recommendations that cannot be put into practice quickly are useless. Prioritize the health problems (in terms of magnitude and severity and of feasibility of response interventions).

9. Emergency Contacts: local donor representatives, DOH counterparts and neighboring regional directors. 10.Annexes: include all detailed information that are relevant *See appendix for sample of rapid health assessment form.

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a. Assume command (until a more senior personnel arrives) b. Assess the situation and advise the appropriate authorities and agencies c. Set perimeters ! Identify and set perimeter (hot zone, warm zone, cold zone) ! Implement safety and security measures ! Identify access and egress routes d. Establish the initial medical command post e. Establish Safety Officer f. Establish Staging Officer g. Establish liaison with other services on site h. Determine priorities and time constraints i. Develop an incident plan in conjunction with members of the Incident Management Team j. Task response agencies and supporting services k. Coordinate resources and support l. Monitor events and respond to changing circumstances m. Report actions and activities to the appropriate agencies and authorities

CRITICAL INCIDENT MANAGEMENT

Steps as First Responders

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PRE-HOSPITAL ACTIVITIES

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Triaging Objective: To quickly identify victims needing immediate stabilization or transport and the level of care needed by these victims by assessing airway, breathing, and circulation (ABC's). Triaging is done if there are more victims than health responders. Reverse triaging is done during the Search and Rescue stage where the priority is to get as much people out of danger with the least effort.

Color Tagging Ideally, the following information should be contained in the patient's color tag: a. patient's sequence number b. name of patient c. injuries identified d. previous interventions given at the scene RED TAG 1st priority: Life-threatening - needs to be treated within 1-3 hours a. obstruction/damage to airway b. breathing disturbance (RR =30/min or RR