Pocket Emergency Tool 2005

i
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
POCKET EMERGENCY TOOL
ii
CONTENTS
Contingency Planning .........................................................85

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

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

1
INTRODUCTION
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.

2
ABBREVIATIONS
CDC Centers for Disease Control and Prevention (USA)
CHD Center for Health Development
CMR Crude Mortality Rate
CSR Communicable disease Surveillance and Response
DND Department of National Defense
DOH-HEMS Department of Health-Health Emergency
Management Staff
DOTC Department of Transportation and Communication
DPWH Department of Public Works and Highways
DSWD Department of Social Welfare and Development
EHA Emergency and Humanitarian Unit
EMS Emergency Medical Services
EOC Emergency Operations Center
EPI Expanded Program of Immunization
ER Emergency Room
IEC Information, Education and Communication
HEICS Hospital Emergency Incident Command System
LGU Local Government Unit
MUAC Mid-Upper Arm Circumference
NBI National Bureau of Investigation
NDCC National Disaster Coordinating Council
NEC National Epidemiology Center
NEHK New Emergency Health Kit
NGO Nongovernmental organization
NNC National Nutrition Council
NPDEP Nutrition Preparedness in Disasters and
Emergencies Plan
OpCen Operation Center
PHC Primary Health Care
PNRC Philippine National Red Cross
RDCC Regional Disaster Coordinating Council
SARS Severe Acute Respiratory Syndrome
WHO-WPRO World Health Organization-Office for the Western
Pacific Region
WMD Weapons of Mass Destruction
3
ROLES AND RESPONSIBILITIES
T.R.A.I.T. of a Health Emergency

Manager/Coordinator
T 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
R ecord and re-evaluate lessons learned to improve
preparedness in the future
A ssess and monitor health and nutrition needs so that they
are immediately dealt with
I mprove health sector reform and capacity building by
networking
T end and protect the practice of humanitarian access,
neutrality and protection of health systems in emergency
situations

4
ROLES AND RESPONSIBILITIES

Roles of Hospitals in Health Emergency
Management
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.
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.

5
PREPARING
FOR EMERGENCIES

6
PREPARING FOR EMERGENCIES

Steps in Preparing for Emergencies
1. Policy Formulation and Development
! policy statement/implementing rules
! guidelines, protocols, procedures
! organizational structure
! roles and functions
! resource mobilization
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,
7
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

8

Roles of Centers for Health Development in
Emergency Management
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)
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)

9
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.)

10

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

11
COORDINATING WITH OTHER AGENCIES
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.

12

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.
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:
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

13
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.

14

Disaster Reaction Sequence:
! 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
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…

15
DRAFTING THE DISASTER HEALTH MANAGEMENT PLAN
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)

16
RESPONDING
TO EMERGENCIES

17
RESPONDING TO EMERGENCIES
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 informa-
tion 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
18
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
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
(Adapted from CDC's Public Health Emergency Response Guide.)

19
RAPID HEALTH ASSESSMENT
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)
20

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
4. 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)
5. 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
6. 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)
7. Conclusions
a. Are the current levels of mortality and morbidity above-
average for this area and this time of the year?
21
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.

22
CRITICAL INCIDENT MANAGEMENT

Steps as First Responders
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

23
Triaging
PRE-HOSPITAL ACTIVITIES
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 <10/min)
c. circulation disturbance (HR =100/min or weak pulses)
d. altered level of consciousness
e. external bleeding with CVS collapse
24
PRE-HOSPITAL ACTIVITIES
YELLOW TAG
2nd priority: Urgent - needs to be treated within 4-6 hours

a. major burns: involving hands, feet or face (excluding
respiratory tract); complicated by major soft tissue trauma
b. spinal injuries; long bone or pelvic fractures
c. environmental injuries (heat/cold exposure)
GREEN TAG
3rd priority: Requires no treatment or can be delayed

a. minor injuries not threatened by ABC instability
b. minor fractures/soft tissue injuries/burns
c. injuries so severe that survival cannot be expected even
under the most ideal conditions; obviously mortal wounds
where death is certain (such as head injuries or massive
burns)
BLACK TAG
Last priority:
a. death or moribund state
In emergency situations the most practical

means of tagging may only be by color ribbons
or even pentel pens

25
HOSPITAL ACTIVITIES
Color-Coded Alert Systems

The hospital alert status shall be declared either by the
Secretary of Health, the HEMS Director, the Chief of Hospital or
the HEMS Coordinator. The alert status shall continue to be in
effect until cancelled by the Chief of Hospital or the HEMS
Coordinator.
CODE WHITE
Alert Mode is called with any of the following conditions:

! a strong possibility of a military operation (e.g., coup
attempt)
! any planned mass action or demonstration within the area
! forecasted typhoons, the path of which may affect the area
! national or local elections or plebiscites
! national holidays or celebrations (e.g., New Year's Eve,
Holy Week, etc.)
! other conditions which may be declared as disasters by
the Chief of Hospital or other appropriate authority
There should be necessary preparations of the necessary

equipment and even personnel. Aside from those who are on
regular duty for the day, the following should be on-call anytime
during his/her duty days:
1. surgeons
2. orthopedic surgeons
3. anesthesiologists
4. internists
5. O.R. nurses
6. ophthalmologists
26
HOSPITAL ACTIVITIES
7. otorhinolaryngologists
8. 2nd response team should be on call
9. EMS, nursing personnel and administrative personnel
residing at the hospital dormitory shall be placed on on-call
status for immediate mobilization
The composition of the back-up and on-call

teams would depend on the type and level of
the hospital. The suggestions here are based
on a general tertiary hospital. Each hospital
can come up with its own team members. In
some places like Metro Manila, there can also
be designated support hospitals (usually
specialty hospitals). These specialty hospitals
act as support to a receiving hospital (e.g., San
Lazaro and Fabella Hospital supporting Jose
Reyes Memorial Medical Center).
CODE BLUE
Partial/Selective Activation is proclaimed when 20-50

casualties (red tags) are expected. This may require the
activation of the hospital network or at the judgment of the
director or the HEMS coordinator, may only involve the hospital
nearest the emergency site.
The following should respond once CODE BLUE is on:

1. on-scene response team
2. medical officer in charge of the emergency room
3. ALL orthopedic residents
4. medical officer in charge of the operating room
5. surgical team on duty for the day
27
HOSPITAL ACTIVITIES
6. officer in charge of supplies at the CSR

7. surgical team on duty the previous day
8. ALL anesthesiology residents
9. nursing supervisor on duty
10.operating nurses living within or in the vicinity of the hospital
11.ENTIRE security workforce
12.ALL third and fourth year residents
13.ALL O.R. nurses
14.institutional workers on duty
CODE RED
Full Activation is put into effect when more than 50 (red tag)
casualties are momentarily anticipated, expected or suddenly
brought to the hospital. The situation may require more than one
hospital to respond by sending an on-scene team.
The following should respond once Code Red is on:

1. ALL persons enumerated under Code Blue
2. ALL institutional workers
3. ALL nursing attendants
4. ALL nurses
5. ALL medical interns and clinical clerks

28
HOSPITAL ACTIVITIES
If there is a strong possibility that there would
be a need to change the alert status from code
white to blue to red, the Chief of Hospital is
authorized to:
1. Cancel all leaves of personnel and for them
to report to the hospital.
2. Put back-up teams on standby within the
hospital for rapid deployment.
3. Take other steps necessary to respond to
the emergency situation (e.g. cancel
elective surgeries, etc.).

29
Steps in Ensuring Communicable

PREVENTION AND CONTROL OF COMMUNICABLE DISEASES
Disease Control in Emergencies

1. Conduct rapid health assessment (see previous section)
2. Provide general prevention measures in coordination with
other sectors, including:
! Food security, nutrition and food aid
! Water and sanitation
! Shelter
3. Provide community health education messages including
information on how to prevent common communicable
diseases and how to access relevant services
! Encourage people to seek early care for fever, cough,
diarrhea, etc., (especially children, pregnant women and
older people)
! Promote good hygienic practice
! Ensure safe food preparation techniques
! Ensure boiling or chlorination of water
4. Implement as indicated, specific prevention measures, such
as mass measles vaccination campaign, Expanded Program
on Immunization, and vector control.
5. Provide essential clinical services
6. Provide basic laboratory facilities
7. Set-up surveillance/early warning systems
a. Detect outbreaks early
b. Report diseases of epidemic potential immediately
c. Monitor disease trends
8. Control outbreaks
a. Preparation
b. Detection
c. Confirmation
30
PREVENTION AND CONTROL OF COMMUNICABLE DISEASES

d. Investigation
e. Control measures
f. Evaluation
Notes on Immunization
! A single suspected measles case is sufficient to prompt an
immediate immunization response. Life-saving measles
vaccine should be made available immediately targeting all
infants and children 6-59 months of age. The suggested
target age group may be expanded up to 15 years, if feasible,
in areas where there is substantial crowding.
! Each visit to health care facilities should be seen as an

opportunity to vaccinate for routine EPI regardless of the
reason for the visit. Vaccination program activities should be
included as part of basic emergency health care services.
! Mass vaccination against cholera and typhoid fever is not

recommended. The most practical and effective strategy to
prevent cholera and typhoid is to provide clean water in
adequate quantities and adequate sanitation. Sufficient soap
and hygiene education will further prevent the transmission of
both diseases.
! Mass tetanus vaccination programs are not indicated.

However, tetanus boosters may be indicated for previously
vaccinated people who sustain open wounds or for other
injured people depending on their tetanus immunization history.
! Mass vaccination for Hepatitis A is not recommended.

31
NUTRITION CONCERNS
Nutrition Preparedness
1. Planning: Every effort should be done to formulate an inter-
sectoral and comprehensive plan (i.e., NNC's Nutrition
Preparedness in Disasters and Emergencies Plan or NPDEP).
2. Nutritional Management: Is an institutional and multi-

sectoral concern. It is equally the responsibility of the national
government, local government and even non-government
units. Disaster Coordinating Teams implement the NPDEP
while involving the Municipal Nutrition Action Officer in the
creation of Disaster Response Teams.
3. Adequate Nutrition: During emergencies, infants (<1y/o)

and children (<5y/o) are the most vulnerable group.
Interrupted breastfeeding and inappropriate complementary
feeding will heighten the risk for malnutrition, illness and
mortality.
4. Resource Generation and Mobilization: Maintain a

stockpile of culturally acceptable food items that can be
stored for a long period of time such as rice, canned goods,
noodles, dried fish and canned/powdered milk. Intensify
campaign on creating vegetable gardens in schools and
backyards. Identify and coordinate with donor agencies and
companies that can donate food during disasters.
5. Public Education: Promote the acceptability and utilization

of donated foods ideal for disasters (i.e. compact food).
Support the innovation of nutritionally dense ready-to-eat
foods.
32
NUTRITION CONCERNS
6. Cultural and Indigenous Habits: Customs should be taken
into consideration in food management.
7. Gate Keepers: Identification of local/tribal leaders are critical for

nutrition education, supplementation, and resettlement feeding.
! Following a major sudden disaster, some

people may have no access to food and/or be
unable to prepare food for a few days at
least.
! In slow-onset crisis or in situations where
the livelihood of the community is greatly
undermined, particularly in areas where
nutritional status was already poor, it will be
important to monitor nutritional status and
households' access to food, and to initiate
remedial action (e.g. through supplementary
feeding) if nutritional status is at risk.
! In extreme cases, nutritional rehabilitation
through intensive, supervised therapeutic
feeding (TF) may be required.
! Because the number of caregivers is

reduced during emergencies and their ability
to cope is diminished by physical and mental
stress, strengthening caregiving capacity is
an essential part of promoting good feeding
practices for infants and young children.
! Healthy workers are essential. Aside from
looking after the basic health and nutritional
needs of the displaced population, health
workers have to be debriefed to look after their
personal health as well.

33
NUTRITION CONCERNS
Energy Requirements
For initial planning purposes:
! Average daily energy requirement : 2,100 kcal/person/
day
! When the data are available, the planning figure should be
adjusted according to:
! Physical activity level add 140 kcal for moderate activity,
350 kcal for heavy activity (e.g., during construction or land
preparation works)
! Age/sex distribution when adult males make up more than
50% of the population, requirements are increased; when the
population is exclusively women and children, requirements
are reduced.
! Special needs of pregnant and lactating women
a. Pregnant women
? Need an additional 300 kcal/day
? If malnourished, need another 500 kcal/day
? Should receive iron and folate supplements
b. Lactating women
? Need an additional 500 kcal/day
? If malnourished, need another 500 kcal/day
? Should receive sufficient fluids, taking into account
activity
Other nutritional requirements:

! Protein: 10 to 12% of diet (i.e. 52 to 64 g)
! Fat/oil: = 17% of diet (i.e. 50 g)
! Micronutrients: a range of micronutrients (vitamins and
minerals) are required for survival and good health

34
NUTRITION CONCERNS
Ideal Foods for Disaster
! Carbohydrate sources rice, root crops, bread, noodles
! Protein sources eggs, canned meat and fish, fresh meat and
fish, dried meat and fish, milk
! Fat sources cooking oil, margarine
! Vitamin and mineral sources fruits and vegetables
! Others coffee and other beverages
* see appendix for examples of rations.
Nutritional Assessment
The most widely accepted practice is to assess malnutrition
levels in children aged 6-59 months as a proxy for the population
as a whole. Reports should always describe the probable causes of
malnutrition, and nutritional edema should be reported separately.
Two-stage cluster sampling is normally used:

30 clusters are selected, then 30 children
within each cluster.
Classification of Acute Malnutrition

Moderate Severe
Mild Malnutrition Malnutrition Malnutrition
Edema of both feet No No Yes
Weight-for-Height* 80-90% 70-79% < 70%
(-1 to -2 SD) (<-2 to -3 SD) (<-3 SD)
MUAC 12.5 to 13.5 cm 12.0 to 12.5 cm <12 cm
Body Mass Index 17 to <18.5 16 to <17 <16

35
NUTRITION CONCERNS
Give vitamin A if a child has severe

malnutrition. Give one dose in your presence
and give one dose to the mother to give it to
the child at home the next day.
Age Dose
6-11 months 100,000 IU
1-5 years 200,000 IU
*see appendix for length-for-weight/height-for-weight reference

values
**see appendix for decision framework for implementing
feeding programs.
There should be a continual search for

malnourished children so that their condition
can be identified and treated before it becomes
severe.
Feeding Recommendations
! Up to 6 months of age: Encourage mothers to exclusively
breastfeed as often as the child wants, day and night, at least
8 times in 24 hours. Do not give any other fluid or food.
! 6 months to 12 months: Breastfeed as often as the child

wants. In addition, give adequate servings of locally available
complementary foods at least 3 times a day.
! 12 months to 2 years: Breastfeed as often as the child wants.

Give adequate serving of locally available complementary
food at least 5 times a day.

36
NUTRITION CONCERNS
! 2 years and older: Give three meals of family food per day.
Also, give nutritious snacks, twice daily.
Notes on Breastfeeding
! Breastfeeding's multiple advantages are especially important
during emergencies (i.e., protection from infection and its
consequences, contraceptive effect, privileged nurturing
moment important for both mother and child). Every effort
should be made to identify ways to breastfeed infants whose
mothers are absent or incapacitated. Every effort should be
made to create and sustain an environment that encourages
frequent breastfeeding for children under two years of age.
! A nutritionally adequate breast-milk substitute, fed by cup,

should be available for infants who do not have access to
breast milk. The use of infant-feeding bottles and artificial
teats in emergency settings should be actively discouraged.
! Emergencies do not justify routine distribution of breast-milk

substitutes. Formula feeding may increase the considerable
risk of child morbidity and mortality.
! The nutritional status of breastfeeding women should be

protected as an end in itself, and as a means of maintaining
the adequate growth and development of their children.

37
ENVIRONMENTAL HEALTH
Minimum level of necessary services to be provided:

1. Adequate shelter for displaced persons
! Evacuees should be protected from the elements
! Secure against violence
! Provide allocations for privacy
! Avoid overcrowding.
! Floor area per person: 3.5 square meters
! Fresh air ventilation per person per hour: 20-30 cubic
meters
! Lighting: adequate (minimum is a 5-foot candle)
! Ventilation: adequate (combined openings at least 10% of
floor area)
2. Sufficient quantities of accessible drinking water
3. Facilities for excreta and liquid waste disposal
4. Protection of food supplies against contamination
5. Protection of individuals in affected population against vector-
borne diseases through vector control activities and through
chemoprophylactic methods.

38
WATER SUPPLY
Provision of adequate amounts of drinking
water is of utmost importance after disaster. It
should first be made accessible to victims and
relief workers and in essential locations, such
as hospitals and treatment centers. After
drinking water is secured within stricken areas,
making water available for domestic uses (such
as cleaning and washing) should be
considered.
Assessment
1. Assess water resources for human consumption to ascertain
the availability of water (quantity and quality) in relation to the
demand.
2. Estimate the demand, identify possible sources and assess
the possibility of developing these resources.
3. Consult local people in the identification of water sources to
be developed.
4. Tap the expertise of the local Sanitary Engineer in the
assessment of the water resources and the conduct of
sanitary survey.
5. Always consider seasonal factors in the assessment.
Organization
1. Organize water allocations between the host community and
the evacuees to prevent overstraining water resources.
2. Evaluate the technology used in the water supply system to
ensure that continuous and long-term operational needs are
within reach of the community and the evacuees.
3. From the start, involve the evacuees in the maintenance and
operation.
39
WATER SUPPLY
4. Train evacuees without prior experience.

5. Combine water control and treatment with improved personal
hygiene and environmental health practices.
6. The design and construction of the water supply system must
be closely coordinated with evacuation camp planning and
layout as supported by health promotion and sanitation.
7. Consider using pumps and other mechanical equipment
attainable in the area where fuel and spare parts are
available, and maintenance is not a complicated aspect.
Technical breakdown should be quickly repaired.
8. Monitor both the organizational and technical aspects of the
complete water supply system.
Immediate Action after a Disaster

1. Estimate water requirements and assess water supply
possibilities.
2. Make an inventory of water sources and assess all sources in
terms of their quality and yield.
3. Protect water sources from pollution. Provide water in good
quantities and reasonable quality.
4. Improve access to supplies by developing water sources and
a storage and distribution system to deliver sufficient
amounts of safe water, including reserve.
5. Conduct regular sample collection and testing of water
quality.
6. If possible, use water sources that do not need treatment. If
there is a large number of evacuees, decontamination of
water is necessary. Treat water according to the
characteristics of the raw water.
7. Set up schedules for operation and maintenance.
40
WATER SUPPLY
8. Maintain and update information on water resources obtained
during needs assessment, planning, construction, operation
and maintenance.
Intermediate Response
1. If the minimum amount of water cannot be made available
from local sources, recommend transfer to another
evacuation camp.
2. If storing the water in tanks is employed, the storage should
be tested periodically.
3. Domestic hygiene and environmental health measures
should be observed in order to protect the water between
collection and use.
Organize a distribution system that prevents pollution of the
source and ensures equity if water is insufficient.
Water Need
1. Minimum Demand (per person per day); calculate the
following:
a. 2 liters for drinking
b. 10 liters for food preparation and cooking
c. 15 liters for bathing
d. 15 liters for laundry
e. 10 liters for sanitation and hygiene
2. Quality: To preserve public health, a large amount of
reasonably safe water is preferred over a small amount of
purified water.
3. Control: Bacteriological, biological, chemical, physical and

41
WATER SUPPLY
radiological quality of water must be deemed safe.

! There are no fecal coliforms per 100 ml at the point of
delivery.
! People drink water from a protected or treated source in
preference to other readily available water sources,
! Steps are taken to minimize post-delivery contamination.
! No negative health effect is detected due to short-term use
of water contaminated by chemical (including carry-over of
treatment chemicals) or radiological sources, and
assessment shows no significant probability of such an
effect.
4. Other Needs:
a. Hospital and Clinics:
! Out-Patient: 5 liters per patient per day
! In-Patient: 40-60 liters per patient per day
b. Mass Feeding Centers: 20-30 liters per person per day
Animals
! Cow/Carabao: 30 liters per day
! Pig: 1.5 liters per day
! Goat: 1.5 liters per day
! Poultry: 2 liters per day
5. Water Decontamination/Disinfectants:
! Water Purifier: 2 tablets per person per day
! HTH (high-test hypochlorite) Stock Solution: 1 liter/20
families/5 days
! Shock Disinfection: 50-100 parts per million (ppm) of 60-
70% of available chlorine
! Environmental Cleaner-Sanitizer
6. Drinking Water Container: one container of 10 liters per family
7. Communal Water Storage Tank: 10 liters per person per day.
Volume of tank good for 2 days demand; half full in the
42
WATER SUPPLY
evening; with free residual chlorine of 0.7 ppm.
8. Shallow Well: for toilet flushing and cleaning
9. Water Points:
! Distance between Water Point and Users: 150 m (max.)
! Minimum Number of Water Points: 1 tap per 250 users
! Queuing time at a water source is no more than 15
minutes.
! It takes no more than three minutes to fill a 20-liter
container.

43
SANITATION AND WASTE MANAGEMENT
Assessment
Excreta Disposal
1. What is the current defecation practice (including anal
cleansing)? If it is open defecation, is there a designated
area?
2. Is the current defecation practice a threat to water supplies
(surface or ground water) or living areas?
3. Are there any existing facilities? If so, are they used, are they
sufficient and are they operating successfully? Can they be
extended or adapted?
4. What is the ratio of domestic facilities to population?
5. What is the maximum one-way walking distance for users?
6. Are people prepared to use pit latrines, defecation fields,
trenches, etc.?
7. What is the level of the groundwater table?
8. Are soil conditions suitable for on-site excreta disposal?
9. Do current excreta disposal arrangements encourage
vectors?
10. Are there materials or water available for anal cleansing?
How do people normally dispose of these materials?
11.How do women manage issues related to menstruation? Are
there appropriate materials available for this?
Drainage
1. Is there a drainage problem (e.g. flooding of dwellings or
toilets, vector breeding sites, polluted water contaminating
living areas or water supplies)?
2. Is the soil prone to water logging?
3. Do people have the means to protect their dwellings and
toilets from local flooding?
44

Solid Waste Management
1. Is solid waste a problem?
2. How do people dispose of their waste? What type of how
much solid waste is produced?
3. Can solid wastes be disposed of on-site, or does it need to be
collected and disposed of off-site?
4. Are there health facilities and activities producing waste?
How are wastes being disposed of? Who is responsible?
Immediate Action
1. Localize defecation and prevent contamination of water
supply.
2. Collect baseline data of the site and locate zones for sanitary
facilities.
3. Develop appropriate systems for the disposal of excreta,
refuse and wastewater.
4. Plan the number and location of sanitary facilities and
services to be established and provided.
5. Establish sanitation teams for the construction and mainte-
nance of facilities.
6. Set up services for vector and vermin control.
7. Set up services for management of dead bodies
8. Establish a monitoring and reporting system.
9. Include environmental health as an integral part of health
promotion.
Excreta Facilities
1. Communal Trench Latrine: for 50 persons, 1.2 m x 0.3 m x
0.6 m. Use only soil for cover.
2. Pit Latrine: 1 seat for 20 persons, 1.2 m x 0.6 m x 0.6 m
45
3. Ventilated Improved Pit:

1 seat for 20 persons, 0.8 m x 0.7 m x 3.0 m
4. Pour-Flush Water-Sealed Toilet: 1 seat for 20 persons.
5. Others: “Antipolo,” Aqua Privy, Deep Pit Latrine, Reed Odorless
Earth Closet (ROEC), Chemical Toilet: 1 seat for 20 persons.
6. Urinals: Urine Soakage, Four-Funnel Urinal
7. Children's Feces: should be disposed of immediately and
hygienically
8. Distance of Latrines:
! From users: 250 m (max.)
! From shelters: 30 m (min.)
! From any water source: 25 m radial distance
Bottom of any latrine should be at least 1.5

meters above the water table. Drainage or
spillage from defecation systems must not run
towards any surface water source or shallow
groundwater source
Liquid Waste Facilities
1. Infiltration Trench, Grease Trap and Soakage Pit, Baffle

Grease Trap, and Cold Water Grease Trap.
2. Locate not less than 25 meters radial distance from any
source of water supply.
3. Protect from vermin harborage and breeding.
4. There should be no standing wastewater around water points
or elsewhere in the settlement.
5. Drainage: Run-in and run-off water management.
6. Shelters, paths, water and sanitation facilities should not be
flooded or eroded by water.
46

Solid Waste Facilities
1. Storage:
! 100-liters capacity per 10 families
! Distance from users: 15 m (max.)
! Bulk storage bin: centralized bin for temporary storage
before collection
! No contaminated or dangerous health waste in living or
public spaces
2. Collection: organize a camp refuse collection team
3. Disposal:
! Burial: Communal Open Pit, 1.2 m x 1.2 m x 1.8 m
! Cross Fire Trench Incinerator: for 20 families (2.4 m x 0.3
m x 0.3 m)
! Barrel and Trench Incinerator, Bailleul Incinerator, Inclined
Plane Incinerator, Open Corrugated Iron Incinerator, Rock
Pit Incinerator, Drying Pan Incinerator and Open Turf
Incinerator: for 10 families
! Final disposal does not create health or environmental
problems
Health-care Wastes
1. Be aware of the public health and occupational risks from

health-care waste
a. Vaccination, notably for Hepatitis B should therefore be
provided to waste handlers.
b. All waste handlers should wear protective clothing.
c. Hand-washing and disinfection are a must.
2. Minimize health-care waste
3. Segregate:
47
! To be done at point of generation using dedicated, colored

and/or marked containers
! Separate wastes into three main categories:
i. infectious sharps (collect sharps in puncture proof
containers with a lid that can be closed, mark with
biohazard symbol)
ii. non-sharp infectious wastes
iii. non-infectious wastes
! If no separation of wastes takes place, the whole mixed
volume of health care waste needs to be considered as
being infectious.
Approximate percentage of waste types
per total waste in PHC centers
Non-infectious waste 80%
Pathological waste and infectious waste 15%
Sharps waste 1%
Chemical or pharmaceutical waste 3%
Pressurized cylinders, broken Less than 1%
thermometers…
1. Dispose properly. Wastes to be buried and should not be

incinerated:
a. used infectious plastic syringes and needles
b. other infectious PVC plastics such as tubing, catheters, IV sets
c. anatomical wastes
All these should be buried in a sharps waste burial pit.
Dig a pit 1 to 2 meters wide and 2 to 5 meters deep. Line the

bottom of the pit with clay or low permeable material. Construct
an earth mound around the mouth to prevent to prevent water
48

from entering. Construct a fence around to prevent unauthorized
entry. Alternately place layers of waste and 10 cm of lime and
soil inside. When the pit is within about 50 cm of the ground
surface, cover the waste with soil and permanently seal it with
cement or embedded wire mesh.
Security fence
Earth mound to
Cement or prevent surface
50cm of embedded water from flowing
soil cover wire mesh into the pit
Soil or soil-lime
layer
2 to 5m
Bio-medical
waste
Bottom clay
layer
1 to 2m
Another method involves placing the sharps waste in hard
containers such as metal drums and adding an immobilizing
material such as bituminous sand, clay or cement mortar. The
container or drum can be sealed and buried in a trench or
transported to a local landfill.
(For other strategies, please see WHO (2004). Management of solid health-care
waste at primary health-care centres: A decision-making guide. Geneva: World
Health Organization.)

49
VECTOR AND VERMIN CONTROL
Assessment
1. What are the vector-borne disease risks and how serious are
these risks?
2. If vector-borne disease risks are high, do people at risk have
access to individual protection?
3. Is it possible to make changes to the local environment (by
drainage, excreta disposal, refuse disposal, etc.) to discour-
age vector breeding?
4. Is it necessary to control vectors by chemical means?
5. What information and safety precautions need to be provided
to households?
Preventive Measures
a. Conduct vermin population density survey.
b. Vulnerable populations are settled outside of the malar-
ial/dengue zone.
In areas of known malaria risk:
! spraying of shelters with residual insecticide and/or
retreatment/distribution of insecticide-treated mosquito
nets in areas where their use is well-known.
In areas endemic of dengue:
! water storage containers should be covered to prevent
them from becoming mosquito-breeding sites. Attempts
should be made to eliminate pooled water which may be
gathering amongst the debris.
c. Vector breeding or resting sites modified.
d. Screening of living quarters.
e. Rats, flies and other mechanical nuisance pests kept within

50

acceptable levels.
f. Intensive fly control is carried out in high-density settlements
when there is risk or presence of diarrhea outbreak.
g. Removal of breeding and harborage places of vectors and
maintenance of sanitation. Garbage must be collected and
appropriately disposed to discourage rodent vector breeding.
h. Larvi-trapping
Chemical Control
a. 1 sprayer for every 50 families
b. 1 misting machine for every 50 families
c. 1 fogging machine for every 500 families
d. Fumigation for the camp, if needed (with proper precautions);
done under the supervision of an emergency Sanitary
Engineer
e. Adulticides: for crawling and flying insects
f. Rodenticide: for rats and mice (under some conditions)
g. Larviciding: introduction of local bioremediation microbes
Estimation of Vector Population

Mosquitoes:
1. Select several shelters in the camp.
2. In the shelter, close all openings, windows, holes, etc.
3. Spread a white sheet on the floor of the rooms.
4. Spray the insecticide and wait 20 minutes until the insecticide
has killed the mosquitoes.
5. Count the number of killed adult mosquitoes and record.
6. The following can be determined:

51
! The number of killed adult mosquitoes divided by the

number of inspected shelters will give the average
mosquito density per shelter.
! The number of killed adult mosquitoes divided by the
number of persons occupying each shelter will give the
average number of mosquitoes per person.
! The number of mosquitoes found with blood in the
abdomen (red or black) divided by the number of person
living in the shelter will give the average number of bites
per person.
7. Send the collected mosquitoes to a laboratory for identifica-

tion.
Flies:
1. Count the average number of flies that land on a grill placed
where flies congregate during three 30-second periods.
(from: Lacarin, CJ and Reed RA (1999) Emergency Vector Control Using
Chemicals, Water, Engineering and Development Center (WEDC),
Loughborough.)

52
EPIDEMIOLOGY AND SURVEILLANCE

Epidemiologic Methods
of Emergency Management
Objectives:
! Assess the urgent needs of human populations
! Match available resources to needs
! Prevent further adverse health effects
! Monitor and evaluate program effectiveness
! Improve contingency planning
! Optimize each component of emergency management
Application:
! Hazard mapping
! Analysis of vulnerability
! Assessment of the flexibility of the existing local system for
emergency
! Assessment of needs and damages
! Monitoring health problems
! Implementation of disease-control strategies
! Assessment of the use and distribution of health services
! Etiological research on the cause of mortality and morbidity
! Follow-up long-term impacts of health, etc.
Steps in Developing a Surveillance

System After a Disaster
1. Establish objectives
! Detect epidemics
! Monitor changes in the population
? Numbers

53
? Health status including nutritional conditions

? Security
? Access to food
? Access to water
? Shelter and sanitation
? Access to health services
! Facilitate the management of relief
2. Develop Case Definitions (Request NEC)

! Standard case definitions of health conditions simplify
reporting and analysis
3. Choose the Indicators

! Indicators must:
? Illustrate the status of the population
? (e.g., death rates)
? Measure the effectiveness of relief
? (e.g., immunization coverage)
“Case definitions” and “Indicators” need to be

agreed upon by all those involved in the relief
operations.
4. Determine Data Sources

! Data can come from health-care facilities (“passive
surveillance”) and from surveys in the community (“active
surveillance”)
! Involve those who provide health care
! Health surveillance in an emergency requires input from
all sectors
54

5. Develop Data Collection Tools and Flows
! Use pre-existing local formats and/or international
standards
! Use formats that facilitate data entry (EpiInfo):
! Utilize existing process flows
6. Field-Test and Conduct Training

! Can these data produce the information required?
! Training field workers will improve data facility and local
analysis
7. Develop and Test the Strategy of Data Analysis

! Data analysis should cover:
? Hazards and impact on the population's health
? Quality and quantity of services provided
? Impact of services on population's health
? Relation between services provided to different groups
(evacuees and hosts)
? Deployment and utilization of resources
! Major operations may require a central epidemiological
unit
8: Develop Mechanisms for Disseminating Information (Risk

Communication)
! Who will receive the information?
! For the information to be useful, it must be disseminated
widely and in a timely fashion:
? Feedback will sustain data collection and the
performance of field workers
? Health information is important for the activities of other
sectors
55
! Sharing information is good coordination
9: Monitor and Assess Usefulness of the System

! Is everybody reporting on time? Which data are missing?
! Lack of information in areas or programs that have
problems
! Is the system useful?
! Is the information generated by the system being used for
decision making?
! If not, readjust the system

56
PSYCHOSOCIAL CARE AND MENTAL HEALTH

The impact of a traumatic event is likely to be
greatest in persons who had a pre-existing
mental health problem, a history of prior
trauma, greater exposure to the disaster and its
aftermath, and those who lack family and peer
support.
Steps in Promoting Psychosocial

and Mental Health
1. Assess psychosocial and mental health concerns. Schedule
consultative meetings with the provincial and municipal health
workers in the affected area to:
! Estimate the psychosocial problems experienced by the
people, guided by the classification of people at high risk
! Estimate available resources for mental health/social
services
* see appendix for Summary Table on Projecting Mental Health Assistance
2. Brief field officers in the areas of health and social welfare

regarding issues of fear, grief, disorientation and need for
active participation. Mobilize informal human resources in the
community (e.g., Red Cross volunteers, religious and political
leaders).
3. Conduct mostly social interventions that do not interfere with

acute needs such as the organization of food, shelter,
clothing, PHC services, and, if applicable, the control of
communicable diseases.

57
As far as possible, manage acute distress

without medication. It is also not advisable to
organize single session psychological debriefing
to the general population as an early interven-
tion after exposure to trauma.
4.Establish contact with PHC.

! Develop the availability of mental health care for a broad
range of problems through general health care and
community-based mental health services.
! Manage urgent psychiatric complaints (i.e., dangerous-
ness to self or others, psychoses, severe depression,
mania, epilepsy) within PHC.
! Ensure availability of essential psychotropic medications at
the PHC level. Many persons with urgent psychiatric
complaints will have pre-existing psychiatric disorders and
sudden discontinuation of medication needs to be avoided.
5. Start planning medium- and long-term development of

community-based mental health services and social
interventions needed during recovery and rehabilitation. This
is vital since it is during this phase that survivors will be
rebuilding their lives amidst the grief from the loss of loved
ones, property, and livelihood.
6. If the acute phase is protracted, start training and supervising

PHC workers and community workers (e.g., provision of
appropriate psychotropic medication, 'psychological first aid',
supportive counselling, working with families, suicide
prevention, management of medically unexplained somatic
complaints, substance use issues and referral).
58

7. Educate other humanitarian aid workers as well as community
leaders (e.g., village heads, teachers, etc.) in core psychological
care skills (e.g., 'psychological first aid', emotional support,
providing information, sympathetic reassurance, recognition of
core mental health problems) to raise awareness and commu-
nity support and to refer persons to PHC when necessary.
8. Carefully educate the public on the difference between

psychopathology and normal psychological distress, avoiding
suggestions of wide-scale presence of psychopathology and
avoiding jargon and idioms that carry stigma.
9. Facilitate creation of community-based self-help support

groups. The focus of such self-help groups is typically
problem sharing, brainstorming for solutions or more effective
ways of coping (including traditional ways), generation of
mutual emotional support and sometimes generation of
community level initiatives.
10.Provide support to caregivers who, because of the exhaustion

and enormity of the job, may experience "burn-out."
Interventions for Children Affected

by Emergencies
1. Encourage parents, teachers, and other caregivers to
understand and monitor child emotional reactions. Remember
that children's reactions vary with age.
2. Help reduce effects by offering emotional support and

security to the child.
59
3. Facilitate recovery by modelling healthy coping strategies.

* See “Mental health and psychosocial care of children in disasters” (WHO,
2005) for further guidance.
Valuable social interventions include:
! Ensuring ongoing access to credible information on the

emergency, on the availability of assistance, and on the
location of relatives to enhance family reunion
! Establishing access to communication with absent relatives, if
feasible
! Organizing family tracing for unaccompanied minors, the
elderly and other vulnerable groups.
! Giving 'psychological first aid':
? basic, non-intrusive pragmatic care with a focus on
listening but not forcing talk
? assessing needs and ensuring basic physical needs are
met
? providing or mobilizing company (preferably family or
significant others)
? encouraging but not forcing social support
? protecting from further harm
! Widely disseminating uncomplicated, empathic information
on normal stress reactions and culturally appropriate
relaxation techniques to the community at large
! Public education should focus primarily on normal reactions,
because widespread suggestion of physical and mental
disease may potentially lead to unintentional harm.
! The information should emphasize an expectation of hope,
resilience and natural recovery.
! Promote community self-help activities- conceived and
60

managed by communities themselves.
! Discouraging unceremonious disposal of corpses. Facilitate
conditions for maintaining or re-establishing appropriate
cultural practices, including grieving and burial rituals by
relevant practitioners.
! Assuming the activity is safe:
1. Encouraging activities that facilitate the inclusion of the
bereaved, orphans, widows, widowers, or those without
their families into social networks
2. Encouraging the organization of normal recreational
activities for children and encouraging starting schooling
for children, even partially
3. Involving adults and adolescents in concrete, purposeful,
common interest activities (e.g., assist in caring for the ill
especially if people are cared for at home, construct-
ing/organizing shelter)
! Strengthening the community's and the family's ability to take

care of children and other vulnerable persons.
Specific Concerns for Victims of Attacks

Involving Biochemical Weapons
Attacks involving biochemical weapons may induce
significant mental and social effects.
1. Exposure to any stressor is a risk factor for a range of long-
term social and mental problems (including anxiety and
mood disorders as well as non-pathological trauma and grief
reactions)
2. Physical exposure to agents may induce organic mental
disorders
61
3. Attacks are associated with experience of intense social and

psychological distress, especially fear
4. Fear of biochemical attacks may be associated with
epidemics of medically unexplained illness
5. Social problems may emerge after exposure to agents (e.g.,
population displacement; breakdown of community support
systems; and social stigma associated with contagion or
contamination)
! In case of quarantine or evacuation, enhance access to

communication with absent relatives and friends.
! If appropriate and feasible, set-up telephone support systems
to reduce isolation of people who are isolating themselves to
reduce the chance of infection.
! Manage medically unexplained symptoms immediately to
prevent potential chronicity of such symptoms.
! Public education campaigns may need to be organized to
reduce social stigma and related social isolation of ex-
patients and health workers who may be shunned because of
undue public fear of contagion or contamination.
Psychosocial Concerns for Disaster Workers

Burnout or Disaster Fatigue:
! state of extreme exhaustion or depletion, physically,
emotionally, mentally and socially
! person feels worn-out and depleted of energy but feels that
he/she has not done enough
Signs of Burnout:
! Low energy and exhaustion
62

! Detachment and separation from one's self; increasing
feeling of “non-feeling,” “deadness,” indifference and even
skepticism
! Aloneness, feeling unappreciated and mistreated
! Impatience, heightened irritability
! Increasing anger, suspiciousness
! Confusion, agitation, limiting ability to focus mind and
behavior
! Depression, psychosomatic complaints
! Denial that anything is wrong; “I don't care”
Management of Burnout
! Rotation of work assignments to allow time away from the
daily routine of disaster work for those in the field
! Rest and recreation program for those in active duty
! CISD sessions should be done regularly for those in the field
! Superiors and the agency itself should provide for situations
to give credit, express appreciation and recognition of their
disaster workers at regular intervals
! Provision of appropriate assistance for those who might
require counseling and/or specialist psychiatric attention
Historical research on group behavior has

shown that contrary to common expectations,
public panic is uncommon. Disasters may
leave some communities with increased social
coherence. Community members often show
great altruism and cooperation, and people
may experience great satisfaction from helping
each other.

63
MANAGEMENT OF DEAD BODIES
! The National Disaster Plan/Emergency

Operations Committee should specify the
institution that will coordinate all processes
related to the management of dead bodies.
! The health sector should take the leading
role in:
1. Addressing concerns about the
supposed epidemiological risks
posed by dead bodies
2. Providing medical assistance to
family members of the victims.
! The work of handling, identifying, and
disposing of dead bodies is based on
forensic sciences and requires a
multidisciplinary team. However, in the
absence of medico-legal experts, the health
officer may need to carry out these tasks to
the best of his or her abilities.
Health Considerations in Cases

of Mass Fatalities
! Emphasize that, in general, the presence of exposed corpses poses
no threat of epidemics. The corpse has a lower risk for contagion
than an infected living person. The key to preventing disease is to
improve sanitary conditions and to educate the public.
! If death resulted from trauma, bodies are quite unlikely to cause
outbreaks of diseases.
! They may, however, transmit gastroenteritis or food poisoning
syndrome to survivors if they contaminate streams, wells, or other
water sources. Thus, any bodies (or dead animals) lying in water
sources should be removed as soon as possible.

64
MANAGEMENT OF DEAD BODIES

! The risk posed by bodies buried by a landslide or mudslide is
nonexistent.
! It should be noted that in areas where certain diseases are endemic,
the disposal of bodies may become a priority. However, even in such
cases the presence of dead bodies should not be considered an
important public health risk.
Principal diseases that should be avoided by those responsible for

managing corpses in order to prevent possible contagion:
1. streptococcal infection
2. gastrointestinal infection (e.g., cholera, salmonellosis)
3. Hepatitis B and C
4. HIV

65
FORENSIC SCIENCE CONCERNS IN MASS FATALITIES
Practical Approach to a Multiple

Fatality Incident
1. Initial Concerns
! Type of incident (natural hazards, e.g., flood, landslide,
earthquake, epidemics; human-generated, e.g., fire,
land/sea/air transport crash, accidental or deliberate use
of biochemical/radionuclear agents)
! Probable condition of remains (e.g. burnt, with severe
trauma, decomposed, contaminated)
! Estimated number of fatalities
! Location of incident
! Local authority in-charge
! Budget
2. Personnel
! Tap medico-legal officers from the NBI or PNP and local
government doctors.
! Mobilize volunteers like medical and dental students or
specialists from the area.
Ideally a list of the people involved and their contact numbers

should have been prepared beforehand.
3. Handling of the Bodies at the Scene

! As much as possible document the location and position
of each body at the scene prior to removal.
! Mark bodies/body parts to preserve their relationship to
one another.
! Sketch and photograph for documentation.

66

! Every effort must be taken to identify the bodies at the site
where they are found. Tags should be attached to the
bodies that provide the name (if known), approximate age,
sex, and location of the body.
Before anything else, observe and record first.
4. Evidence and Property

! All items of property that are on the body should remain on it.
! Other items associated with a body should be collected as
property and tagged with the body.
! The location of loose items (e.g., proximity to which body)
should be documented prior to collection.
5. Removal and Transport of Remains

! Before removing any body, body part or property, there
should be adequate documentation.
! Care must be taken not to lose, contaminate or switch
such body, body parts or property to be removed and
transported.
! Properly labeled separate bags must be used.
! Be particularly careful of potential loss of teeth if they are
loose (e.g., badly burned or crushed remains); put a bag
around the head.
! When adapting vehicles to transport dead bodies, it is
advisable to use trucks or vans, preferably closed, with
floors that are either waterproof or covered with plastic
! Using health service vehicles—specifically, ambu-
lances—to transfer human remains from the site of the
disaster is ill-advised.
67
6. Temporary Mortuary Facility

! Identify a place that can be converted into a makeshift
morgue (e.g., empty warehouse, covered basketball
court).
! Basic requirements:
? Security
? Adequate lighting, ventilation, water supply
? Examining tables
? Instruments for examining the remains and documenta-
tion
! Ideally, should consist of a reception, a viewing room, a
storage chamber for bodies not suitable for viewing and a
room to store personal possessions and records.
7. Examination of Remains
! Objectives of the postmortem examination:
? Identification of the remains
? Cause of death determination
? Manner of death determination
? Collection of forensic evidence
! In emergency situations, usually the critical need is to
identify the victims.
! Identification through visual identification by the next-of-kin
should be limited to bodies that are suitable for viewing
(i.e., not decomposed, burnt or mangled) and should be
subject to verification by other means.
! A more reliable system of identification entails an
objective comparison of antemortem and postmortem
information.
! Because of limited resources, not all bodies can undergo a
full autopsy; priority may be given to certain remains (such
68

as those of transport operators driver, pilot/ship captain
and crew).
! A detailed examination of the external body is done; marks
such as tattoos, scars, moles and deformities are
searched.
! Fingerprints are obtained and dental charting is done.
! Blood and other tissue/fluid samples are collected for
possible tests (e.g., histopathology, DNA analysis,
toxicology).
! Property collected from each body (e.g., clothes, jewelry,
wallets, IDs) must be described and inventoried.
8. Preservation of the Body

! Remains are best stored refrigerated (e.g., in rented
refrigerated storage trucks) while awaiting examination.
! After the postmortem examination, embalming can be
done.
9. Dealing with Claimants

! Notify family members of the death or disappearance of
victims in a clear, orderly, and individualized manner.
! Organize a separate area where the next-of-kin can be
systematically interviewed for data.
! Useful antemortem information to get:
Name, age, sex, height, build
Appearance when last seen
Distinguishing features (tattoos, scars, moles, deformities,
etc.)
Significant medical history
! Ask the next-of-kin to submit the following:
Medical records including x-ray films
69
Dental records
Clear photograph with teeth bared
Fingerprints on file
! Note that personal items that a person believed to be
among the victims could have used (e.g., toothbrush,
hairbrush, other items), could potentially contain reference
fingerprints or DNA samples.
10.Death Certification and Release of Bodies

! Properly identified victims shall be issued death certifi-
cates and the bodies released to the next-of-kin.
! Maintain a record of how the bodies are disposed of
including information regarding the claimants' names,
addresses and contact numbers.
! Bodies could remain unidentified in case of insufficient
antemortem and postmortem data; these remains should
be buried separately (not cremated!) and their postmortem
records stored for future evaluation.
! Court proceedings could be initiated according to
Philippine laws that would legally declare dead the
unidentified and missing victims.
11.Disposal of Dead
! Respond to the wishes of the family and provide all
possible assistance in final disposition of the body.
! Burial is the preferred method of body disposal in
emergency situations unless there are cultural and
religious observances that prohibit it.
? The location of graveyards should be agreed upon by
the community and attention should be given to ground
conditions, proximity to groundwater drinking sources
70

(which should be at least 50 m) and to the nearest
habitat (500 m).
? Burial depth should be at least 1.5 m above the
groundwater table, with at least 1 m of soil cover.
? If coffins are not available, corpses should be wrapped
in plastic sheets to keep the remains separate from the
soil.
? Burials in common graves and mass cremations are
rarely warranted and should be avoided.
! Reject unceremonious and mass disposal of unidentified

corpses. As a last resort, unidentified bodies should be
placed in individual niches or trenches, which is a basic
human right of the surviving family members.
12.Other concerns
Ensure that there is a plan for the psychological and
physical care for the relief workers. Handling a large number
of corpses can have an enormous impact on the health of the
working team.
Give priority to the living over the dead: The

priority is to treat survivors and re-establish the
health care system as soon as possible!

71
RESOURCE MANAGEMENT
The arrival of inappropriate relief donations can

cause major logistic chaos.
Supply Management General Guidelines:

! Only a single government official should be made responsi-
ble for channeling requests to avoid duplication and
confusion.
! Donors should be asked to provide large amounts of a few
items to simplify and expedite transfers.
! Requests should indicate clearly the order of priority,
amounts, and formulations (compatible with the size of the
affected population).
! Do not request perishable products and vaccines unless
refrigeration and special handling facilities are available.
Guidelines for Drug Donations

! Based on expressed needs of the affected population.
! Sent only with prior consent of recipient.
! Based on the list of essential drugs.
! Obtained from a quality source with quality standards.
! Formulation and efficacy of foreign donations should be
similar to those commonly used in the country.
! Label should at least contain generic name, dosage forms,
strength, quantity in container, and expiry date.
! After the arrival of foreign drug donations, the medicines must
have a remaining shelf life of at least 1 year.

72
RESOURCE MANAGEMENT
Donation Labeling and Donation Marking
RED — foodstuff
BLUE — clothing and household items
GREEN — medical supplies/equipment
1. Labeling:
! Consignments of medicines branded green should
indicate expiry date and temperature controls.
! English should be used on all labels.
2. Size and weight

! Goods should be in a 25-50 kg container, manageable by
a single person.
3. Contents
! Relief supplies must be packed by type in separate
containers.
! Value of relief goods is lost if there is no color-coding.
! Give advance notice to the health relief coordinator and
supply information about the package (e.g., name and
contact number of donor, date, method of transport, details
of contents, and other special requirements for handling).
Upon arrival of the donations/ consignments,

acknowledge their receipt. Call or write the
senders and thank them.

73
RISK COMMUNICATION
Communication Objectives:
! Acknowledge the event with empathy.

! Establish spokesperson credibility
! Explain and inform the public, in simplest terms, about the
risk
! Provide emergency courses of action (including how/where
to get more information)
! Commit to partners and public to continued
communication.
! Listen to feedback and correct misinformation.
! Empower risk/benefit decision-making.
Steps in Communicating Risks

1. Verify situation
! Get the facts.
! Obtain information from additional sources to put the
event in perspective.
! Review and critically judge all information. Determine
credibility.
! Clarify information through subject matter experts.
! Begin to identify staffing and resource needs to meet the
expected media and public interest.
! Determine who should be notified of this potential
emergency.
2. Conduct notifications
3. Activate Crisis Plan

! Ensure direct and frequent contact with the EOC
74
RISK COMMUNICATION
! Determine what your organization is doing in response to
the event.
! Determine what other agencies/organizations are doing.
! Determine who is being affected by this crisis. What are
their perceptions? What do they want and need to
know?
! Determine what the public should be doing.
! Determine what's being said about the event. Is the
information accurate?
4. Organize assignments
! Identify the spokesperson for this event.
! Determine if subject matter experts are needed as
additional spokespersons.
! Determine if the organization should continue to be a
source of information to the media about this emergency,
or would some issues be more appropriately addressed by
other government entities?
5. Prepare information and obtain approvals
6. Release information to media, public and partners

through arranged channels
! Provide only information that has been approved by the
appropriate managers. Don't speculate
! Repeat the facts about the event
! Describe the data collection and investigation process
! Describe what your organization is doing about the
emergency.
! Describe what other organizations are doing.
! Explain what the public should be doing
75
RISK COMMUNICATION
! Describe how to obtain more information about the

situation
7. Obtain feedback and conduct communication evaluation
8. Conduct public education
9. Monitor events
(Adapted from CDC (2002). Crisis and Emergency Risk Communication.)
Media Management
Stick to facts, and put them in context
! There is no such thing as 'off-the-record'.
Everything you say and do can be reported.
Be careful with what you say in the
presence of journalists, even after a formal
interview is finished and at social gatherings
! Never make disparaging or critical remarks
about local authorities or international
partners
! Do not mention weaknesses they might be
all that is reported
What makes a “good” spokesperson?

! Media savvy/rapport
! Versatility to be a statesman or a brawler
! Consistent and continuous authority
! Sufficient knowledge and information
! Available anytime (24 hours/day, 7 days/week)

76
RISK COMMUNICATION
Spokespersons must be supported by authority with
the following:
! Information and facts
! Resources and contacts
! Equally competent alternate
What do the people want to know?

! What has happened? (Incident and Scope)
! Why did it happen? (Cause)
! Who or what should be held responsible? (Blame)
! What is being done about it? (Action)
! What will prevent it from recurring? (Result)
Press Releases:
! Titles and opening lines are the most important parts grab
attention and encourage awareness
! Put key points in first paragraph
! Text needs to be brief (max. A4)
! Use language appropriate for the audience
! Advocate for health in general
! Share credit and visibility with partners

77
APPENDICES

78
EMERGENCY MANAGER DEPLOYMENT CHECKLIST

This list contains basic supplies, materials,
equipment needed in the field.
YES NO
1. Did you receive your orders?
2. Is/are the mission objective/s clear?
3. Did you inform your family?
4. Do you have with you
a. Mission order?
b. Identification card?
c. Emergency call number directory?
d. Mission area map?
e. List of contact persons/numbers?
f. Communication equipment?
g. Cell phone? Mobile phone?
h. Handheld radio & accessories?
i. Pocket notebook & ball pen?
j. Laptop computer?
k. Transistor radio (with extra batteries)?
l. Basic PPE (cap, mask, gloves)?
m. Cash & reimbursement vouchers?
n. Water canteen?
o. Food provisions?
p. First aid kit?
q. Backpack with clothing & blanket?
r. Flashlight/candles & matches?
s. Portable tent (if available)?
t. Mosquito repellent?
u. Pocket knife?
v. Digital camera?
w. Pocket Emergency Tool?

79
RAPID HEALTH ASSESSMENT FORMS
HEMS FORM 1

(To be submitted within 24 hrs)
as of ____________________.
Nature of Event: ___________________________________________

Date and Time of Occurrence: ________________________________
Region: __________________________________________________
A. Magnitude of Event
No. of
Families &
No. of No. of No. of Individuals
Municipality Families Individuals Evacuation in Evac'n
Province /City Affected Affected Centers Centers
TOTAL
B. Consequences
Municipality /City No. of Death/s No. of Injured No. of Missing
TOTAL

80

C. Health Facilities Available in Affected Area
Total No. No. of Functional No. of Non Functional Remarks

Hospitals
Gov't
Private
RHU
Others
D. Lifelines Available in Affected Area
Type Yes No Remarks

Communications
Electric Power
Water
Roads/Bridges
Others
E. Status of Essential Drugs/Suppliers
Stock level good for ________________________________

(no. of cases/no. of days/weeks/month)
F. Actions Taken
G. Problems Encountered

81
H. Recommendations
Prepared by: ___________________

Position: ______________________
Office: ________________________
Date: _________________________
HEMS FORM II

FOR MASS CASUALTY INCIDENT
(To be submitted within 24 hrs)
A. Description of the Event
Nature of the Event: ________________________________

Time of the Event: _________________________________
Date of the Event: _________________________________
Place of the Event: _________________________________
B. Number of persons affected
Death: __________________________________________
Injured: __________________________________________
Treated on site: _________________________________
Referred to hospital: _____________________________
OPD: _________________________________________
Admitted: ______________________________________
Missing: __________________________________________
Total: ___________________________________________

82

C. Actions Taken
D. Problems Encountered
E. Recommendations
Prepared by: ___________________

Position: ______________________
Office: ________________________
Date: _________________________
* Please fill up Form A for the listing of cases.HEMS FORM III

FOR OUTBREAKS
A. Description of the Event
Nature of the Event: _______________________________

Time of the Event: _________________________________

83
Date of the Event: _________________________________

Place of the Event: ________________________________
B. Consequences
Population Exposed: _______________________________

Number of Death/s: ________________________________
Number of Cases: _________________________________
Admitted: _____________________________________
OPD: _________________________________________
C. Actions Taken
D. Problems Encountered
E. Recommendations
Prepared by: ___________________

Position: ______________________
Office: ________________________
Date: _________________________
* Please fill up Form A for the listing of cases.

84

List of Patients / Victims
Name Age Sex Diagnosis Status Remarks /Actions Taken
(Injured, Died, Missing) (Sent Home, Admitted, Outpatient,
Referred, Surgery Done, etc.)
HEMS FORM A
85
REFERENCE VALUES FOR RAPID HEALTH ASSESSMENT AND CONTINGENCY PLANNING
Estimating Population Size

Age Groups Average % in Population
0 — 4 years 12.4
5 — 9 years 11.7
10 — 14 years 10.5
15 — 19 years 9.5
20 — 59 years 48.6
*Pregnant women 2.4
Basic Needs
Average Requirements
Water
Quantity 20 L/person/day
Quality 200 persons/water point
In hospital settings more water per person is
needed
Sanitation
Latrine Ideally one per family; minimum of one seat
per 20 persons
6 to 50 meters from housing
Waste disposal 1 communal pit per 500 persons;
size: 2 m x 5 m x 2 m
Soap 250 g/per person/per month
Shelter
Individual 4m2/person
requirements
Collective 30m2/person
requirements including shelter, sanitation, services,
community activities, warehousing access
Household fuel
Weight of firewood 15 kg/household/day
with one economic stove per family, the
needs may be reduced to 5 kg/stove/day

86

Emergency Food Requirements
Food kcal content g/person/month

Cereals 350/100 g 13.5
Pulses 335/100 g 1.5
Oil (vegetable) 885/100 g 0.8
Sugar 400/100 g 0.6
Recommended ration person/day: 2,116 kcal

Total kg/person/month for alimentation: 16.4 kg
Micronutrients (e.g., iodine, Vit. A) are important.
Examples of Rations for General Food Distribution

(Providing 2100 kcal/person/day)
Commodities Ration 1 Ration 2 Ration 3 Function

(g) (g) (g)
Meal with rice 450 420 400 Main source of energy and protein
Pulses 50 60 60 Provide protein and various
(i.e. peas, micronutrients
beans, mongo)
Oil/fat 25 30 25 Concentrated source of energy for
palatability and the absorption of
Vit. A
Fortified cereal - - 50 Provides essential vitamins and
minerals, and is useful as weaning
food
Canned fish/meat - 30 - Needed for proteins and minerals
(including iron)
Sugar 20 20 15 Needed for cultural habits,
palatability, and home oral
rehydration
Salt 5 5 5 Provides sodium, and is needed for
home oral rehydration
Vegetables/fruits - As available - Valuable source of vitamins and
minerals
Continued on next page

87
Examples of rations continued
Condiments/ - As available - Needed because of cultural habits

spices and for palatability
Approximate food
value:
Energy (kcal 2116 2092 2113
Protein (g 51 45 58
Fat (g) 41 38 43
Essential Primary Health Care (PHC) Activities
Essential PHC Target Optimal Coverage of Target

Activities
<5y/o clinic & all children of 0- 100% of <5y/o per month
growth monitoring 59 months
Antenatal clinic all pregnancies 50% of pregnancies/month
Assisted deliveries all deliveries 1/12 of total group per month
OPD Consultation 1.5 per person/yr
0.13 per person/month
Treatment & follow- 4 per outpatient consultation
up sessions
Vaccination
Tetanus toxoid 1.5 per 30% per month
pregnancy
BCG all new births 1/12 of total group per month
DTP1-TT1 0-1 yr 1/12 of total group per month
DTP2-TT2 0-1 yr 1/12 of total group per month
Measles 9-12 months 1/12 of total group per month

88
Health Personnel Requirements

Hospital:Population ratio 1:150,000 to 300,000
Normal staffing:
2 medical officers 1:500 or 1:1000
60-100 other staff CHWs
(or home visitors) or 1 person/day = 7 hours
Health Information Teams of field work
Health Workers Emergency requirements (e.g. refugee camp) for

treatments, management and clerical duties: 60 staff x 10,000
population
Health Supplies Requirements
Essential drugs and medical equipment

WHO Basic NEHK Unit 1 kit for 10,000 pop for 3 mos.
WHO Supplementary 1 kit for 10,000 pop for 3 mos.
NEHK Unit
Safe water
Preparing 1 L of stock calcium hypochlorite 70%: 15 g/L of water
solution 1% bleaching powder 30%: 33 g/L of water
sodium hypochlorite 5%: 250 ml/L of water
sodium hypochlorite 10: 110 ml/L of water
Using the stock solution 0.6 ml or 3 drops/liter of water
60 ml/100 liters of water
Allow the chlorinated water to stand at least 30

minutes before using.

89
Cut-off Values for Emergency Warning

Health Status More than

Daily Crude Mortality Rate 1 per 10,000 population
Daily Under-5 Mortality Rate 2 per 10,000 children <5 y/o
Acute Malnutrition (W/H or MUAC) in 10% of children <5 y/o
Under-5
Growth Faltering Rate in Under-5 30% of monitored children
Low Weight at Birth (<2.5 kg) 7% of live births

90
NCHS/WHO normalized reference values for weight-for-length

(49-84) and weight-for-height (85-110 cm) by sex.
Boys
Length Boys' weight (Kg)
(cm) Median -1 SD -2 SD -3 SD -4 SD
90% 80% 70% 60%
49 3.1 2.8 2.5 2.1 1.8
50 3.3 2.9 2.5 2.2 1.8
51 3.5 3.1 2.6 2.2 1.8
52 3.7 3.2 2.8 2.3 1.9
53 3.9 3.4 2.9 2.4 1.9
54 4.1 3.6 3.1 2.6 2
55 4.3 3.8 3.3 2.7 2.2
56 4.6 4 3.5 2.9 2.3
57 4.8 4.3 3.7 3.1 2.5
58 5.1 4.5 3.9 3.3 2.7
59 5.4 4.8 4.1 3.5 2.9
60 5.7 5 4.4 3.7 3.1
61 5.9 5.3 4.6 4 3.3
62 6.2 5.6 4.9 4.2 3.5
63 6.5 5.8 5.2 4.5 3.8
64 6.8 6.1 5.4 4.7 4
65 7.1 6.4 5.7 5 4.3
66 7.4 6.7 6 5.3 4.5
67 7.7 7 6.2 5.5 4.8
68 8 7.3 6.5 5.8 5.1
69 8.3 7.5 6.7 6 5.3
70 8.5 7.8 7 6.3 5.5
71 8.8 8.1 7.3 6.5 5.8
72 9.1 8.3 7.5 6.8 6
73 9.3 8.6 7.8 7 6.2
74 9.6 8.8 8 7.2 6.4
75 9.8 9 8.2 7.4 6.6
76 10 9.2 8.4 7.6 6.8
77 10.3 9.4 8.6 7.8 7
78 10.5 9.7 8.8 8 7.1
79 10.7 9.9 9 8.2 7.3
80 10.9 10.1 9.2 8.3 7.5
81 11.1 10.2 9.4 8.5 7.6
82 11.3 10.4 9.6 8.7 7.8
83 11.5 10.6 9.7 8.8 7.8
84 11.7 10.8 9.9 8.9 7.9

91
Boys continued
Length Boys' weight (Kg)

90% 80% 70% 60%
85 12.1 11 9.9 9 7.9
86 12.3 11.2 10.1 9 8.1
87 12.6 11.5 10.3 9.2 8.1
88 12.8 11.7 10/5 9.4 8.3
89 13 11.9 10.7 9.6 8.4
90 13.3 12.1 10.9 9.8 8.6
91 13.5 12.3 11.1 9.9 8.8
92 13.7 12.5 11.3 10.1 8.9
93 14 12.8 11.5 10.3 9.1
94 14.2 13 11.7 10.5 9,2
95 14.5 13.2 11.9 10.7 9,4
96 15.7 13.4 12.1 10.9 9.6
97 15 13.7 12.4 11 9.7
98 15.2 13.9 12.6 11.2 9.9
99 15.5 14.1 12.8 11.4 10.1
100 15.7 14.4 13 11.6 10.3
101 16 14.6 13.2 11.8 10.4
102 16.3 14.9 13.4 12 10.6
103 16.6 15.1 13.7 12.2 10.8
104 16.9 15.4 13.9 12.4 11
105 17.1 15.6 14.2 12.7 11.2
106 17.4 15.9 14.4 12.9 11.4
107 17.7 16.2 14.7 13.1 11.6
108 18 16.5 14.9 13.4 11.8
109 18.3 16.8 15.2 13.6 12
110 18.7 17.1 15.4 13.8 12.2
Girls
Length Girls' weight (Kg)
90% 80% 70% 60%
49 3.3 2.9 2.6 2.2 1.8
50 3.4 3 2.6 2.3 1.9
51 3.5 3.1 2.7 2.3 1.9
52 3.7 3.3 2.8 2.4 2
53 3.9 3.4 3 2.5 2.1
54 4.1 3.6 3.1 2.7 2.2

92

Girls continued

90% 80% 70% 60%
55 4.3 3.8 3.3 2.8 2.3
56 4.5 4 3.5 3 2.4
57 4.8 4.2 3.7 3.1 2.6
58 5 4.4 3.9 3.3 2.7
59 5.3 4.7 4.1 3.5 2.9
60 5.5 4.9 4.3 3.7 3.1
61 5.8 5.2 4.6 3.9 3.3
62 6.1 5.4 4.8 4.1 3.5
63 6.4 5.7 5 4.4 3.7
64 6.7 6 5.3 4.6 3.9
65 7 6.3 5.5 4.8 4.1
66 7.3 6.5 5.8 5.1 4.3
67 7.5 6.8 6 5.3 4.5
68 7.8 7.1 6.3 5.5 4.8
69 8.1 7.3 6.5 5.8 5
70 8.4 7.6 6.8 6 5.2
71 8.6 7.8 7 6.2 5.4
72 8.9 8.1 7.2 6.4 5.6
73 9.1 8.3 7.5 6.6 5.8
74 9.4 8.5 7.7 6.7 6
75 9.6 8.7 7.9 7 6.2
76 9.8 8.9 8.1 7.2 6.4
77 10 9.1 8.3 7.4 6.6
78 10.2 9.3 8.5 7.6 6.7
79 10.4 9.5 8.7 7.8 6.9
80 10.6 9.7 8.8 8 7.1
81 10.8 9.9 9 8.1 7.2
82 11 10.1 9.2 8.3 7.4
83 11.2 10.3 9.4 8.5 7.6
84 11.4 10.5 9.6 8.6 7.6
85 11.8 10.8 9.7 8.7 7.7
86 12 11 9.9 8.8 7.7
87 12.3 11.2 10.1 9 7.9
88 12.5 11.4 10.3 9.2 8.1
89 12.7 11.6 10.5 9.3 8.2
90 12.9 11.8 10.7 9.5 8.4
91 13.2 12 10.8 9.7 8.5
92 13.4 12.2 11 9.9 8.7

93
Girls continued

90% 80% 70% 60%
85 12.1 11 9.9 9 7.9
93 13.6 12.4 11.2 10 8.8
94 13.9 12.6 11.4 10.2 9
95 14.1 12.9 11.6 10.4 9.1
96 14.3 13.1 11.8 10.6 9.3
97 14.6 13.3 12 10.7 9.5
98 14.9 13.5 12.2 10.9 9.6
99 15.1 13.8 12.4 11.1 9.8
100 15.4 14 12.7 11.3 9.9
101 15.6 14.3 12.9 11.5 10.1
102 15.9 14.5 13.1 11.7 10.3
103 16.2 14.7 13.3 11.9 10.5
104 16.5 15 13.5 12.1 10.6
105 16.7 15.3 13.8 12.3 10.8
106 17 15.5 14 12.5 11
107 17.3 15.8 14.3 12.7 11.2
108 17.6 16.1 14.5 13 11.4
109 17.9 16.4 14.8 13.2 11.6
110 18.2 16.6 15 13.4 11.9
1. Length is generally measured in children

below 85 cm, and height in children 85 cm
and above. Recumbent length is on
average 0.5 cm greater than standing
height; although the difference is of no
importance to the individual child, a
correction may be made by deducting 0.5
cm from all lengths above 84.9 cm if
standing height cannot be measured.

94

2. SD = standard deviation score (or Z-score).
The relationship between the percentage of
median value and the SD-core or Z-score
varies with age and height, particularly in
the first year of life, and beyond 5 years.
Between 1 and 5 years median -1 SD and
median -2 SD correspond to approximately
90% and 80% of median (weight-for-length,
and weight-for-age), respectively. Beyond 5
years of age or 110 cm (or 100 cm in
stunted children) this equivalence is not
maintained; median 02 SD is much below
80% of media. Hence the use of
“percentage-of-median” is not
recommended, particularly in children of
school age. Somewhere beyond 10 years
or 137 cm, the adolescent growth spurt
begins and the time of its onset is variable.
The correct interpretation of weight-for-
height data beyond this point is therefore
difficult

95
Decision Framework for Implementing

Selective Feeding Programs
Findings Actions Required

Serious situation: ! 'Blanket' supplementary feeding for
Malnutrition rate: all members of vulnerable groups
= 15% (especially children, pregnant and
or lactating women, adults showing
10-14%, plus aggravating signs of malnutrition)
factors ! Therapeutic feeding programs for
severely malnourished individuals
Alert/Risky situation: ! Targeted supplementary feeding for
Malnutrition rate: individuals identified as
10-14% malnourished in vulnerable groups
Or (mildly to moderately malnourished
5-9%, plus aggravating children under 5 years, selected
factors other children and adults)
! Therapeutic feeding programs for
severely malnourished individuals
Unsatisfactory situation: ! Improve general rations until local
Food availability at food availability and access can be
household level below 2100 made adequate
kcal per person per day
Acceptable situation: ! No need for population interventions
Malnutrition rate: ! Attention for malnourished
< 10% with no aggravating individuals through regular
factors community services

96

1. Malnutrition rate: defined as the percentage
of the child population (6 months to 5 years)
who are below either the reference median
weight-for-height minus 2 SD or 80% of
reference weight-for height and/or with
edema.
2. Aggravating factors:
! Food availability at household level less
than the mean energy requirement of
2100 kcal/person/day
! Crude mortality rate more than 1 per
10,000 per/day
! Epidemic of measles or whooping cough
! High incidence of respiratory or
diarrheal diseases

97
Summary Table on Projecting Psychosocial/Mental

Health Assistance
Before
Disaster: After Disaster:
12 month 12 month
prevalence prevalence Type of aid
Description rates rates recommendations
Severe disorder (e.g., 2-3 % 3-4% Make mental health care
psychosis, severe available through general
depression, severely health services and in
disabling form of anxiety community mental health
disorders, etc.) services
Mild or moderate mental 10% 20% 1. Make mental health care
disorder (which over the available through general
(e.g., mild and moderate years reduces to health services and in
forms of depression and 15% through community mental health
anxiety disorders natural recovery services
including PTSD) without 2. Make social interventions
intervention) and basic psychological
support interventions
available in the community
Moderate or severe No estimate 30-50% Make social interventions and
psychological distress (which over the basic psychological support
that does not meet years will reduce interventions available in the
criteria for disorder, that to an unknown community
resolves over time or extent)
mild distress that does
not resolve over time
Mild psychological No estimate 20-40% No specific aid needed
distress, that resolves (which over the
over time years increase
as people with
severe problems
recover)
These rates vary with setting (e.g. sociocultural

factors, previous and current disaster
exposure) and assessment method but give a
very rough indication what WHO expects the
extent of morbidity and distress to be.

98
RADIO PROCEDURES
Good communications are essential for management and security.
Use the correct prowords and phonetic alphabet. Spell only important
words.
A — Alpha N — November
B — Bravo O — Oscar
C — Charlie P — Papa
D — Delta Q — Quebec
E — Echo R — Romeo
F — Foxtrot S — Sierra
G — Golf T — Tango
H — Hotel U — Uniform
I — India V — Victor
J — Juliet W — Whiskey
K — Kilo X — X-ray
L — Lima Y — Yankee
M — Mike Z — Zulu
Numerals should be transmitted digit by digit except round figures
as hundreds and thousands. Repeat only important numbers.
Check your equipment regularly.

99
CONVERSION TABLE
METRIC TO ENGLISH ENGLISH TO METRIC

To convert into Multiply by To convert into Multiply by
Length
mm inches 0.03937 inches mm 25.4
cm inches 0.3937 inches cm 2.54
meters inches 39.37 inches meters 0.0254
meters feet 3.281 feet meters 0.3048
meters yards 1.0936 yards meters 0.9144
km yards 1093.6 yards km 0.0009144
km miles 0.6214 miles km 1.609
Surfaces
cm2 sq. inches 0.155 sq. inches cm2 6.452
m2 sq. feet 10.764 sq. feet m2 0.0929
m2 sq. yards 1.196 sq. yards m2 0.8361
km2 sq. miles 0.3861 sq. miles km2 2.59
hectares acres 2.471 acres hectares 0.4047
Volumes
3
cm cubic inches .06102 cubic inches cm3 16.387
m3 cubic feet 35.314 cubic feet m3 0.028317
m3 cubic yards 1.308 cubic yards m3 0.7646
m3 gallons (US) 264.2 gallons (US) m3 0.003785
liters cubic inches 61.023 cubic inches liters 0.016387
liters cubic feet 0.03531 cubic feet liters 28.317
liters gallons (US) 0.2642 gallons (US) liters 3.785
ml teaspoon 0.2 teaspoon ml 5.0
ml tablespoon 0.067 tablespoon ml 15.0
ml fluid ounces 0.033 fluid ounces ml 30.0
liters cups 4.166 cups liters 0.24
liters pints 2.128 pints liters 0.47
liters quartz 1.053 quartz liters 0.95
Weights
grams grains 15.432 grains grams 0.0648
grams ounces 0.03527 ounces grams 28.35
kg ounces 35.27 ounces kg 0.02835
kg pounds 2.2046 pounds kg 0.4536
kg ton (US) 0.001102 ton (US) kg 907.44
kg ton (long) 0.000984 ton (long) kg 1016.0
metric ton pounds 2204.6 pounds metric ton 0.0004536
metric ton ton (US) 1.1023 ton (US) metric ton 0.9072
metric ton ton (long) 0.9842 ton (long) metric ton 1.0160

100
CONVERSION TABLE
Temperature
Centigrade to Fahrenheit: Multiply by 1.8 and add 32
Fahrenheit to Centigrade: Subtract 32 and multiply by 0.555
Weight of water by volume (at 16.7°C or 62°F):

1 liter = 1 kg 1 UK gallon = 10 pounds
1 UK gallon = 1.2 US gallons 1 UK gallon = 4.54 liters
1 US gallon = 0.8333 UK gallons 1 US gallon = 8.33 pounds
1 US gallon = 3.79 liters 1 liter = 0.26 gallons
1 cubic foot = 62.3 pounds

101
WEBSITES
NAME ADDRESS
National
Department of Health-Philippines (DOH) http://www.doh.gov.ph
National Disaster Coordinating Council (NDCC) http:/www.ndcc.gov.ph
Phil. Atmospheric, Geophysical and Astronomical http://www.pagasa.dost.gov.ph
Services Administration (PAGASA)
Phil. Institute of Volcanology & Seismology http://www.phivolcs.dost.gov.ph
(PHIVOLCS)
Phil. Nuclear Research Institute (PNRI) http://www.dost.gov.ph/pnri
Phil. National Red Cross http://www.redcross.org.ph
Asian
Asian Disaster Preparedness Center (ADPC) http://www.adpc.ait.ac.th
Asian Disaster Reduction Center (ADRC) http://www.adrc.or.jp
Asian Disaster Reduction & Response Network http://www.adrrn.net
WHO
Emergency and Humanitarian Action (EHA) http://www.who.int/disasters
Regional Office for the Western Pacific http://www.wpro.who.int/sites/eha
(WPRO)-EHA
European Region- Emergency Preparedness http://www.euro.who.int/emergencies
and Response Programme
Pan-American Health Organization http://www.paho.org/english/ped
(PAHO)- Disasters & Humanitarian Assistance
Regional Office for the South-East Asia (SEARO) http://w3.whosea.org/index.htm
Essential Drugs and Medicines policy http://www.who.int/medicines
Injuries and Violence Prevention http://www.who.int/violence_injury_
prevention
Mental Health http://www.who.int/mental_health
Nutrition http://www.who.int/nut
Reproductive Health http://www.who.int/reproductive_health
Water and Sanitation http://www.who.int/water_sanitation
_health
PAHO SUMA http://www.disaster.info.de
sastres.net/SUMA
Centro Regional de Informacion Sobre Desastres http://www.crid.or.cr/crid
Health Library for Disasters http://www.helid.desastres.net
Other UN Agencies
UNAIDS http://www.unaids.org
UN Disaster Management Training Program http://www.undmtp.org
(UNDMTP)
UN Environmental Programme http://www.unep.org
UN High Commissioner for Refugees (UNHCR) http://www.unhcr.ch
UN International Children's Educational Fund http://www.unicef.org
(UNICEF)

102
WEBSITES
Websites continued
NAME ADDRESS
UN International Strategy for Disaster Reduction http://www.unisdr.org
UN Population Fund http://www.unpfa.org
UN Office for the Coordination of Humanitarian http://ochaonline.un.org
Affairs (UN-OCHA)
World Bank http://www.worldbank.org
World Food Programme http ://www.wfp.org
Other International Organizations
Emergency Management Australia (EMA) http://www.ema.gov.au
Federal Emergency Management Agency http://www.fema.gov
(FEMA), USA
Centers for Disease Control & Prevention http://www.cdc.gov
(CDC), USA
Agency for Toxic Substances and Disease Registry http://atsdr1.atsdr.cdc.gov:8080/
hazdat.html
EM-DAT: Center for Epidemiology and Disaster http://www.cred.be/emdat/
(CRED) International Disaster Database
Databases on Emergency Statistics and http://www.md.ucl.ac.be/entites/
Bibliographic References (CRED) esp/epid/mission
International Directory of Emergency Centers http://www.oecd.org/dataoecd/
for Chemical Accidents (2000) 0/39/1933385.pdf
World Meteorological Organization http://wmo.ch/web/www/reparts/
expert-ERA-0498.html
Alertnet http://www.alertnet.org
Disaster Relief http://www.disasterrelief.org
International Committee of the Red Cross http://www.icrc.org
International Federation of Red Cross and Red http://www.ifrc.org
Crescent Societies
Medecins Sans Frontiers http://www.msf.org
One World http://www.oneworld.net
Organization for Economic Co-operation http://www.oecd.org
and Development
Relief Web http://www.reliefweb.int
Refugee Nutrition Information System http://acc.unsystem.org/scn/
publications/html/rnis.html
Reproductive Health for Refugee Consortium http://www.rhrc.org
(RHRC)
Sphere Project http://www.sphereproject.org
American College of Emergency Physicians (ACEP) http://www.acep.org
Natural Hazards Center at the University http://www.colorado.edu/hazards
of Colorado
Central Investigation Agency (CIA) Factbook http://www.cia.gov/cia/publications/
factbook

103
REFERENCES
General
1. WHO. Essentials for emergencies.
2. WHO. (2003). Emergency response manual (provisional version).
3. CDC. Public health emergency response guide for State, Local, and
Tribal Public Health Directors Version 1.0. Atlanta, Georgia: Centers
for Disease Control and Prevention.
4. Sphere Project (2004). Humanitarian charter and minimum
standards in disaster response. Geneva: The Sphere Project.
5. UP Open University/DOH/WPRO. Emergency Medical Services
System Manual. Postgraduate Course in Health Emergency
Management, Module 3: Public Health Issues in Emergencies.
August 14-20, 1999.
6. UP Open University/DOH/WPRO. Emergency Medical Services
System Manual. Postgraduate Course in Health Emergency
Management, Module 5: Emergency Medical Services System.
August 14-20, 1999.
Communicable Diseases
1. WHO (2005). Communicable disease control in emergencies: A field
manual. Geneva: World Health Organization.
2. WHO (2004). Technical note: Post-tsunami flooding and
communicable disease risk in affected Asian countries. Geneva:
World Health Organization.
Nutrition
1. WHO (2003). Guiding principles for feeding infants and young
children during emergencies. Geneva: World Health Organization.
2. Joint UNICEF WHO ISP (2005). Recommendations on infant
feeding in emergencies. Jakarta, Indonesia January 7, 2005.
Environmental Health
1. WHO (2004). Management of solid health-care waste at primary
health-care centres: A decision-making guide. Geneva: World Health
Organization.

104
REFERENCES
2. WHO/SEARO. (2005) Planning Emergency Sanitation. Technical
Notes in Emergencies, Technical Note No. 12. India: WHO/Regional
Office for South Asia.
3. Lacarin, CJ and Reed RA (1999) Emergency Vector Control Using
Chemicals, Water, Engineering and Development Center (WEDC),
Loughborough.
Psychosocial Care and Mental Health

1. WHO. (2003). Mental health in emergencies: psychological and
social aspects of health of populations exposed to extreme
stressors. Geneva: World Health Organization.
2. WHO. (2005). Mental health and psychosocial care of children in
disasters. Geneva: World Health Organization.
3. WHO. (2005). Mental health of populations exposed to biological
and chemical weapons. Geneva: World Health Organization.
Management of Dead Bodies

1. PAHO (2004). Management of dead bodies in disaster situations.
Washington DC: Pan American Health Organization.
2. WHO/SEARO. (2005), Disposal of dead bodies in emergency
conditions. Technical Note No.8. India: WHO/Regional Office for
South Asia.
Resource Management
1. WHO. (1999). Guidelines for drug donation 2nd ed. Geneva: World
Health Organization.
Risk Communication
1. CDC (2002). Crisis and emergency risk communication. Atlanta,
Georgia: Centers for Disease Control and Prevention.

105
EMERGENCY CALL NUMBER DIRECTORY
Organization Hotline Number/s

AFR Reserve Command-Rescue and Emergency Medical Team 921-3746
AFP-Office of the Surgeon General (AFP-OTSG) 911-6509
911-6001 loc. 6416
Assoc. of Phil. Volunteer Fire Brigades, Inc. 522-2222
Assoc. of Volunteer Fire Chiefs & Firefighters of the Phil., Inc. 160-16
Bureau of Fire Protection (BFP) 928-8363
EARNET Network 911-9009
DOH-Dengue 723-2493
DOH OPCEN 929-6919/929-6853
743-1937/741-7048
Metro Manila Development Authority (MMDA)
Road Emergency Group 882-0851
EARNET Network 136
National Disaster Coordinating Council (NDCC) 912-5668
National Poison Control Control & Information Service 524-1078/404-0257
5218450 local 2311
National Voluntary Blood Center 929-6274
Office of Civil Defense (OCD) Operation Center 911-1406/912-2556
Philippine Atmospheric, Geophysical and Astronomical 929-4570/927-1541
Services Administration (PAGASA) 928-2031/927-2877
Philippine Coast Guard (PCG)
Action Center 527-3880/338-5634
527-8481 loc 6134
Coast Guard Medical 301-9369
Philippine General Hospital (PGH)
521-8450 loc. 3166
Philippine Institute of Volcanology and Seismology (PHIVOLCS) 426-1468/927-1104
Philippine Long Distance Telephone Company (PLDT) 171
Philippine National Police (PNP) Patrol 117 117
Philippine National Red Cross (PNRC)
Disaster Management 527-8384 loc 133/134
PNP Firearms and Explosives 724-8085
Quezon City Rescue-Sagip Buhay

106
Centers for Health Development.

CHD Coordinator Tel No./Cell No.
CHD I Ms. Michelle Dumbrique (075) 515-6842
0928-2979687
CHD II Dr. Baldomero Lasam (078) 844-6585
0927-3046479
CHD III Dr. Nemesio Santos (045) 961-3802
0917-4586351
CHD IV-A CALABARZON Dr. Noel Pasion (02) 913-0864
0920-2290001
CHD IV-B MIMAROPA Dr. Aurora Enojado (02) 995-0827
020-9242841
CHD V Dr. Juancho Gideon Torres (052) 483-0840 loc 513
0919-4704465
CHD VI Mr. Jerry Porras, RN (033) 321-0607 loc 15
0919-5555194
CHD VII Mr. Rennan Cimafranca, RN (032) 418-7629
0917-3248741
CHD VIII Atty. Anabelle De Veyra, RN (053) 323-5025
0920-2587119
CHD IX Dr. Marcos Redoble Jr. (062) 9911313
0919-3424124
CHD X Dr. Marianne Trabajo (088) 350-4322
0918-4477173
CHD XI Dr. Paolo Pantojan (082) 224-3011
0927-7798177
CHD XII Mr. Leo Chiong, RN (064) 421-4583
0920-2031559
CHD-Metro Manila Dr. Marilyn Go (02)535-1488
0920-2993329
CHD-CAR Ms. Elnoria Bugnosen, RN (074) 444-5255
0918-3641876
CHD-CARAGA Dr. Teodofreda Sarabosing (085) 342-5208 loc 102
0921-7650285
CHD-ARMM Ms. Julie Villadolid (064) 421-6842
0919-8981919

107
Hospitals
HOSPITALS Coordinator Tel No./Cell No.

Metro Manila Hospital
Amang Rodriguez Medical Dr. Rommel Menguito (02) 942-5988
Center 0920-9624967
Dr. Jose Fabella Memorial Dr. Romeo Bituin (02) 734-5561-65
Hospital 0919-2045910
Dr. Jose N. Rodriguez Dr. Joseph Espinosa (02) 962-8209
Memorial Hospital 0918-6973937
Dr. Jose R. Reyes Memorial Dr. Arthur Platon (02) 740-3785
Medical Center 0919-5538588
East Avenue Medical Center Dr. Emmanuel Bueno (02) 921-6480
0917-8391240
Las Pinas General Hospital Dr. Rodrigo Hao (02)873-0556 loc 105
& Satellite Trauma Center 0917-8255210
Lung Center of the Philippines Dr. David Geollegue (02) 924-6101 loc 333/403
0927-4407329
National Center for Mental Dr. Romeo Sabado (02) 531-9001 loc 356
Health 091 5-7444709
National Children's Hospital Ms. Celia Pangan, RN (02) 724-0656-59
0915-4406067
National Kidney & Transplant Ms. Ma. Belinda Evangelista (02) 924-3601 loc 3094
Institute 0917-9514096
Philippine Children's Medical Dr. Maria Eva Jopson (02) 924-9158
Center 0917-6454339
Philippine Heart Center Mr. Elmer Benedict Collong (02) 925-2401 loc 3830
0919-4175540
Philippine Orthopedic Center Mr. Willy Veloria (02) 711-2316
0928-2142979
Quirino Memorial Medical Dr. Roberto Dalmacion (02) 421-9289
Center 0918-9121169
Research Institute for Tropical Dr. Renato Alegabres (02)V807-2628-32
Medicine 0920-2452485
Rizal Medical Center Dr. Roel Tito Marcial (02) 671-9740
0918-9100589
San Lazaro Hospital Dr. Miguel Montes La'o (02)732-3776 loc 428
0918-4230855
San Lorenzo Ruiz Women's Dr. Noel Valderrama (02) 294-4853
Hospital 0916-4838300
Taguig-Pateros District Dr. Alexis Uy (02) 838-3485 loc 116
Hospital 0919-6525470
Tondo Medical Center Dr. Arnel Rivera (02) 251-8420-23 loc 234
0919-5905244

108

Hospitals continued
Valenzuela General Hospital Ms. Aida Caudra (02) 294-6711 loc 106
0920-8225384
Regional Hospital
Ilocos Training & Rehional Dr. Cesar Bernabe (072) 242-5543
Medical Center, San 0919-2500155
Fernando City, La Union
Mariano Marcos Memorial Dr. Jesus Tomas (077) 792-3144
Hospital & Medical Center, 0919-8183679
Batac, Ilocos Norte
Region I Medical Center, Dr. Dominador Manzano, Jr. (075) 523-4103
Dagupan City 0919-8888067
Batanes General Hospital, Dr. Epifanio Pagalilauan 0321-6349448
Basco, Batanes
Cagayan Valley Medical Center, Dr. Jaime Balubal (078) 844-0033-34
Tuguegarao, Cagayan 0321-5803907
Veterans Regional Hospital, Dr. Joselito Gonzales, DMD (078) 805-3561 loc 132
Rosario, Santiago City, 0919-6314981
Isabela
Bataan General Hospital, Dr. Manuel Ponce (047) 237-3635
Tenejero, Balanga City, 0920-5743077
Bataan
Jose B. Lingad Memorial Dr. Alfonso Danac (045) 963-6845
General Hospital, Dolores, 0917-5106373
City of San Fernando
Paulino J. Garcia Memorial Dr. Huberto Lapuz (044) 463-9937
Regional Medical Center, 0918-9173970
Cabanatuan City
Batangas Regional Hospital, Dr. Ernesto Reyes (043) 723-0165
Batangas City 0918-9250911
Bicol Medical Center, Dr. Rico Nebres (054) 472-5106
Naga City 0920-9055649
Bicol Regional Training Dr. Jose Gabriel Penas (052) 483-0635
& Teaching Hospital, 0919-3340542
Legaspi City, Albay
Bicol Sanitarium, Cabusao, Dr. Edgardo Sarmiento (054) 451-2244
Camarines Sur 0919-3210904
Corazon Locsin Montelibano Dr. Antonio Vasquez (034) 435-1591 loc 229
Memorial Hospital, 0920-9277506
Bacolod City
Don Jose Monfort Medical Ms. Jacobina Padojinog, RN (033) 361-2011
Center, Barotac Nuevo, 0915-9671354
Iloilo

109
Hospitals continued
Western Visayas Medical Ms. Freida Sorongon, RN (033) 321-1797
Center, Mandurriao, 0919-4316384
Iloilo City
Gov. Celestino Gallares Dr. Edgar Pizarras (038) 411-3185
Memorial Hospital, 0918-5047051
Tagbilaran City
Vicente Sotto Memorial Dr. Joseph Al Alesna (032) 253-9891 loc 134
Medical Center, Cebu City 0917-5469234
Eastern Visayas Regional Dr. Adelaida Asperin (053) 321-3129
Medical Center, 0919-5540022
Tacloban City
Margosatubig Regional Ms. Nona Galvez, RN
Hospital, Margosatubig,
Zamboanga del Sur
Zamboanga City Medical Dr. George Rojo (062) 991-8523
Center, Zamboanga City 0919-4970004
Amai Pakpak Medical Center, Engr. Emmanuel Cadut (063) 352-0070
Marawi City, Lanao del Sur
Mayor Hilarion Ramiro Dr. Proceso Mintalar (088) 521-0022
Regional Training & 0917-5803174
Teaching Hospital, Mindog,
Maningcol, Ozamis City
Northern Mindanao Medical Dr. Enrique Saab (08822) 726-362
Center, Cagayan de 0917-4042987
Oro City
Davao Medical Center, Dr. Ricardo Audan (082) 227-2731 loc 4116
Davao City 0927-3455823
Davao Regional Hospital, Dr. Sergio Dalisay (084) 400-4416
Apokon, Tagum City 0920-9219690
Cotabato Regional Medical Dr. Dimarin Dimatingkal (064) 421-2340 loc 303
Center, Cotabato City 0917-7266737
Baguio General Hospital Dr. Manuel Quirino (074) 443-5678
& Medical Center, 0920-9117224
Baguio City
Luis Hora Memorial Regional Dr. Edgardo Bolombo 0919-4418559
Hospital Abatan, Bauko,
Mt. Province
Adela Serra Ty Memorial Dr. Amando Gen Barbadillo (086) 211-3700
Medical Center, Tandag, 0918-5848214
Surigao del Sur
Caraga Regional Hospital, Dr. Panfilo Jorge Tremedal (085) 341-2579
Butuan City 0916-8283513

Pocket Emergency Tool 2005

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Pocket Emergency Tool 2005

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PREPARING FOR EMERGENCIES ..........................................5

RESPONDING TO EMERGENCIES .......................................16

Contingency Planning .........................................................85

POCKET EMERGENCY TOOL

The first edition was through the efforts of the following

POCKET EMERGENCY TOOL

Human survival and health are the common objectives and

The goal of the Department of Health (DOH) through the

This pocket tool, however, neither provides nor claims to be

Furthermore, this pocket tool is an evolving text; this 2nd

POCKET EMERGENCY TOOL

T.R.A.I.T. of a Health Emergency

T ake the lead within the community in:

POCKET EMERGENCY TOOL

ROLES AND RESPONSIBILITIES

2. Ensure enhancement of their facilities to respond to the

3. Network with other hospitals in the area to optimize resources

4. Report all health emergencies to the Operation Center, and

POCKET EMERGENCY TOOL

POCKET EMERGENCY TOOL

PREPARING FOR EMERGENCIES

6. Public Information and Mass Media

7. Post-disaster Response Evaluation

9. Establishment of Emergency Operation Centers

10. Documentation and Research

POCKET EMERGENCY TOOL

PREPARING FOR EMERGENCIES

2. Manintain updated hazard and vulnerability assessment of

3. Observe all requirements and standards needed to respond

4. Organize health sector in the region and provide mechanism

5. Maintain operation center as regional repository of vents for

6. Provide technical assistance and empower all LGUs in the

7. Report to the Central DOH (HEMS) for all emergencies and

8. Document all health emergency events and conduct

POCKET EMERGENCY TOOL

At the Center for Health Development (CHD) level…

The following information should be readily available

POCKET EMERGENCY TOOL

PREPARING FOR EMERGENCIES

POCKET EMERGENCY TOOL

Prepare internal arrangements within the DOH and with other

Steps in Establishing Good Working

POCKET EMERGENCY TOOL

COORDINATING WITH OTHER AGENCIES

Health coordination must start as soon as

2. PRODUCT describes the session's deliverables in specific

3. PARTICIPANTS push the issues. Know their perspectives

4. PROBABLE ISSUES give an idea of the potential

POCKET EMERGENCY TOOL

5. PROCESS is the detailed set of steps that will be taken to

The resulting consensus should be that

Coordination is sharing information with other

POCKET EMERGENCY TOOL

COORDINATING WITH OTHER AGENCIES

! Surprise: Is it true? Has it really happened?

Common Communication Concerns:

! “I don't have the correct facts.”

If you do not tell, information will be gathered

POCKET EMERGENCY TOOL

You may follow the outline provided below; however, it is not

II. Goals and Objectives

III. Potential Problems Analysis