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LUNG CENTER OF THE PHILIPPINES
EMERGENCY PREPAREDNESS, RESPONSE AND
RECOVERY PLAN
TABLE OF CONTENTS
I. Background 1
II. Plan Description 2
III. Goals and Objectives 3
IV. Planning Group 4
V. Management Structures 7
VI. Roles and Responsibilities 8
VII. Hospital Emergency Preparedness Plan 9
A. Hazards assessment 9
B. Vulnerabilities reduction 21
C. Capacity development 22
D. Fire emergency plan 30
VIII. Hospital Emergency Response Plan 36
A. Organization 36
B. System activation 37
C. Resource mobilization 38
D. Partnership 38
IX. Hospital Recovery and Reconstruction Plan 38
A. Damage assessment and needs analysis 38
B. Provision of services 38
C. Psychosocial support 39
D. Restoration of utilized/damaged resources and services 39
E. Planning Matrix 40
X. Annexes
A. Directory of contact persons 45
B. Hospital Map & Pre-emergency evacuation designated area 46
C. LCP Organizational Chart 47
D. Glossary 48
E. Risk assessment form for all hazard 53
F. Risk assessment form for highly infectious disease 76
G. Flow chart for referral of emerging and re-emerging respiratory
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disease 81
H. Protocols on the triage of emerging and re-emerging respiratory
disease
I. Advice form for home quarantine 83
J. Triage screening form 84
K. Protocols in response to trauma emergencies outside the hospital 85
L. Protocols in response to earthquake incident 86
M. Protocols in the conduct of fire drill 88
N. Protocols in response to fire incident 90
O. Protocols in the activation of HEICS 92
P. Incident Command System Organization 93
Q. Hospital policies, guidelines, protocols 110
R. Post Mission Report 117
S. Hospital Floor Plan 118
T. Metro Manila DOH Zoning Plan 122
U. Reference 123
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Health Emergency Preparedness, Response and Recovery Plan
I. Background
The Lung Center of the Philippines is a government owned and controlled
corporation and established through Presidential Decree No. 1823 on January
16, 1981, to address respiratory diseases which were already recognized as the
leading cause of illnesses and deaths in the country. Lung Center is situated in
the district of Diliman, Quezon City, Metro Manila, with 12 hectares of prime
property. On January 23, 1982, the portals of the institution were first opened to
the public. It has since provided tertiary level care services to around 30,000
problematic and difficult cases annually and admitted 6,000 patients per year; it
has a bed capacity of 250. Around 70% of these are service patients and 30%
are pay patients. It has a complementary manpower consisting of 65 Physicians,
177 Nurses, 98 Nursing Attendants, 1 Dentist, 6 nutritionist-dietician, 41 Medical
Technologist, 17 Radiology Technologist, 3 Social Workers, 2 Mechanical
Engineers, 1 Electrical Engineer, 3 Driver and 3 Security Guard. Janitorial,
Maintenance Engineering and other Clerks are under contractual status. With
regards to health statistics, the leading causes of mortality and morbidity are (1)
Malignant Neoplasm of Trachea, Bronchus and Lung; (2) Respiratory TB
(MDRTB, TB Bronchiectasis, PTB); (3) Chronic lower respiratory diseases
(COPD, Bronchial Asthma, Bronchiectasis); (4) Pneumonia; (5) remainder of
diseases of the respiratory system (Aspiration pneumonia, ARDS, Interstitial
Lung Diseases, Pneumothorax). Other Services include:
1. PHDU Programs:
a. DOTS
b. MDRTB
c. Sagip Baga
2. ER OPD Specialty Clinics
a. HEMS Program
b. Surgery, Asthma, COPD
c. Smoking Cessation, Pain Clinic
d. Cancer support, Oncology
3. Services Areas for In-Patients
a. OR, ER, PACU-SICU, MICU, STU, IMCU, Pediatrics, Sleep
Lab, SRS, Laboratory, X-ray (CT-Scan, Ultrasound), VATS,
Pharmacy
b. Dietary, Social Services, Linen, PPSD and General Services
Lung Center focuses on the promotion of health of the majority of the Filipino
people and kept abreast with the technological advances in the field of medical
services.
But on that unfortunate event of May 18, 1998, Lung Center was gutted by
fire and 90 percent of its complex totally burned to the grounds including loss of
lives. Lung Center is in a state of shock for several years, affecting and
displacing hundreds of hospital personnel and patients.
The Lung Center suffered and tremendous reversals as a result of the 1998
fire, but its services, particularly to its numerous outpatients, never stopped. It
continued to give out-patient medical services even in a temporary field tents. Its
recovery took 2-4 years utmost, recalling gradually administrative and nursing
staff to manned small number of units. With the construction of the new building,
the design for safety focuses on multiple and easily accessible fire exits/ramps,
electronic fire/smoke detection and sprinkler system.
Its processes are directed primarily in reducing morbidity and mortality, while
preserving basic community service. The hospitals function in basic community
service will be fulfilled by protecting the patients, visitors, staff, and facility while
Goal:
To enhance the hospitals capacity for prompt and effective attendance to
the largest possible number of people requiring medical and health care in a
health emergency or disaster ultimately reducing mortality, morbidity and
disability and promoting their early recovery.
Objectives:
1. To provide policy for effective response to both internal and external
disaster situations that will affect the operation of the hospital and its staff,
visitors, patients and the community.
2. To identify the hospitals capability to handle mass casualty in all
scenarios.
3. To identify responsibilities of individuals and departments in a disaster
situation.
4. To identify Standard Operating Guidelines/Procedures, protocols for
emergency activities and responses.
5. To continuously improve risk reduction framework of the hospital.
6. To promote health emergency preparedness through networking, inter
hospital collaboration, technical assistance, training, public information,
advocacy, research and development.
7. To document best practices and lessons learned during simulation
exercises, emergencies and disasters.
1. Executive Director
5. Finance Division
11. Representative from the Philippine National Red Cross, Quezon City
Chapter
C. Initiates testing of the plan for its functionality and adaptability to multi-
hazard situation.
Specific functions:
V. Management Structures
These command structure may be revised according to the need of the facility
and available human resources. If the facility is not affected by the disaster, a
designated group shifts to an emergency/disaster mode for the HEICS, while the rest of
the staff conduct normal or regular hospital transaction/services.
If the hospital raises its alert status to Code Blue, normal office transactions are
suspended and the hospital is shifted to emergency/disaster mode.
HAZARDS MAPS
BIOLOGICAL
1. Dengue 3 1 1 3 5 3
2. Nosocomial 3 2 2 2 4 5
Infection
3. Water Borne 2 2 2 3 5 4
Dse.
4. Food 2 2 2 3 5 4
Poisoning
TECHNOLOGICAL
1.Radio-Nuclear 2 1 1 1 1 4
accident
2. chemical Spill 1 1 1 1 1 3
3. Hazardous 2 1 1 1 1 4
waste
4. Power Supply 2 1 2 2 5 2
Failure
5. Elevator 2 1 1 1 5 0
System Failure
6. HVAC Failure 2 1 1 1 5 0
7. Telecom. 2 1 2 2 5 2
failure
8. Fire 2 1 3 2 4 4
SOCIETAL
1.Bomb Threat 4 1 2 2 3 6
2. Hostage 3 1 2 2 3 5
Taking
3. Mass 2 1 1 1 4 1
Gathering
4. Bombing 3 1 3 3 3 7
2. Preventive strategies
a. Activities includes:
1) Continuous monitoring and updating of preparedness
capability in terms of policies, guidelines and
procedures.
2) Strengthening human resource capability by
encouraging continuous training.
3) Conduct a table top or an actual drill at least quarterly
or semi-annual.
4) Conduct post evaluation of the drill and make
appropriate recommendations for improvement
identifying what went wrong and what went right.
5) Team building among LCP-HEMS responders
b. Identifying resource requirements for all types of hazards.
1) Technical expertise on occupational safety, lectures
on first aid, basic life support, mass casualty handling
and incident command system.
2) Identifying alternative portable electric generators and
water pumps
3) Alternative source of electricity like solar power
devices.
4) Stockpiling of medicines and supplies.
5) Stockpiling of gasoline and diesel fuel for at least 5-10
days without compromising hospital safety.
6) Proper utilization of HEMS sub-allotted fund for
hospital capacity building activities.
7) Appropriate inclusion of specific supplies and
materials in annual procurement plan for proper
allocation and budgeting.
8) Networking with other government and private
agencies.
c. Assigning point person to monitor the different activities and
to source out any deficiencies in terms of resource
utilization.
1) General Services Chief as the Safety Officer in-
charge. Monitoring of all potential hazards and
vulnerable areas and take action immediately.
B. Vulnerabilities reduction
1. Vulnerable areas in times of emergencies and disasters.
a. Radiology Department
b. Pathology Department
c. General Services Division
2. All identified areas must be able to follow the guidelines in
assessing health facilities in responding to health emergency in
order to effectively reduce morbidity and mortality among its
personnel and clients. Vulnerability is categorized as:
a. Structural Related to the construction of the facility.
b. Non-Structural The non-structural elements of a building
include ceilings, windows, doors, mechanical, electrical,
plumbing equipment and installation.
c. Functional There are three aspects:
1) Deals with general physical lay-out of a facility,
including location, accessibility and distribution of
areas within the facility.
2) Individual services: medical (supplies and equipment)
and non-medical (utilities, transportation and
communication vital to continuous operation of
facility).
3) Public service and safety measures.
d. Human Resources Includes:
1) Organization of the health facility (e.g., emergency
planning group, subcommittees)
2) Inventory and mobilization of personnel
3) Preparedness activities for the personnel (e.g.,
hazards and vulnerability analysis, drills and training,
C. Capacity development
1. Training
a. All ER personnel must attend the Basic Life Support Training
(BLS), Advance Cardiac Life Support Training (ACLS),
Pediatric Advance Life Support Training (PALS) and
Emergency Medical Responder Course (EMR)
b. All hospital personnel must attend the following training:
1) Basic Life Support Training
2) First Aide Course
3) Fire & Earthquake Seminar
4) Incident Command System and Mass Casualty
Management Seminar
c. All identified high risk area personnel must attend special
training to resolve any immediate threat to hospital
operations. This training shall include:
1) Hospital Emergency Awareness and Response
Training
2) Special handling of highly flammable substance
3) Fire suppressant training
4) Radiological emergency training
5) Use of special personnel protective equipment (PPE)
for biological hazards and hazardous materials.
6) Basic water sanitation training
the hospital
- The Executive Director can temporarily stop all
elective admissions and surgeries and network
with other hospitals.
- The Executive Director should anticipate
request for additional manpower and specialists
not available in his hospital. He is further
authorize to accept medical volunteers and
other professional to augment the hospitals
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.
- Answer 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 Executive Director specifically be
concerned with safety and security, not only of
the patients but of the personnel as well.
1. General Instructions
a. Notification
1) Notify the telephone operator (local 444, 401 right
away the source of fire, exact location and possibly
the extent. Speak in a moderate tone of voice so that
the patient will not overhear and become frightened.
2) Notify the Charge Nurse who shall in turn notify the
Nursing Department Manager/Supervisor
3) Notify the Safety Committee and activate the Fire
Brigade
b. Evacuation strategies
1) Removal/Evacuation of Patients
i. Do not move patients unless with specific
instruction from the safety officer.
ii. Move patients with utmost caution bring along
their charts and medications.
iii. When patients are moved out from the room,
close the doors and windows.
iv. Everyone should know the location of the exits
nearest to the room to be evacuated, the
location of the keys to the exits, or the exit to
be used, ensure that exits are free from any
obstruction.
v. Evacuation priorities shall be as follows
1. FIRST those nearest the source
of fire or posed with
greatest danger or those
farthest from safety
2. SECOND helpless patients, use
available stretcher. If
none, roll in top covers
and carry with help by
grasping blanket under the
patient.
3. THIRD wheelchairs patient, wrap
in blankets and wheel out
towards exit
4. FOURTH walking patients; wrap in
blanker and lead towards
exit.
c. Removal/Evacuation of Equipment/Instruments/Supplies
All equipments should have been color coded at the
time they were installed in the unit. Color codes are used for
priority of evacuation. Color tags should be luminous or
reflectors.
1) RED FIRST PRIORITY
Equipment that contains
flammable gases such as
Oxygen
Halothane, Nitrous Oxide, etc.
C. Resource mobilization
1. All resource mobilization will be decided by the incident commander
upon recommendation by his command staff
a. Purchases of necessary supplies and materials will be
decided by the command staff based on priorities.
b. Review of MOA with other agencies
2. Construction of field hospital in case one is needed for patients and
staff in the pre-designated area. (Please see Annexes B. Hospital
Map)
a. Tents must be constructed as soonest possible time to
prevent delays in providing hospital services.
b. This temporary shelter must be supplied with adequate
water and electricity
c. Portable toilets must be closely monitored by sanitary
inspector assigned.
X. Annexes
A. Directory of contact persons
Name Designation Contact No./s
Dr. Jose Luis J. Danguilan Executive Director 0917-8220690
Dr. Rey Desales Deputy Director for Hospital 0917-8376920
Support Services
Dr. Raoul Villarete Deputy Director for Medical 0919-7461807
Services
Dr. Jaime Mendoza Department Manager III, ER- 0916-3751974
Out Patient Department
Mrs. Elvira N. Baura Department Manager II, 0919-4452198
Nursing Service
Mr. Albilio Cano Department Manager II, 0917-8397185
Corporate Services
Dr. Benilda Galvez Infection Control Coordinator 0918-9158378
Mrs. Heminia Tolentino Infection Control Nurse 0921-2656355
Dr. David F. Geollegue HEMS Coordinator 0927-4407329
Mr. Gerardo I. Lirag Asst. HEMS Coordinator 0917-6106534
Ms. Angie Roxas Division Chief, Accounting 0928-5050758
and Budget
Mrs. Consolacion Balderosa Division Chief, Property and 0919-8202527
Procurement
Mrs. Carol Manduraoi Division Chief, Cashier 0917-6265248
Engr. Conrado Yangat Division Chief, GSD 0919-5877499
Engr. Boyet Panlaqui Asst Chief, GSD 0927-9794857
Ms. Heidi Basobas Division Chief, Pharmacy 0917-8962363
Mrs. Donnabelle Arcillo Chief, Social Service 0922-8247115
B. Hospital Map
D. Glossary
with the impact of the scale of the hazard and therefore the event is
managed from outside of the affected communities; any major
emergency where response is also constrained by damage or
destruction to infrastructure (i.e., the lack of resources plus loss of
infrastructure overwhelms local capacity and event management from
outside the affected area is needed to direct and support local
response efforts
Disaster recovery The coordinated process of supporting disaster-
affected communities in the reconstruction of the physical
infrastructure and restoration of emotional, social, economic and
physical well-being
Donation Act of liberality whereby a foreign or local donor disposes
gratuitously of cash, goods or articles, including health and medical-
related items, to address unforeseen, impending, occurring or
experienced emergency and disaster situations, in favor of the
Government of the Philippines which accepts them
Donor All persons, countries or agencies that may contract and dispose
of cash, goods or articles, including health and medical-related items,
to address unforeseen, impending, occurring or experienced
emergency and disaster situations
Emergency Any situation in which there is imminent or actual disruption
or damage to communities, i.e., any actual threat to public health and
safety
Emergency management A management process that is applied to
deal with the actual or implied effects of hazards
Emergency operation center A place activated for the duration of an
emergency within which personnel responsible for planning,
organizing, acquiring and allocating resources and providing direction
and control can focus these activities on response to the emergency
Emergency preparedness An integrated program of long-term,
multisectoral development activities whose goal are the strengthening
of the overall capacity and capability of a country to ready to manage
efficiently
Hazard Any potential threat to public safety and/or public health; any
phenomenon which has the potential to cause disruption or damaged
to people, their property, their services or their environment. i.e., their
communities. The four classes of hazards are natural, technological,
biological and societal hazards.
F. Risk Assessment Form for Highly Infectious Diseases (SARS, Avian Flu-
H5N1, Pandemic Flu, H1N1, Mers-Cov, etc.)
relationships.
Sensitive on restriction in contents of news and
patient care activities.
Functions & Obtain appointment and briefing from the Incident
Responsibilities Commander.
Ensure that all news releases have the approval of
the Incident Commander.
Responsible for collating relevant information
needed to inform the public and for media.
Releases; obtain progress reports from respective
areas as appropriate.
Issue an initial incident information report to the
news media especially on the casualty status and
the actions being done.
Schedule press conferences on a regular basis.
Inform on-site media of the physical areas that they
have access to, and those which are restricted.
Coordinate with Safety and Security Officer.
Contact other scene agencies to coordinate
released information.
Direct calls from those who wish to volunteer to
Liaison Officer. Contact Operations to determine
request to be made to the public via the media.
Identifications Proper signage (hard hat with mark of Public
Information Officer or a vest)
LIAISON OFFICER
Mission Functions as incident contact person for
representatives from other agencies (government or
private).
Qualifications Preferably with experience in liaison procedures
and coordination.
Good or excellent public relation skills.
Preferably with understanding of Mass Casualty
Management.
Understand the bureaucracy and working
relationships of the different government as well as
private agencies responding to emergencies and
disasters.
Good grasp of patient care and management in
mass casualty situation; informed on inter-hospital
emergency communication network, municipal
operation centers and/or province, region or
national as appropriate.
Knowledgeable on the inventory of resources
available in the area/country.
Understand municipal (provincial, regional,
national) organizational charts to determine
appropriate contacts and message routing.
Functions & Obtain appointment and briefing from the Incident
Responsibilities Commander.
In coordination with the Public Information Officer
should always be knowledgeable on the following:
The number of Immediate and Delayed
patients that can be received and treated
immediately (Patient Care Capacity); also the
status of all other victims, especially in mass
dead situations
Any current or anticipated shortage or
personnel, supplies, etc.
Number of patients transferred to hospitals.
Any resources which are requested by each
area (i.e., staff, equipment, supplies)
Establish contact with liaison counterparts of each
assisting and cooperating agency.
Keep appropriate agency Liaison Officers updated
on changes and development of response to
incident.
Request assistance and information as needed
through the different networks of government and
private organizations responding to emergencies
and disasters.
Respond to request and complaints from incident
personnel regarding inter-organization problems.
Prepare to assist Labor Pool with problems
encountered in the volunteer credentialing process.
assistance applications.
Schedule planning meetings to include Planning
Section Unit Leaders, Section Chiefs and the
Incident Commander for continued update of the
Action Plan.
Coordinate with the Liaison Officer and Labor
especially with regards to manpower requirements.
Identifications Proper signage (hat or vest).
STAGING OFFICER
Mission Coordinate all resources arriving at the scene. For
manpower resources, referring them to appropriate
area of assignment. For transportation resources,
organizing them and dispatching them as required.
Qualifications At least a paramedic or an EMT.
Preferably with knowledge in Mass Casualty
Management and understand the organizational
chart.
Functions & Receive appointment and briefing from the Incident
Responsibilities Commander/Operation Section Chief.
MORGUE MANAGER
Mission Collect, protect and identify deceased patients.
Qualifications Doctor of Medicine aided by a social worker, a
psychosocial support officer.
For medico-legal cases forensic experts from the
b. Legal Framework
DOH Administrative Order No. 6-B of 1999:
Institutionalization of a Health Emergency Preparedness and
Response Program within the Department of Health and
DOH Administrative Order No. 168 s 2004. It stated that all
hospital must have a working and updated health emergency
preparedness, response and recovery plan as a basic
requirement by the Bureau of Licensing of the Department of
Health.
c. Rationale
This aimed to promote health emergency
preparedness among the general public and strengthen
health sectors capability to respond to emergency and
disaster. The administrative order likewise gives advice and
policy directions regarding health emergencies. It embodies
the framework of Health Emergency Management (HEM).
HEM strategies, organizational structure, human resource
development, support systems and roles and responsibilities
of HEMS, DOH offices, and attached agencies, and other
health sector.
d. Statement of Policy
1) All hospital personnel must have a full knowledge and
understanding of the Hospital Health Emergency
Preparedness, Response and Recovery Plan
Guidelines
a. Before a Health Emergency Preparedness Response
and Recovery can be perceived a reality, a planning
committee must be formed and must be supported by
a Center Order.
b. Members of the committee must be equally
represented to the different main section of the
organization and this must be headed by the
Executive Director or by the Deputy Director. The
members are:
i. Medical
ii. Nursing
iii. Pathology
iv. Radiology
v. Infection Control
vi. GSD
vii. Finance
viii. HEMS
ix. Representative from Medical Specialty Society,
PNRC and BFP
c. The committees function is as follows:
i. Review existing HEPRR plan and makes
necessary updates
ii. Review roles and responsibility of members of
the committee
iii. Assignment of major responsibilities within the
hospital for emergency prevention, preparedness
and response.
iv. Selecting priorities for the acquisition of
emergency supplies and medicines.
v. Initiates testing of the plan for its functionality
and adaptability to a multi hazards situations.
b. Legal Framework
The design, construction and maintenance of
buildings, structures and facilities shall adhere to all
applicable provisions of the Fire Code of the Philippines.
Electrical systems, equipment and installation
mentioned in the Fire Code shall conform to the provisions of
the Philippine Electrical Code. Likewise, mechanical
systems, equipment and installation mentioned in the Fire
Code shall conform to the provisions of the Philippine
Mechanical Engineering Code.
c. Rationale
The built environment in hospitals and other health
facilities is becoming more complex as these institutions plan
and design their buildings and structures to response to the
demands of their growing bed capacity and service capability
and advance technology for quality healthcare services
delivery.
However with the continuing physical development in
hospitals and other healthcare facilities, comes the
corresponding responsibility of keeping the buildings and
structures properly maintained and safe especially against
man-made disasters.
Fire, which can be the most devastating but
preventable ma-made disaster to happen to hospitals and
other healthcare facilities, may result in loss of lives, loss of
essential equipments, damaged to infrastructures and
displacement of hospital employees. It can suspend
infrastructure projects, waste hard fought resources, and
d. Policy
The management of the Lung Center of the
Philippines holds in high regards the safety, welfare and
health of its employee, patients, and other clients.
Accordingly, it is the policy of the institution to integrate
safety in every work stage and to promote and maintain a
good working environment to safety guards all personnel,
facilities and equipments.
U. References