HEALTH EMERGENCY AND DISASTER Mass Casualty

NURSING → Any event resulting in a number of victims large

ADRIAN M. CHOG-AP, MAN, RN, LPT enough to disrupt the normal Incident course of
The Center for Research on the Epidemiology of administrative, emergency and healthcare
Disasters (CRED) ranked the Philippines third worldwide services
in terms of the number of reported natural disaster events Mass Casualty Management
in 2012, and with the highest number of disaster-related → Management of victims of a mass casualty event
mortalities. The Philippines' archipelagic makeup and to minimize loss of lives and disabilities
geographic location make it most vulnerable to disasters Mental Health
and hazards, both natural and man-made. → A state of well-being in which the individual
realizes his or her own abilities, can cope with the
The Philippines is host to an average of 22
normal stresses of life, can work productively and
typhoons annually, usually resulting in severe/ flash
fruitfully, and is able to make a contribution to his
flooding in several parts of the country. Typhoon Yolanda
or her community
in 2013 resulted in a total of 6,293 deaths on top of
Partner Agencies
thousands of others injured and missing and the massive
→ Multi-sectoral body composed of different
devastation it inflicted on the overall economic growth
departments of the government and institutions to
and development of the country.
ensure multi-sectoral participation in the
There have also been several volcanic eruptions,
development, updating, and sharing of a national
given the 407 volcanoes in the country, 17 of which are
risk map based on the Disaster Risk Reduction
active. In 1991, Mt. Pinatubo, despite being a non-active
and Management Information System and
volcano, erupted, resulting in many deaths with a number
Geographic Information System, and which can
of municipalities buried, making it as one of the worst
be used as policy, planning and decision-making
volcanic eruptions in the decade.
tools
Located in the Pacific seismic belt, the
Risk
Philippines has five earthquake occurrences daily, most of
which are imperceptible. In 2013, Bohol Province and → Anticipated consequences of a specific hazard
affecting a specific community (at a specific
Cebu City experienced an earthquake with a magnitude of
time); the level of loss of damage that can be
7.2.
predicted to result from a particular hazard
The country is also beset by human-generated
affecting a particular place at a particular time;
emergencies, such as maritime and air mishaps,
conflagration, and armed political or religious conflicts, probable consequences to public safety of a
the most recent of which was the siege in Zamboanga City community being exposed to a hazard (ie., death,
injury, disease, disability, damage, destruction,
in 2013.
All these have resulted in gargantuan numbers of displacement)
lost lives, and injured, disabled and unproductive → Type of hazard determines the kind of risks, eg,
individuals along with massive economic losses and the floods cause few deaths but earthquakes cause
destruction of properties and crops. Cognizant of the ill many
effects and adverse implications of disasters, the → Vulnerabilities and capacity to respond determine
government has instituted measures and established how much risk is in the community, L.e., how
mechanisms to be more responsive to disasters and many deaths are likely, where they will occur and
emergencies. The DOH, as the primary government the kind of people likely to be killed (e.g., old,
instrumentality for health concerns, is one of the major disabled)
players in disaster and response management under the Risk Management
overall coordination of the National Disaster Risk → A comprehensive strategy reducing risk to public
Reduction and Management Council (NDRRMC). safety by preventing exposure to hazards (target
group hazards), reducing vulnerabilities (target
Health Emergency and Disaster Response group elements of community), - and enhancing
Definition of Terms preparedness, i.e., response capacities (target
group- response agencies); a strategy for
Health Emergency Management Health Sector identifying potential threats and managing both
→ An organization of agencies each with a health the source of threats and their consequences
unit primarily devoted to and united to provide Strategic
state-of-the-art, appropriate and acceptable → Deals with the concepts of relatively long-term
technical assistance and/or direct services on and big picture in relation to the pattern or plan
health emergency preparedness and response to that integrates an organization's major goals,
any entity - international or national policies and action sequences into a cohesive
Major Emergency whole. The concept is always relative - what a
→ Any emergency where a response is constrained local level of government sees as strategic from
by insufficient resources to meet immediate their perspective is likely perceived as tactical
needs hence DOH comes in to support either by from the perspective of a more senior government
logistics or manpower

G.M Basmayor
Tactical - Refers to those activities, resources and
maneuvers that are directly applied to achieve goals. DOH A.O. No. 168 s. 2004: "National Policy on Health
Compare with "strategic" above. Emergencies and Disasters," which prompted the
formulation and implementation of a national policy
Objectives framework for emergencies and disasters for the health
In general, this chapter provides a brief sector in order to decrease mortality and promote physical
background on the legal foundation of the DOH's role in and mental health, as well as prevent injury and disability
emergency and disaster response management and on the part of both victims and responders. The AO sought
presents a comprehensive perspective of the components to: (i) develop goals, strategies, plans and policies for
of a well-organized and effective response in health and ensuring an efficient system for managing emergencies
health-related emergency or disaster. Specifically, this and disasters in the health sector; (ii) improve the
chapter aims to enable you, the response manager, to: effectiveness of DOH systems, structures, capacities and
mechanisms; (iii) build up the preparedness and response
a. Appreciate the overall mandate of DOH and its activities of both the public and private health facilities
instrumentalities in managing response to any emergency for administering mass casualty events; and (iv)
or disaster. strengthen links between partner agencies and
b. Identify the basic principles of an effective and efficient stakeholders in responding to and managing emergencies
response. and disasters in the country.
c. Describe the key components constituting a well-
organized response and the elements required for each DOH A.O. No. 155 s. 2004: "Implementing Guidelines
response component. for Managing Mass Casualty Incidents (MCI) During
Emergencies and Disasters," which tasked the DOH to
Legal Mandate of the DOH in Emergency and implement a mass casualty management system and
Disaster Response procedures for resource mobilization, field management
and hospital reception to ensure a comprehensive and
The 1991 Local Government Code (LGC) transferred the well-coordinated response in MCI.
responsibility of delivering health care and services from
the DOH to the LGUs. One the functions that remained DOH A.O. No. 0017 s. 2007: "Guidelines on the
with the DOH is disaster management focused on Acceptance and Processing of Foreign and Local
preparedness and prevention. The LGUs have the primary Donations During Emergency and Disaster
responsibility of providing immediate and direct response Situations," which set a rational and systematic
to disasters, but in cases where disasters have reached procedure for the acceptance, processing and distribution
proportions beyond the capability of the LGUs, the of foreign and local donations that are exclusively for
national government takes control as stipulated under unforeseen, impending, occurring and experienced
Section 105 of the Code: emergency and disaster situations.

Health Emergency and Disaster Response DOH A.O. No. 0024 s. 2008: "Adoption and
Over the past two decades, the DOH has come up with Institutionalization of an Integrated Code Alert
salient policies and guidelines that further defined its roles System Within the Health Sector," which defined the
and functions in disaster response management in Code Alert System that must be in place, specifically in
addition to the laws and executive orders that were passed the mobilization and deployment of resources, and
over the same period. described the expected levels of preparation and the most
appropriate response by all facilities in emergencies and
E.O. No. 102 s. 1999: "Redirecting the Functions and disasters. A previous AO (No. 182 s. 2001) was issued in
Operations of the DOH," which transformed DOH from 2001 for the Adoption and Implementation of the Code
being the sole provider of health services to being a Alert System for DOH Hospitals During Emergencies and
provider of specific health services and technical Disasters.
assistance as a result of the devolution of basic services to
the LGUS. R.A. No. 10121 s. 2010: "The Philippine Disaster Risk
To fulfill its responsibilities concerning the Health Reduction and Management System," which aimed to
Emergency Management functions under this mandate, strengthen the Philippine Disaster Risk Reduction and
the DOH shall: Management System, providing for the National Disaster
➢ Serve as the lead agency in health emergency Risk Reduction and Management Framework,
response services, including referral and institutionalizing the Disaster Risk Reduction and
networking systems for trauma, injuries and Management Plan and the appropriation of funds. This
catastrophic events. issuance established the NDRRMC as the multi-sectoral
➢ Promote health and well-being through public body overall in charge of emergency and disaster response
information and provide the public with timely and management, composed of heads of the 38 member
and relevant information on health risks and agencies/organizations including the DOH. The RA
hazards. called for, among other things, each member agency to:
➢ Assume leadership in health in times of (i) establish a disaster office; (ii) maintain a functional
emergencies, calamities and disasters, and system operations center; (iii) mainstream disaster risk reduction
failures.

G.M Basmayor
management (DRRM) in all planning activities; and (iv) with outbreak potential and in accessing real-time
orient all their employees on DRRM. information for prompt and appropriate response.

DOH A.O. No. 29 s. 2010: "Policies and Guidelines on ▪ In June 2014, the NDRRMC also prepared and issued
the Establishment of Operations Center for the National Disaster Response Plan which outlined
Emergencies and Disasters," which aimed to provide the policies, key strategies and guidelines on response
policies and guidelines in the establishment of an management, including the roles and functions of the
Operations Center (OpCen) at all levels from the national different agencies. The DOH, in particular, was
to the local government to ensure a well-coordinated tasked to lead in the provision of Health, WASH,
response of the health sector. It sought to: (i) develop Nutrition, and Psychosocial Services.
policies and guidelines on the establishment and
management of an Operations Center; (ii) identify the Health Emergency and Disaster Response Framework
functions of the OpCen at the different levels; (iii) set the Given the above mandates and policies, the DOH
minimum specification for the design of an OpCen and uses the following framework in the overall management
minimum standards for logistical requirements, human of health emergency and disaster response in the country
resource requirements, coordination mechanisms, and
relationship among Operations Centers; and (iv) provide Overall Purpose of the Response
funds to sustain its functionality. It is envisioned that a well-organized and
effective response should redound to the overall well-
DOH A.O. No. 0014 s. 2012: "Policy and being of the population at risk or those affected by
Implementing Guidelines on Reporting in disasters due to any hazard, and to minimize the incidence
Emergencies and Disasters," which aimed to provide of related death, injury, disease, and disability. It is,
guidance in ensuring an effective and efficient reporting therefore, necessary that the design, implementation, and
mechanism for a responsive evidence-based decision- management of the response be geared towards saving as
making process during emergencies and disasters. This many lives as possible, minimizing the number of injured
enabled all reporting units at all levels of the health sector and disabled individuals, and preventing and controlling
to submit timely, reliable and continuous reports of all morbidities during and post-disaster. In addition, the
health-related events and to standardize reporting response should aim to rehabilitate and restore the
mechanisms at all levels for emergencies/disasters. It also physical, emotional, and mental health of those affected
aimed to ensure consistency and compliance of all and their family members and loved ones even after the
reporting units with the reporting mechanisms in onslaught of the emergency or disaster.
emergencies and disasters.
Principles in the Management of Response
Slide 21 There are basic principles to observe in
designing, implementing, and managing the response to
DOH A.O. No. 2013-0014: "Policies and Guidelines on any health emergency or disaster.
Hospitals Safe from Disasters," which aimed to reduce
disaster risks to ensure the protection and the continuous 1. The response must be able to address a wide
operation of hospitals and other health facilities, and save range of or multiple hazards that pose risks to the
lives during emergencies and disasters. Specifically, it health of communities. The response must take an
prepares the hospitals to address the operational all-hazards approach, particularly in building up
challenges attendant to emergencies and disasters and to the core capacities in managing disasters. This is
remain standing and functional by: (i) strictly enforcing in consideration of the fact that most risk
national and local government safety regulations and management measures are similar across varying
codes in the construction, expansion, renovation, repair types of hazards and that one deals with the same
and rehabilitation of hospitals; (ii) inclusion in the responders using the same system.
hospital licensure requirements of a program for regular
maintenance consistent with the most current Hospitals Health Emergency and Disaster Response
Safe from Disasters indicators; (iii) subjecting hospitals to 1. The response must be multi-level in coverage,
yearly self-assessments and action planning to address taking into consideration the actions at the
their structural, non-structural, and functional national, regional, and local levels.
vulnerabilities and capacities using the most current 2. The response must be multi-sectoral in
assessment tool; (iv) ensure surge capacity to be able to cognizance of the fact that the health sector
manage increased demand; and (v) utilize, build and cannot singly address all the needs and
strengthen partnerships and networks and develop requirements of any health emergency or disaster.
corresponding mechanisms in times of emergencies and It is therefore important to adopt a whole-of-
society, multi-sectoral and multi-institutional
DOH A.O. No. 2014-0011: "Policies and Guidelines on approach requiring coordination, collaboration,
the Implementation of Surveillance in Post Extreme and partnerships in all phases of the emergency or
Emergencies and Disasters (SPEED)," which aimed to disaster response implementation.
institutionalize SPEED at all levels of health emergency 3. The response should be proactive throughout the
and management response. SPEED as an early warning disaster risk management cycle from prevention,
system is vital in detecting health conditions or diseases preparedness, response, and recovery - given the

G.M Basmayor
 essential and interlinked contributions of each each of the mandated offices/units or officials/staff
phase to the overall health status of the population has to carry out.
at risk. ▪ Second is the establishment and running of the
5. The response must be owned primarily by the national, Operations Center (OpCen), which serves as the hub
regional, and local governments with their full- pledge of for coordination, communication, command and
commitment and corresponding investment to achieve control, in close coordination with the Incident
and sustain the goal and objectives of the response. Command (IC).
6. The response must thrive on the empowerment and ▪ Third is setting up and sustaining intra/inter and
resilience of the community members as they are the multi-sectoral coordination at various levels of
driving force and primary actors of the response. Local operation: local, regional, national, and international.
partnerships, therefore, must be forged among the local ▪ Fourth is the establishment of the EWARS that
governments, nongovernment organizations, the private prompts appropriate levels and types of response
sector, and other stakeholders on the ground. measures according to levels of alert.
7. The response must be evidence-based, relying on the
accurate, complete, and timely results of the risk 2. Management of the Victims. Management of victims
assessment as basis of decision-makers in identifying the covers both the living and the dead. It includes the
appropriate response measures and actions to undertake. provision of a package of services to the victims in various
8. The response must be supported with a strengthened settings and situations and the provision of technical
national and local health care delivery system that will support in the management of the dead. There are five
enable the delivery of Health Services, WASH, Nutrition elements in the management of victims, as summarized
and Psychosocial Services during the Response Phase up below:
to the early Recovery Phase; ▪ First is the management of mass casualty
9. The response must observe and promote equity among incidents, which includes both prehospital and
all concerned through the identification and monitoring of hospital care and services.
the health status of vulnerable groups, disadvantaged or ▪ Second covers the management of displaced
marginalized groups, and those in geographically isolated populations in the community and those placed in
and depressed areas (GIDAS). It should also be able to temporary shelters or evacuation centers.
detect pockets of low coverage of essential health services ▪ Third is concerned with the surge capacity in
in areas at high risk of natural disasters. hospitals, which necessitates the provision of
10. The response must take prominence in the overall extra space, staff, stuff, and special services (e.g.,
development agenda of the national, regional and local fast discharge of inpatients, transfer of in-patients
governments. This will be reflected in the continuous to other hospitals, etc.).
formulation and issuance of policies and guidelines, ▪ Fourth is the package of Health Services (public
allocation of increasing budget for the implementation of health including pre-hospital and hospital care),
the response, and regular monitoring of adherence and Water, Sanitation and Hygiene (WASH),
performance of all agencies mandated to implement and Nutrition, and Psychosocial Services to be made
manage the response. available as part of the response.
▪ Fifth is the management of dead where the
specific role of the DOH is established relative to
the other government agencies.
3. Management of Service Providers. This component
provides support to the continuous delivery of the
package of services by identifying, mobilizing and
deploying appropriate and a sufficient number of teams
on time, supported with continuous monitoring and
evaluation. This entails the following elements:

▪ First is the identification, mobilization and

deployment of teams during special events. These
are events that involve mass gatherings of people
1. Management of the Event/Incident. The management at the local, sub-national, and national levels.
of the event could either make or break the response. It These may entail the presence of very important
sets the overall direction of the actions to be undertaken, personalities (e.g., the President, other
holds the other key elements in place, and keeps them government officials, etc.) or international
functional. The effective and efficient management of the personalities (e.g., the Pope, etc.). These special
incident requires the establishment and operationalization events may also include international
of four key elements which are multi-layered and multi- conferences/ summits that which the Philippines
sectoral. hosts (e.g., APEC, etc.). Appropriate response
▪ First is the establishment of the Incident Command teams need to be mobilized and deployed for
System (ICS), which clearly establishes the chain of these events.
command in managing the event, the structure and ▪ Second covers the guides and protocols on the
lines of authority, and the roles and functions that identification, mobilization and deployment of
response teams during health emergency or

G.M Basmayor
 disasters. This involves the identification of the logistics. This necessitates the timely and proper
different types of response teams to be mobilized, stockpiling and prepositioning, warehousing,
their composition and tasks, and the expertise special procurement arrangements, and
required of them. Teams include those needed to management of donated goods, commodities and
perform rapid health assessment (RHA), to equipment. This also includes the inter-hospital,
deliver Health Services, WASH, Nutrition and interagency and inter-regional sharing of
Psychosocial Services, to provide medical logistics.
services, and handle trauma cases, as well as ▪ Second is the establishment of mechanisms to
teams to attend to the administrative and financial facilitate the mobilization, allocation and release
needs of the operations. of funds, including: the utilization of petty cash,
▪ Third is the identification, mobilization and contingency fund, and Quick Response Fund;
deployment of humanitarian teams to other mobilization of PhilHealth financing; and
countries requesting assistance from the mobilization and management of cash donations.
Philippines. Alternative mechanisms to facilitate the release
▪ Fourth is the management of volunteers and and utilization of funds during an emergency are
partners, both local and foreign (Foreign Medical also elaborated.
Teams). ▪ Third is ensuring the availability and accessibility
4. Management of Information System. This component to lifeline facilities, which include transportation,
deals with the management of information that are communication, and source of energy during the
essential in managing the response, from data collection, response. This section, however, is limited to the
reporting, analysis and utilization as input to decision- identification of these essential lifeline equipment
making, to policy and guideline enhancement, and facilities, and recommended actions for
prioritization of resources, etc. It also provides guidelines alternative options when these are no longer
on knowledge management as information are functional as a result of the disaster.
disseminated/communicated to the general public and The Response Phase
other groups of stakeholders, using risk communication The major activities that are to be undertaken
approach with the proper management of the media. The prior to impact, during impact, and post impact are
overall process and documenting the response is also described below. Although the focus of this is the
considered as part of managing the information system, management of the response itself, there are measures that
including the conduct of Post-Incident Evaluation (PIE). are largely dependent on the extent of preparation done
The elements of this component are the following: prior to the Response Phase, and several actions are also
expected to extend to or overlap with the Recovery Phase.
▪ First is data and information management,
particularly in identifying specific data to be
collected and the different data sources, and the
processing and consolidation of these data. These
are part of the functions of the OpCens. This
element also involves providing guidelines on the
different types of reports to be prepared and
submitted for specific purposes and the targeted
users of said information.
▪ Second element is knowledge management, with
focus on the use of the risk communication
approach in disseminating key messages to the
DOH family, the general public, and other groups
of stakeholders. It also includes media
management. Pre-Impact Phase (Could be day or days before)
▪ Third element provides guidelines in the overall
documentation of the response, identifying those There are hazards with warnings (e.g., typhoons, volcano,
to be involved in the assessment and tsunami, lahar, etc.) which allow enough time for
documentation. This section also includes a brief preparation. But there are also hazards that come without
discussion on the Post-Incidence Evaluation warning (e.g., earthquake, bombing, etc.), which put the
affected population at higher risks. The Pre- impact Phase
(PIE) which is one of the tools in assessing and
refers to the period immediately before the onset of the
documenting the response. event. This is different from the Preparedness Phase
during which the major activities include the
5. Management of Non-human Resources. The last development, review and testing of the disaster
component of a well-organized and effective response is management and preparedness plan, trainings, drills,
the proper management of non-human resources. Non- exercises, etc. During the Pre-impact Phase, the major
human resources encompass logistics, finances, and activities at the are:
major transportation and communication equipment and ▪ Activation of all Response Plans
facilities. The elements of this component are as follows: ▪ Prepositioning of logistics/checking of all other
▪ First is the need to ensure the availability,
accessibility and equitable distribution of logistics requirements

G.M Basmayor
 ▪ Setting up stand-by teams/DOH reps in their recognition Deactivation of response teams once
the local health office is fully functional
respective areas of assignment
▪ Activation of the OpCens 2nd PPT
Management of the Victims
▪ Coordination among concerned agencies (e.g.,
local, sub-national and National Disaster Proper management of victims is an integral
component of a well-organized and effective response to
▪ Risk Reduction and Management Councils
any health emergency or disaster. Saving lives,
(NDRRMC) minimizing disabilities, and preventing the victims' health
conditions from worsening are the paramount concerns in
▪ Collecting and gathering data about the
any emergency or disaster. It is essential that victims,
hazard/event and possible effect/impact. especially in mass casualty incidents (MCI), are given
proper management and care on-site before they are
Impact Phase or Occurrence of the Incident (0 hour to brought to the hospital, while they are being transported
48 hours) to the hospital, and while they are confined in the hospital.
The hospitals, therefore, must be able to address the surge
This phase addresses the health service response for all capacity of victims resulting from emergencies and
emergencies to minimize the health impacts on disasters of mega proportions. Equally important is for
individuals and the community. The key actions in this victims who are displaced in temporary
phase include: shelters/evacuation centers to receive the same care and
attention. A must in all these settings is the availability
▪ Immediate deployment medical assets Rapid and accessibility of the essential package of health care
health assessment and services to the victims regardless of where they are
▪ Activation of the appropriate plans and sub-plans located or found.
▪ Deployment of public health and/or welfare
assets as required While the living victims are the focus of victim
▪ Coordination with local, regional or territory management, we also provide guidelines on the proper
counter-disaster controllers management of the dead in as far as these is also part of
▪ Deployment of liaison staff to the emergency the role of the DOH Central Office, the regional offices,
operations centers or crisis centers and the DOH hospitals
▪ Continuing coordination with higher and lower
levels Objective
In general, our discussion provides a comprehensive set
This phase will conclude when there is no further medical, of guidelines and procedures to help you manage victims
public health, or welfare response required at the of health emergencies and disasters. It is hoped that
emergency site, and further support will then be provided through this chapter, you will be able to:
during recovery operations. a) Install and run a well-coordinated mass casualty
incident management system.
Post-impact (After 48 hrs and onwards which may b) Enhance the capacities of hospitals to respond to
overlap with Recovery Phase) the surge volume of victims during mass casualty
incidents resulting from emergencies and
This phase involves continuing the operations disasters of mega proportions
commenced at the "during-disaster" phase and includes c) Establish and operate proper management and
activities that lead to the demobilization of resources. It care for victims in the community and in
addresses the process of returning an affected community temporary shelters.
to its normal level of functioning or "building back better" d) Provide victims with the essential emergency
after an emergency. It is quite difficult to delineate when package of services in different settings: pre-
the response phase ends and the recovery phase begins, hospital, hospital, community and temporary
which may last for months or years. The duration of this shelters.
phase varies according to the type of emergency/ disaster. e) Perform your expected roles and functions in
Essential health tasks include: managing the dead in close collaboration with the
DILG and other national, regional and local
▪ Continuous provision of public health, pre- agencies taking the lead in this concern.
hospital and hospital services (Health WASH,
Nutrition and Psychosocial Services)
▪ Provision of support in accordance with the
Health Emergency Preparedness, Response and
Recovery Plan (HEPRRP), and preparation of a
Recovery and Rehabilitation Plan in coordination
with the LGU
▪ Conduct of debriefing and PIE to serve as inputs
to the enhancement of policies and guidelines to
guide future prevention d preparation actions
▪ Inventory of all resources for replacement, repair
or reconstruction Inventory of human resources • Pre-Hospital Care comprises the care and
providing support/aid and giving them management of victims housed in temporary

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 shelters or evacuation centers and MCI victims 1.5 Protection and safety of responders and volunteers
before they are brought to the hospital. must always be observed in the retrieval, handling,
• Hospital Care consists of care and treatment of transport and disposition of body parts and dead bodies.
MCI victims and the other Individuals or This shall be the primary consideration of sending
populations affected by the emergency or disaster agencies and properly coordinated with other concerned
who require a higher level of care and services: agencies.
• Care in Temporary Shelter/Evacuation
Center covers the provision of care and services 1.6 Proper information should be disseminated that dead
to populations displaced into temporary shelters bodies due to natural disasters do not pose a risk for
(e.g., evacuation centers). It specifies the epidemic.
provisions stipulated in the DSWD's guidelines
for managing victims in evacuation centers with 1.7 Unidentified dead bodies shall never be buried in
a focus on Health Services to be provided, common graves. Instead, they should be placed in
including WASH, Nutrition, and Psychosocial individual niches, trenches or any culturally acceptable
services. burial place.
• Care of other affected populations refers to the
management of victims affected during an 1.8 Mass cremation of bodies should be discouraged.
emergency or disaster (not necessarily victims of
MCI) that seek care and treatment in the 1.9 Final disposition of dead bodies due to infectious
hospitals. diseases and chemical, biological, radiological, nuclear,
• Management of the Dead and their love ones and explosive (CBRNE) shall be done in accordance with
and relatives provides guidelines on- the the DOH recommended guidelines and procedures.
expected roles and functions of the DOH (Central
Office, regional health offices, and hospitals) 1.10 Bereaved families must be provided with
relative to this concern vis-à-vis the psychosocial services.
responsibilities of other lead agencies and offices
at different levels of operations. Specific Guidelines
• The Package of Service Includes Health
Services, WASH, Nutrition and Psychosocial 2.1 The DILG is the lead agency in the management of
services that must be made available to the the dead. It has the prime responsibility in the planning,
emergency/disaster victims in different settings. monitoring and evaluation of the Management of the
Dead and coordinates with the LGUs in the Search,
Management of the Dead Rescue and Retrieval (SRR) operations, identification and
disposal of the dead, management of missing persons, and
In emergency or disaster management, most efforts are management of bereaved families.
concentrated on the living victims, while the very least
consideration are given to the dead. This section provides 2.2 The DOH, on the other hand, is expected to undertake
the guidelines on the management of the dead, with the the following in support of the management of the dead:
DOH providing technical assistance to the agencies in-
charge, such as the DILG For better appreciation, the • Formulate standards/specifications of cadaver
general guidelines are presented in whole although these bags and personal protective equipment's (PPE)
are beyond the domain of the DOH. The specific to be used in the search, rescue and retrieval of
guidelines, however, are confined to the roles of the DOH the dead.
Central Office, ROS, and DOH hospitals in the retrieval, • Include in the licensing requirements of
storage, identification, transfer and final disposal of the morticians the training on Management of the
dead, including what the local health offices are expected Dead
to carry out under the technical oversight of DOH. • Develop the protocols to prevent contamination
of the environment while disposing of the dead
General Guidelines • Provide technical inputs in establishing
1.1 Every dead person has the right to be found, identified, temporary morgue and burial sites.
and buried according to their culturally acceptable
2.3 The DOH shall provide technical oversight to the local
1.2 The rights to privacy of the dead shall be observed at health office (LHO) as they participate in the management
all times. of the dead:

1.3 All efforts shall be exerted for the proper retrieval, • LHO shall coordinate all processes related to the
identification and disposition of the remains in a management of corpses, including the retrieval,
respectable and dignified manner to prevent if not handling, transport and disposition of body parts
minimize the negative psychosocial impact on the and dead bodies.
bereaved and the community including the responders. • LHO shall retrieve ante-mortem
information/records from hospitals/PhilHealth.
1.4 The handling of the dead body, from retrieval, LHO shall issue a Death Certificate based on the
identification and disposition, must be carried out it a Certificate of Identification issued by the
sanitary manner so as not to pose infection to the NBI/PNP.
responders and contaminate the environment. • LHO shall authorize the release of the identified
dead body to the family or claimant upon
verification of the legitimacy of the claimant

G.M Basmayor
 • LHO shall be witness to the exhumation of c) Listen to the public's specific concerns. People
unidentified remains for proper disinfection of often care more about trust, credibility,
the interment area. competence, calmness, and empathy than about
statistics and details.
2.4 Together with the other agencies, the DOH shall: d) Be honest, frank and open. Trust and credibility
• Provide psychosocial services to the responders are difficult to obtain: once lost, they are almost
and bereaved families of the dead and missing impossible to regain
persons together with DSWD; PRC and DILG. e) Work with other credible sources. Conflicts and
• Provide a minimum package of services to the disagreements among organizations make
responders, particularly medical services, communication with the public much more
through the DOH hospitals. difficult.
f) Meet the needs of the media. The media are
2.5 The DOH hospitals should submit the report on the usually more interested in politics than risk.
number of dead bodies to the ROS. In turn, the DOH- simplicity than complexity, danger thin safety
CHDS shall integrate the reports from the hospitals and g) Speak clearly and with compassion. Never let
submit these to DOH Central Office. The DOH-CO then your efforts prevent you from acknowledging the
shall submit the report to the NDRRMMC. tragedy of an illness, injury or death. People can
understand risk information, but they may still
Risk communication not agree with you; some people will not be
satisfied.
Risk communication is the purposeful exchange
of information about the existence, nature and form, and Specific Guidelines
severity or acceptability of health risks between 2.1 Identification of Risks to be addressed
policymakers, health care providers, and the Identify risks of the hazard using the risk management
public/media. It is aimed at changing behavior and process. Determine the knowledge and the behaviors to be
inducing action to minimize/reduce risks. It is imperative learned and adopted to prevent the risks. These will be the
that the DOH-CO, RO and DOH hospital officials and basis for the development of the risk communication
staff involved in response management, including the message.
local health officials and health workers, develop the habit
of communicating health risks before, during and post- Example
disaster. Hazard: Typhoon
Risk: Flooding
General Guidelines Knowledge:
1.1 Risk communication is essential in informing the • Prevention of leptospirosis
public. the DOH family and its partner regarding th • Signs and symptoms of leptospirosis
response to health emergency and disaster for the • Measures to prevent complications from
following reasons: leptospirosis
Behavior:
• It is the fundamental right of the population to
access information about the risks they face. • Home management of leptospirosis
• Organizations are seen to be more legitimate and • Bring eligible children for measles immunization
effective when they are transparent and open with and vitamin A supplementation.
information. • Bring children with early signs and symptoms of
• The risk is shared by the organization and the measles to health workers.
population • Proper care and management of measles.
• Risk communication serves as an avenue for
information and education to the communities, 2.2 Program implementation. Execute the communication
health personnel and decision-makers. It gives a strategies identified in the Risk Communication Plan
better chance of explaining risks to the population 2.3 Program Evaluation and impact assessment
more effectively
• Populations can make better choices when they a) Evaluate the process or assess the
are better informed. The emergency information strategies/activities that were implemented as
can stimulate behavior change. against the plan. in the
• Risk communication prevents misallocation and b) Assess the impact of the program in terms of the
wasting of resources change in knowledge and behavior of the target
group/audience.
• It can lower the incidence of illness, injuries and
deaths
Management of Non-Human Resources
1.2 There are seven principles you need to observe in risk
Non-human resources - including logistics (drugs,
communication
medicines, supplies, equipment, etc.), lifeline facilities
a) Accept and involve the public as a partner. Your
(transportation, communication, energy supply), and
goal is to produce an informed public, not to
finances - are basic elements of a response. Making these
defuse public concerns or replace actions.
resources available and accessible to the teams of
b) Plan carefully and evaluate your efforts. Different
responders is critical to the conduct of timely, continuous,
goals, audiences, and media require different
and well- organized response actions from pre-impact to
actions.
post-impact.

G.M Basmayor
Objectives services and came to the victims and their loved ones.
Sourcing of emergency funds (eg, Quick Release Funds,
This chapter provides the policies and guidelines in contingency funds, etc.), including the role of PhilHealth
managing the non-human resources essential in providing reimbursements, require equal attention.
emergency response to affected areas and populations.
Specifically, it aims to help you! Policy Statements

a) Ensure the availability and accessibility of all Policy Statements 1:

necessary logistics during emergencies and The DOH-CO, ROs and DOH hospitals must establish
disasters according to DOH protocols and their respective logistics management systems with the
standards. aim of providing the right logistics. to victims and
b) Mobilize and operate essential facilities for affected populations in the right amount with the night
transportation, communication, and energy pace at the right timer and right place during emergencies
source. and disaster.
c) Accept allocate, distribute and document local
and foreign-donated commodities and equipment Policy Statements 2:
according to DOH recommended protocols. The DOH-CO, ROs and DOH hospitals must establish
d) Facilitate the timely release and proper utilization and activate their separate financial agent system that will
of funds and ensure their proper accounting and ensure adequate financial support on time is flexible to
documentation use to meet the varying needs of the victims/affected
e) population and response teams, and free from legal
impediments.

Policy Statements 3:
The DOH-CO, ROs and DOH hospitals must be self-
sufficient in terms of lifeline facilities (transportation,
communication, energy source, etc.) and observe
redundancy throughout the Response Phase

Policy Statements 4:

The DOH-CO, ROs and DOH hospitals must establish a

mechanism to facilitate sharing of resources with other
government agencies, cluster members and partners.
Logistics Management This element covers the
planning, procurement/acquisition, delivery! distribution Policy Statements 5:
and utilization of logistics during the Response Phase.
Logistics intended for the victims would include drugs, All donated commodities, equipment and funds, both
medicines, materials/supplies and equipment, while local and foreign sources must be properly receipted,
logistics for the Use of the response teams include rationally allocated and delivered on time with
primarily their personal protection equipment appropriate documentation.

Managing of Lifetime Facilities Transportation and

communication facilities and energy supply are the felines
during emergency response. The DOH must ensure that
these are adequate and functional throughout the
Response Phase with alternative options to source them
from. Since other agencies. in addition to DOH. are also
expected to provide for these facilities, defining and
establishing the systems and procedures on how to
coordinate with the concerned offices are major
considerations during the response.

Management of Donated Commodities The outpouring

of logistics support from local and foreign sources during
emergencies and disasters poses both positive and
negative implications to response management. Donated
goods are very much welcome as an augmentation to what
the DOH and LGUs can provide. However, they also pose
problems for those involved in the response if they do not
conform to DOH-recommended protocols and are not
properly managed.

Financial Management This element refers to the

requisitioning, release: utilization and accounting of funds
during response. Mechanisms to expedite these processes
are very important for the timely mobilization of
responders and the timely provision of the needed

G.M Basmayor