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Hospital Emergency Preparedness Plan
A. Hazards assessment
1. Identification of all potential hazards inside and outside the vicinity of the hospital.
Hazard
MAP
Hazard Prevention Plan
a. Activities includes:
1) Continuous monitoring and updating of preparedness capability in terms of policies,
guidelines and procedures.
2) Strengthening human resource capability by encouraging continuous training.
3) Conduct a table top or an actual drill at least quarterly or semi-annual.
4) Conduct post evaluation of the drill and make appropriate recommendations for
improvement identifying what went wrong and what went right.
5) Team building among LCP-HEMS responders
b. Identifying resource requirements for all types of hazards.
1) Technical expertise on occupational safety, lectures on first aid, basic life support, mass
casualty handling and incident command system.
2) Identifying alternative portable electric generators and water pumps
3) Alternative source of electricity like solar power devices.
4) Stockpiling of medicines and supplies.
5) Stockpiling of gasoline and diesel fuel for at least 5-10 days without compromising
hospital safety.
6) Proper utilization of HEMS sub-allotted fund for hospital capacity building activities.
7) Appropriate inclusion of specific supplies and materials in annual procurement plan for proper
allocation and budgeting.
8) Networking with other government and private agencies.
c. Assigning point person to monitor the different activities and to source out any
deficiencies in terms of resource utilization.
1) General Services Chief as the Safety Officer in-charge. – Monitoring of all potential
hazards and vulnerable areas and take action immediately.
2) HEMS Coordinator – updating of hospital preparedness, response and recovery plan
3) Asst. HEMS Coordinator – in-charge for the monitoring and training of all hospital
staff on emergency preparedness and response.
4) Infection Control Nurse – monitoring of all potentially infectious diseases through
active surveillance approach and reporting immediate concern to higher authorities.
B. Vulnerabilities reduction
1. Vulnerable areas in times of emergencies and disasters.
a. Radiology Department
b. Pathology Department
c. General Services Division
2. All identified areas must be able to follow the guidelines in assessing health facilities
in responding to health emergency in order to effectively reduce morbidity and
mortality among its personnel and clients. Vulnerability is categorized as:
a. Structural – Related to the construction of the facility.
b. Non-Structural – The non-structural elements of a building include ceilings,
windows, doors, mechanical, electrical, plumbing equipment and installation.
 c. Functional – There are three aspects:
1) Deals with general physical lay-out of a facility, including location, accessibility
and distribution of areas within the facility.
2) Individual services: medical (supplies and equipment) and non-medical
(utilities, transportation and communication vital to continuous operation of
facility).
3) Public service and safety measures.
d. Human Resources – Includes:
1) Organization of the health facility (e.g., emergency planning group,
subcommittees)
2) Inventory and mobilization of personnel
3) Preparedness activities for the personnel (e.g., hazards and vulnerability
analysis, drills and training,
C. Capacity development
1. Training
a. All ER personnel must attend the Basic Life Support Training (BLS), Advance
Cardiac Life Support Training (ACLS), Pediatric Advance Life Support Training
(PALS) and Emergency Medical Responder Course (EMR)
b. All hospital personnel must attend the following training:
1) Basic Life Support Training
2) First Aide Course
3) Fire & Earthquake Seminar
4) Incident Command System and Mass Casualty Management Seminar
c. All identified high risk area personnel must attend special training to resolve any
immediate threat to hospital operations. This training shall include:
1) Hospital Emergency Awareness and Response
2) Special handling of highly flammable substance
3) Fire suppressant training
4) Radiological emergency training
5) Use of special personnel protective equipment (PPE) for biological
hazards and hazardous materials.
6) Basic water sanitation training
2. Purchase of emergency equipment's.
a. Purchase of at least 10 radio communication equipments.
1) Executive Director - 1
2) Deputy Directors – 2
3) HEMS Coordinator – 1
4) Head of Communication Section – 1
5) Department Manager Nursing – 1
6) Senior House Officer – 1
7) ER – 1
8) GSD Head – 1
9) Security - 1
b. Purchase of at least 2 portable generators capable of delivering 500KVA
each
c. Purchase of alternate water pumps.
d. Purchase of alternate solar power devices.
3. Provision of temporary shelters for patients and staffs.
a. Purchase of 10 tents that can accommodate at least 20 patients at a
time.
b. Identify areas where to construct the field hospital (Please see maps
for the possible locations of tents)
c. Provisions of portalets (portable toilets).
4. Alarm Code and Alert Status.
a. Hospital Alarm Code
1) Code 98 – Fire Incident
2) Code 55 – Evacuation Alert
b. Medical Emergency Code Alert
1) Code 82 – Adult Cardiac Arrest
2) Code 41 – Pediatric Cardiac Arrest
c. Security Alert
1) Code 77 – Internal Hospital Violence or potential violence
d. Hospital Code Alert Level
 c. Guidelines in implementing the Tri-Color Code Alert
1. The Hospital Code Alert shall be declared by the Secretary of Health or by the Director of HEMS for
external emergencies.
2. The Medical Center Chief or the Hospital HEMS Coordinator of the hospital shall declare the code alert
based on his assessment of the emergency within his catchment area.
3. The Medical Center Chief shall automatically declare a Code White Alert during national events and
activities especially with the potential of an MCI (Mass Casualty Incident).
4. The alert level is raised, lowered or suspended by the Secretary of Health, Director of HEMS for
external emergencies and national events.
5. The alert level status (raised, lowered or suspended) within the hospital catchment area shall be the
responsibility of the Medical Center Chief or his designates.
d. Determining Priority for Case Management
1. Use of Color Tag for Prioritization of care
i. Categories
a. RED – Immediate: Priority One (Life-threatening Conditions). The condition is life-threatening and
the patient requires immediate attention and transport. The following conditions
d. Determining Priority for Case Management
1. Use of Color Tag for Prioritization of care
i. Categories
a. RED – Immediate: Priority One (Life-threatening Conditions). The condition is
life-threatening and the patient requires immediate attention and transport. The
following conditions should be present for a Mass Casualty Incident (MCI) victim to be
classified Priority One.
1) Obstruction or damage to airway.
2) Disturbance of breathing – respiration above 30/min.
3) Disturbance in circulation – capillary refill greater than 2 seconds or
carotid pulse weak, irregular or absent, radial pulse absent.
4) Does not follow commands or altered level of consciousness.
5) Need for life-saving measures (BLS and ATLS) and urgent hospital
admission.
6) Victims whose injuries demand definitive treatment in the hospital but
which treatment may be delayed without prejudice to ultimate recovery
b. YELLOW – Urgent: Priority Two. Patient has passed primary survey, but with
major system injury, may delay transport to one hour. Any one of the following conditions
could place a victim into a Priority Two Category:
1) Needs to be treated within one hour; otherwise they will become
unstable.
2) Severe burns; burns involving hands, feet or face (not including
the respiratory tract); burns complicated by major soft tissues trauma.
3) Hospital admission is required.
c. GREEN – Delayed: Priority Three. An injury exists but treatment can be delayed for four to six
hours. Generally, anyone who can walk (walking wounded) to a designated area for treatment
will be a Priority Three. The following injuries are examples:
1) Minor injuries not threatened by airway, breathing and circulatory instability
2) Minor fractures, minor soft tissue injuries, minor burns.
3) May or may not be admitted.
d. BLACK or WHITE – Dead: Last Priority. Condition are the following:
1) Patient is dead.
2) Those who die awaiting treatment, and those in cardiac arrest following trauma.
Special Note: For Moslem communities, white tag will be used for dead Moslems.
5. Commencing quarterly or semi-annual drills to different scenarios.
a. Table top Drill
b. Actual Drill

D. THE FIRE EMERGENCY PLAN

The main concern in any fire emergency plan is to:

1) Stop and prevent spread of fire
2) Evacuate patients/personnel, records and equipment.
3) Allay panic
4) Be able to render emergency treatment for various forms of fire related
injuries i.e., wound or inhalation injuries.
Every hospital personnel should be aware of the following instructions in case of fire
1. General Instructions
a. Notification
1) Notify the telephone operator (local 444, 401 right away the source of
fire, exact location and possibly the extent. Speak in a moderate tone of
voice so that the patient will not overhear and become frightened.
2) Notify the Charge Nurse who shall in turn notify the Nursing Department
Manager/Supervisor
3) Notify the Safety Committee and activate the Fire Brigade
b. Evacuation strategies

1) Removal/Evacuation of Patients
i. Do not move patients unless with specific instruction from the safety officer.
ii. Move patients with utmost caution bring along their charts and medications.
iii. When patients are moved out from the room, close the doors and windows.
iv. Everyone should know the location of the exits nearest to the room to be
evacuated, the location of the keys to the exits, or the exit to be used, ensure that
exits are free from any obstruction.
v. Evacuation priorities shall be as follows
1. FIRST - those nearest the source of fire or posed with greatest danger or
those farthest from safety
2. SECOND - helpless patients, use available stretcher. If none, roll in top covers
and carry with help by grasping blanket under the patient.
3. THIRD - wheelchairs patient, wrap in blankets and wheel out towards exit
4. FOURTH - walking patients; wrap in blanker and lead towards exit.
b. Evacuation strategies

1) Removal/Evacuation of Patients
i. Do not move patients unless with specific instruction from the safety officer.
ii. Move patients with utmost caution bring along their charts and medications.
iii. When patients are moved out from the room, close the doors and windows.
iv. Everyone should know the location of the exits nearest to the room to be
evacuated, the location of the keys to the exits, or the exit to be used, ensure that
exits are free from any obstruction.
v. Evacuation priorities shall be as follows
1. FIRST - those nearest the source of fire or posed with greatest danger or those
farthest from safety
2. SECOND - helpless patients, use available stretcher. If none, roll in top covers
and carry with help by grasping blanket under the patient.
3. THIRD - wheelchairs patient, wrap in blankets and wheel out towards exit
4. FOURTH - walking patients; wrap in blanker and lead towards exit.

c. Removal/Evacuation of Equipment/Instruments/Supplies
All equipments should have been color coded at the time they were installed in the unit.
Color codes are used for priority of evacuation. Color tags should be luminous or reflectors.
1) RED FIRST PRIORITY
 Equipment that contains flammable gases such as Oxygen
 Halothane, Nitrous Oxide, etc.
 Containers that contains flammable liquids, such as petroleum,
 2) GREEN SECOND PRIORITY
 Equipments needed life
support especially of patients already evacuated
 Expensive equipments
3) YELLOW THIRD PRIORITY
 All others
d. Stop the fire
1) What everyone should know
i. Location of the fire extinguisher in the unit. How to operate them.
1. Pull the pin
2. Aim the extinguisher with nozzle pointing at the base of the flames.
3. Squeeze the hand trigger as you hold the extinguisher upright
4. Sweep the extinguisher from side to side, covering the area/base of the
flames.

ii. Location of fire hydrants/hose/water source

iii. When and how to use wet blankets or rugs when necessary. Place wet
blankets under the floor to keep out the smoke.
2) Turn-off at once all oxygen tanks in operations and electrical devices
3) Close al doors and windows
 e. Allay fear and panic
The greatest danger in hospital fires is panic caused by fear or smoke. BE CALM! Fear
and panic can do as much damage as fire. Patients usually become aware of the
existence of fire. Reassure them that the alarm has been Health Emergency
Preparedness, turned on and that the emergency plan has been activated. DO NOT
BECOME ALARMED YOURSELF.
2. Specific Instructions
a. Nursing Department Manager/Supervisor
1) Once notified by the Head Nurse/Charge Nurse and once on the scene she shall
assume responsibility
2) Keep someone on the telephone all the time for further instructions and
coordination and to relay instructions.
3) She shall direct the removal of the patients when authorized and shall do so
according to priority.
4) She shall coordinate and give instructions to other units or employees who have
come to help.
5) She shall have a complete list of all patients in the unit immediately and shall
make all patients are accounted for along with their charts and medications.
6) She makes sure that all EXITS are free from any obstructions.
b. Other Departments
1) Radiology/Laboratories
i. Turn of all electrical machinery
ii. Remove patients
iii. Close doors and windows
 2) Linen/Housekeeping
i. Turn off all electrical machinery
ii. Close doors and windows
iii. Assemble blankets, linens and gowns
iv. Remain alert at the telephone for instruction as where to deliver
3) Operating Room
i. Turn off all gases, electrical machineries and closed all tanks with
combustible gases
ii. Close doors and windows
iii. Get ready for first aid or immediate wound care

4) Emergency Room/OPD
i. Turn off all gases, electrical machineries and closed all tanks with
combustible gases.
ii. Close doors and windows
iii. Get ready for first aid or immediate wound care
5) Motorpool
i. Double check if all ambulances are all in running conditions
ii. Double check ambulance equipments
iii. Awaits instruction from a staging officer/transport
6) Dietary
i. Turn off gas and electrical machinery including ventilation fans
ii. Close doors and windows
iii. Report to Command Post for any instructions
7) Engineering Section
i. Turn off air conditioning system and any other equipment with blower fans
ii. Switch off all circuit breakers in the floor where the fire is raging and
those next or above it.
8) Communications (PABX (Switchboard Operators)
i. Upon receiving notice of fire, verify through the engineering personnel, if
positive call fire department with telephone numbers 928-3974, 928-8363
or 117.
ii. Post a very conspicuous place in the switchboard the telephone numbers
of fire and police department
iii. Meralco – 531-1111
iv. Engineering and Maintenance section local number 201 and 208
v. Call police and in-house security services
vi. Notify other key personnel in the Hospital Emergency Plan
vii. Notify dormitory
viii. Call all hospital units
ix. Keep line open in unit where fire is located
x. Seek assistance from the Command Post to assist in transmitting calls.
xi. Sound the alarm code for fire Code 98, if instructed by higher authorities
9) Accounting and Billing Section
i. Turn off gas and electrical machinery including ventilation fans
ii. Close doors and windows
iii. Report to Command Post for any instructions
i. Get all cash together in one receptacle
ii. Get all valuable from safe, gather all ledgers and important books ready
be removed
iii. Gather all accounts receivable cards ready to be removed
iv. Keep track of file containing names and accounts of patients in the
hospital
10) Information Technology Section
i. Backs-up all the hospital transaction records daily
11) Medical Records
i. Evacuate all hospital and patients records accordingly
ii. Backs-up all hospital record accordingly
12) Security
i. Cordon the area.
ii. Assure safe passage of patients thru exits
iii. Prevent loss of personal property thru pilferage and looting.
iv. Coordinate with fire and law enforcement officer as soon as they arrive at
the scene and direct them to the Incident Commander.
 c. Disaster Control Committee
As soon as the Hospital Emergency Plan has been activated to Code Blue, the
Incident Commander (Hospital Director, Deputy Director, HEMS Coordinator, Senior House
Officer) is expected to coordinate the activity in a large as scale.
1) He makes sure that the notice of fire has been relayed to the fire station and
police department.
2) Let other department know as to the progress of the fire so they can prepare to
remove other patients as necessary or can assure patients that the fire has been
controlled.
3) Shall proceed with networking with other hospital if necessary by first informing
the Department of Health-Operation Center of the status of the fire incident.
4) Shall monitor number of casualties and the extent of injury
5) Shall monitor the extent of the fire and water damage.
6) Makes sure that the Command Post is established as well as the Treatment Area,
Triage Area, Staging Area as well.
7) Can direct as to where to send employees to help where they are most needed.
8) Give orders for removal of patients when necessary
9) Maintains coordination with other member of the emergency command
structures and other key hospital personnel.
Hospital Emergency Response Plan
B. System activation and termination
1. Activation and termination of alarm status is designated to the following:
a. Hospital Director
b. Deputy Director
c. HEMS Coordinator
d. Senior House Officer (after office hours)
2. The incident commander is always the hospital director or to his duly designate personnel, on the other hand the officer of
the day or the senior house officer will act on the latter’s behalf after office hours.
3. The incident commander will immediately form his command staff as shown in the organizational structure. The roles and
responsibilities are shown on Annexes p. 91
4. With the declaration of the alert, the plan is activated. Depending on the alert level status, corresponding human resource
and other requirements are mobilized.
5. Under Code Blue, the Hospital Emergency Incident Command System (HEICS) is immediately established using the six-
step response.
a. Step 1 – Assume command. The pre-assigned incident commander must assume command based on the emergency
plan.
b. Step 2 – Assess the situation. Assess magnitude of the incident form sources like the DOH-Operation Center and
other reliable network.
c. Step 3 – Identify critical areas. These include emergency rooms, decontamination, triage, treatment, security, media,
etc.
d. Step 4 – Activate of Identify the Operations Center. Coordinate with DOH-HEMS Operation Center; assign staff and
ensure communication system is in place.
e. Step 5 – Identify the Safety Officer. The Safety Officer is the one to go around the compound to ensure safety of the
staff, the hospital, and the patients.
f. Step 6 – Secure the hospital and critical areas. Identify area for ambulances, points of ingress and egress.
C. Resource mobilization
1. All resource mobilization will be decided by the incident commander upon recommendation by his command staff
a. Purchases of necessary supplies and materials will be decided by the command staff based on priorities.
b. Review of MOA with other agencies
2. Construction of field hospital in case one is needed for patients and staff in the pre-designated area. (Please see Annexes B.
Hospital Map)
a. Tents must be constructed as soonest possible time to prevent delays in providing hospital services.
b. This temporary shelter must be supplied with adequate water and electricity
c. Portable toilets must be closely monitored by sanitary inspector assigned.
D. Partnership through Memorandum of Agreement (MOA)
1. As part of DOH-HEMS network with other government hospital and NGO within the catchment area
a. East Avenue Medical Center
b. National Kidney and Transplant Institute
c. Philippine Heart Center
d. Philippine Children’s Medical Center
e. Philippine National Red Cross, Quezon City Chapter
f. Bureau of Fire, Quezon City
2. Private hospital
3. Medical Societies
4. Drug Store (Mercury Drug, South Star Drug)
5. Medical supplies and equipment distributor
6. Media
IX. Hospital Recovery and Reconstruction Plan
A. Damage assessment and needs analysis
1. Depending of type of calamities, all structures must be check prior to re-occupying the facilities.
2. All damaged structures must be checked by a structural engineer and make necessary recommendation.
3. Damage assessment must be reported to the appropriate authority, estimating the cost of damages to the facilities.
4. All the incurred cost during response must be fully documented indicating the name of patients seen, the services rendered
and the supplies and medications given.
5. Appropriate networking must be fully utilized not only for augmentation purposes but for maximizing the special services
each medical center/hospital has to offer.
B. Provision of services
1. Hospital operation must continue to provide basic medical services.
2. Surveillance of the water and sanitation, food safety, emergent and re-emergent endemic diseases and nutritional status.
C. Psychosocial support and recognition to personnel
1. Psychosocial support must be given to victims of calamity as well as to the medical, nursing and support staff of the
hospital.
2. There must be point person to monitor hospital staff that shows signs of increasing anxiety and take immediate actions.
3. Awarding and recognition rites for responders
4. Provision of overtime compensation for responders.
5. Provision of assistance to hospital personnel who were also affected by the calamity.
6. Re-training of hospital staff on technical and administrative procedures.
D. Restoration of utilized/damaged resources and services
1. Evaluation, clean-up and/or repair of damages to the hospital building/facilities/equipment.
2. Accounting and recording of available materials, medicines, supplies and equipment.
3. Requisitioning and replenishment of utilized materials and logistics
4. Decontamination of areas, ambulance and equipment.
Protocols in response to trauma emergencies outside the
hospital
Protocols in Response to Earthquake Incident
Protocols in the conduct of fire drill
Protocols in Response to Fire Incident
Protocols in the Activation of the Hospital Emergency
Incident Command System (HEICS)
Incident Command System Organization
San Juan Medical
Center Emergency
Plan Summary
Pre-Disaster(Preparedness)
 Assemble SJMC Command Center
 Open communication with CDRRMO
 Stock the ER and OR with supplies and medicines
 Talk to the nearest pharmacies in case of emergency purchases
 Communicate with Tertiary (Level 2 and 3) hospitals for possible transfers
(e.g. Burn Units.)
 Coordinate for possible mortuary services
 Alert personnel for possible disasters
 Prepare ER for triage to be set up outside the hospital (prepare tagging
system)
 Additional ER beds
Medical Triage:
Code Tags and
Triage Terminology
 Triage refers to the evaluation and categorization of the sick or wounded when there are
insufficient resources for medical care of everyone at once. Historically, triage is believed to
have arisen from systems developed for categorization and transport of wounded soldiers on the
battlefield. Triage is used in a number of situations in modern medicine, including:

• In mass casualty situations, triage is used to decide who is most urgently in need of
transportation to a hospital for care (generally, those who have a chance of survival but who
would die without immediate treatment) and whose injuries are less severe and must wait for
medical care.

• Triage is also commonly used in crowded emergency rooms and walk-in clinics to determine
which patients should be seen and treated immediately.

• Triage may be used to prioritize the use of space or equipment, such as operating rooms, in a
crowded medical facility.
WALK-IN
CLINIC/EMERGENCY
Hospital
DEPARTMENT
 Ina walk-in clinic or
emergency department, an
 In a hospital, triage
interview with a triage nurse might prevent an
is a common first step to operation for an
receiving care. He or she elective facelift from
generally takes a brief
medical history of the being performed if
complaint and measures vital there are numerous
signs (heart rate, respiratory emergent cases
rate, temperature, and blood
pressure) in order to identify
requiring use of
seriously ill persons who operating facilities
must receive immediate and surgical nursing
care. staff.
DISASTER/MASS CASUALTY
 In a disaster or mass casualty situation, different systems for triage
have been developed. One system is known as START (Simple Triage
And Rapid Treatment). In START, victims are grouped into four
categories, depending on the urgency of their need for evacuation. If
necessary, START can be implemented by persons without a high level
of training. The categories in START are:

• the deceased, who are beyond help

• the injured who could be helped by immediate transportation
• the injured with less severe injuries whose transport can be delayed
• those with minor injuries not requiring urgent care.
Another system that has been used in mass casualty situations is an example
of advanced triage implemented by nurses or other skilled personnel. This
advanced triage system involves a color-coding scheme using red, yellow,
green, white, and black tags:

 RED TAGS - (immediate) are used to label those who cannot

survive without immediate treatment but who have a chance
of survival.

 YELLOW TAGS - (observation) for those who require

observation (and possible later re-triage). Their condition is
stable for the moment and, they are not in immediate danger
of death. These victims will still need hospital care and would
be treated immediately under normal circumstances.
 GREEN TAGS - (wait) are reserved for the "walking wounded" who will need
medical care at some point, after more critical injuries have been treated.

 WHITE TAGS - (dismiss) are given to those with minor injuries for whom a
doctor's care is not required.

 BLACK TAGS - (expectant) are used for the deceased and for those whose
injuries are so extensive that they will not be able to survive given the care
that is available.
 Personal on stand-by according to
Integrated Code Alert System (DOH)
 Code White: Stand-by team/strong possibility of a
disaster
 First Response Team
 Second Response Team
(ON CALL)
 2 doctors pref. surgeon,
internist, anesthesiologist,
 General Surgeons
etc.  Orthopedic Surgeon
 2 nurses  Anesthesiologists
 First aider/ EMT  Internists
 Driver  O.R Nurses
 EENT
 Infectious Disease
Specialist
Code Blue: 20-50 casualties Red Tagged brought to the hospital
50% operating capacity is down.
 
 ER Doctors
 All Resident Physicians
 Surgical Team on-duty for the day and previous duty
 Administrative officer or designates
 Nursing Supervisor on-duty
 All OR Nurses
 Social Workers
 Dietary Personnel
 CSR Officer
 Entire Security Force
 All Personnel on duty and from duty
Code Red: More than 50
casualities/severe damage to hospital
 All personnel enumerated under Code Blue
 All Nurses
 All institutional workers
 All Administrative Stuff

 (possibility of setting up field hospital with CDRRMC)

Post- Disaster:

 Ensure all documentation properly submitted for public

information.
 Assistance in Management of the Dead and Missing
Person (MDM) through identification of patients.
 Provision of Psychosocial support to victims
 Safety officer will conduct a headcount of the
participants and make sure everyone is accounted for.
 Proper documentation will be done in coordination with
the assigned evaluators.
Summary

 ICS is a standardized management tool designed to allow its users

to adopt an integrated organizational structure flexible enough to
meet the demands of small or large emergency or nonemergency
situations.
 Identification of areas of management weakness resulted in the
development of ICS.
 ICS represents organizational “best practices,” and has become the
standard for emergency management across the country.
 Designers of ICS recognized early that it must be interdisciplinary
and organizationally flexible.
 Applications of ICS have included planned events, natural
disasters, and acts of terrorism.