HARMONIZATION OF CODE ALERT SYSTEM

HEMS CENTRAL OFFICE DOH

CODE WHITE 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 1-50 casualties (deaths, injuries) Notification of reliable information of terrorist/ attack activities Unconfirmed report of reemerging diseases eg. bird flu or SARS Any other hazard that may result to emergency 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 1-50 casualties (deaths, injuries) Unconfirmed report of reemerging diseases eg. bird flu, SARS within the region Any other hazard that may result to emergency 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. 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 area National or local elections and other political exercises National events, holidays or celebrations with potential for MCI Any emergency with 1-50 casualties (deaths, injuries) Unconfirmed report reemerging diseases eg. of bird flu, SARS within the region Any other hazard that may result to emergency

HOSPITAL

CENTER FOR HEALTH DEVELOPMENT

HEMS CENTRAL OFFICE DOH -

HOSPITAL -

CENTER FOR HEALTH DEVELOPMENT -

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2. Human Resource requirements for responding to the System: Emergency Officer on Duty (EOD) 1 and 2 Driver and Security Guard to assist at the Operation Center Reliever 1 and 2 (next day EODs) on stand by Response Division Chief or alternate on continuous monitoring and will serve as Medical Controller for Mass Casualty Incident. EOD to inform National Epidemiology Center regarding the case for confirmatory report.

2. Human Resource requirements for responding to the Code:

Manpower
First response team ready for dispatch to include the following: 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

2. Manpower 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

DOH -

HEMS CENTRAL OFFICE -

HOSPITAL -

CENTER FOR HEALTH DEVELOPMENT -

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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

3. Other requirements: The Hospitals Operation Center should be activated. It should continuously report and coordinate with the Regional and DOH Central Operation Center 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 for all health personnel. Triage system should be activated

3. Other requirements: The Regional Operation Center should be activated on 24 hours and the DOHContinuously report and coordinate with HEMS Operation Center 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.

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CODE BLUE

HEMS CENTRAL OFFICE

1. Conditions for Adopting Code Blue Any condition mentioned in Code White

HOSPITAL
1. Conditions for Adopting Code Blue: Any

CENTER FOR HEALTH DEVELOPMENT

Conditions for Adopting Code Blue:

plus any of the two below:

of the following conditions:

Mobilization of DOH resources is needed (manpower, materials, etc.) 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 50100 casualties irrespective of color code High case fatality rate for epidemics Confirmed human to human for avian flu or SARS

When 20-50 casualties (red tags) are expected or 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 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) in the area

Any of the following conditions:

Expected 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 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

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CODE BLUE

HEMS CENTRAL OFFICE

2. Manpower requirements for responding to the Code: Response Division Chief or alternate as team leader should be physically present at OPCEN EOD 1 and 2 Driver and Security Guard to assist at the Operation Center Incoming EODs on call for immediate mobilization Logistics Officer or alternate to go on duty

HOSPITAL
2. Manpower 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 of 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

CENTER FOR HEALTH DEVELOPMENT

Manpower 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

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

DOH

HEMS CENTRAL OFFICE

HOSPITAL

CENTER FOR HEALTH DEVELOPMENT

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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 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

Other requirements:

All those mentioned in Code White plus

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 Command should assign a Safety Officer, Liaison officer, Public Information Officer to coordinate with other agencies and serves as the spokesperson of the hospital Social Service section should prepare assistance to victims in coordination with mental 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 regular report to media

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.

Mobilize teams to affected areas for Rapid Assessment in coordination with the DOH Rep Regional Director or his designate to make proper coordination with RDCC and other agencies like DSWD, DEPED etc. for networking and other requirements Incident Command should assign needed staff in Operations, Logistics, Planning and Administrative to assist affected LGUs Public Information Officer to prepare and have regular media conference or press release. Continuous IEC 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 cluster under the DOH: Health, Nutrition and WASH. Provides technical support to LGUs Mobilize other requirements as needed such as psychosocial team etc.

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

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CODE RED

HEMS CENTRAL OFFICE

1. Conditions for Adopting Code Red Any natural, manmade or technological where

HOSPITAL
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 service of the hospital is paralyzed due to 50% of the manpower are victims of the disaster Hospital is structurally damaged requiring evacuation and/or transfer of patients l Conditions requiring mandatory quarantine of hospital and its personnel (e.g. sars, avian flu); Uncontrolled human to human transmission of SARS/Avian flu in the area

CENTER FOR HEALTH DEVELOPMENT

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/ 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 Mobilization of entire regional resources not enough and thus require external support Uncontrolled epidemic/outbreak Uncontrolled human to human transmission of SARS/Avian Flu within the region 2. Manpower requirements for responding to the Code: Mobilize all regional staff as needed on rotation basis Establish surveillance system in all evacuation centers All other teans deployed in affected area

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

2. Manpower 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: 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

2. Manpower 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

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CODE RED

HEMS CENTRAL OFFICE

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 for SARS/Avian Flu Activate Crisis Committee who serves as the technical, operations arm and prepares recommendation to the Execom 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

HOSPITAL
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 of not only the patients but the personnel

CENTER FOR HEALTH DEVELOPMENT

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 Provide updated report to HEMS Central OPCEN.

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HEMS CENTRAL OFFICE

Procedures 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

HOSPITAL
Procedures in implementing the Code

CENTER FOR HEALTH DEVELOPMENT

Procedures 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 emergencies within their catchments area or region 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 its 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 catchments areas or region Conditions to raise or supend the alert level Once the threat is increased or is no longer present Arrival of patients in the hospitals to warrant 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

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) 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 its own procedures in declaring and lifting the Code Conditions to raise or suspend the alert level Once the threat is increased or is no longer present

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