Disaster Management

Lecturer: Dr. Quebral 1.08

Date: September 7, 2017

OUTLINE
I. Introduction
II. Important Terms and Concepts
III. Disaster Management and NDRRMC
A. Disaster Management
B. National Disaster Response Plan
C. Alert System
IV. Dealing with Disaster
A. Determining Priority for Case Management
B. Basic Colors
C. Mass Casualty Management System
D. HEICS Structure
Figure 1. Frequency and Destructive Power.
V. Mini Quiz
The left side of the chart shows the magnitude of the
OBJECTIVES earthquake and the right side represents the amount of
To discuss the common hazards that lead to disaster high explosive required to produce the energy released by
To define terms related to disaster management the earthquake. The middle of the chart shows the relative
To discuss the process of dealing with disasters frequencies. A 7.2 magnitude would be a major
To discuss the set-up for disaster management earthquake with severe economic impact and would
To discuss triage in relation to disaster management
produce large loss of life
To describe disaster response set-up at UERMMMCI

C. PHIVOLCS Earthquake Intensity Scale

REFERENCE
Dr. Quebrals Lecture
2018 A and B transes
1. Scarcely Perceptible
Guidelines for Health Emergency Management of DOH 2008
Perceptible to people under favorable circumstances.
Delicately balanced objects are disturbed slightly.
Legend: Still Water in containers oscillates slowly.
Remembe
Previous Trans
r Lecturer Book 2. Slightly Felt
Trans Com
(Exams)

Felt by few individuals at rest indoors.
I. INTRODUCTION
Hanging objects swing slightly.
IIn 2004, a study was conducted by Japa International
Still Water in containers oscillates noticeably.
Cooperation Agency in cooperation with MMDA and
PHIVOLCS - Study for Earthquake Impact Reduction for
3. Weak
Metropolitan in the Republic of the Philippines (MMEIRS).
Felt by many people indoors especially in upper floors of
A. Objectives of the Study buildings.
Vibration is felt like one passing of a light truck.
To formulate a master plan for earthquake impact reduction Dizziness and nausea are experienced by some people.
for Metropolitan Manila Hanging objects swing moderately.
To carry out technology transfer to Philippines personnel of Still water in containers oscillates moderately.
MMDA and PHIVOLCS in the course of the study
4. Moderately Strong
B. Summary of the Study
Felt generally by people indoors and by some people
In a 7.2 magnitude earthquake at the West Valley Fault,
outdoors.
Metro Manila would most likely suffer, in terms of: Light sleepers are awakened.
o Residential buildings 40% collapse/damage
Vibration is felt like a passing of heavy truck.
o Deaths 34,000 Hanging objects swing considerably.
o Injuries 114,000 Dinner, plates, glasses, windows and doors rattle.
o Additional deaths from fire 18,000 Floors and walls of wood framed buildings creak.
Standing motor cars may rock slightly.
Liquids in containers are slightly disturbed.
Water in containers oscillate strongly.

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 Rumbling sound may sometimes be heard.
5. Strong
Generally felt by most people indoors and outdoors.
Many sleeping people are awakened.
Some are frightened, some run outdoors.
Strong shaking and rocking felt throughout building.
Hanging objects swing violently.
Dining utensils clatter and clink; some are broken.
Small, light and unstable objects may fall or overturn.
Liquids spill from filled open containers.
Standing vehicles rock noticeably.
Shaking of leaves and twigs of trees are noticeable.
6. Very Strong
Many people are frightened; many run outdoors.
Some people lose their balance.
Motorists feel like driving in flat tires.
Heavy objects or furniture move or may be shifted.
Small church bells may ring.
Wall plaster may crack.
Very old or poorly built houses and man-made
structures are slightly damaged though well-built
structures are not affected.
Limited rock falls and rolling boulders occur in hilly to
mountainous areas and escarpments.
Trees are noticeably shaken.
7. Destructive
Most people are frightened and run outdoors.
People find it difficult to stand in upper floors.
Heavy objects and furniture overturn or topple.
Big church bells may ring.
Old or poorly-built structures suffer considerably
damage.
Some well-built structures are slightly damaged.
Some cracks may appear on dikes, fish ponds, road
surface, or concrete hollow block walls.
Limited liquefaction, lateral spreading and landslides
are observed.
Trees are shaken strongly.
Liquefaction is a process by which loose saturated
sand lose strength during an earthquake and behave
like liquid
8. Very Destructive
People panicky.
People find it difficult to stand even outdoors.
Many well-built buildings are considerably damaged.
Concrete dikes and foundation of bridges are
destroyed by ground settling or toppling.
Railway tracks are bent or broken.
Tombstones may be displaced, twisted or overturned.
Utility posts, towers and monuments mat tilt or topple.
Water and sewer pipes may be bent, twisted or broken.
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Editors: Bibera
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Liquefaction and lateral spreading cause man- made
structure to sink, tilt or topple.
Numerous landslides and rockfalls occur in
mountainous and hilly areas.
Boulders are thrown out from their positions particularly
near the epicenter.
Fissures and faults rapture may be observed.
Trees are violently shaken.
Water splash or stop over dikes or banks of rivers.
9. Devastating
People are forcibly thrown to ground.
Many cry and shake with fear.
Most buildings are totally damaged.
Bridges and elevated concrete structures are toppled
or destroyed.
Numerous utility posts, towers and monument are
tilted, toppled or broken.
Water sewer pipes are bent, twisted or broken.
Landslides and liquefaction with lateral spreadings and
sandboils are widespread.
Ground is distorted into undulations.
Trees are shaken very violently with some toppled or
broken. Boulders are commonly thrown out.
River water splashes violently on slops over dikes and
banks.
10. Completely Devastating
Practically all man-made structures are destroyed.
Massive landslides and liquefaction, large scale
subsidence and uplifting of land forms and many
ground fissures are observed.
Changes in river courses and destructive seiches in
large lakes occur.
Many trees are toppled, broken and uprooted.
II. IMPORTANT TERMS AND CONCEPTS
A. Important Terms
11. Health Hazard
Any potential threat to public safety and/or public
health; any substance, phenomenon, event that has
the potential to cause disruption / damage in a
community
Types of Hazards:
o Natural - geophysical, hydrometerological
Example: fault lines that may cause
earthquakes and landslides
o Technological
Examples: Fukushima and Chernobyl
nuclear accidents
o Biological
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 Examples: SARDS, MERS-CoV, Ebola III. DISASTER MANAGEMENT AND THE NDRRMC
o Societal
Ultra Stampede, Mendiola Massacre, A. Disaster Management
conflicts in Mindanao Disaster management is a discipline and a
continuous process.
12. Emergency For it to be successful, it has to have integration at
Actual threat to public safety and/or public health the different levels of society, from national to local
and institutional.
A collaborative effort between the governemnt and
13. Disaster
the private sector.
A civil emergency in which humanitarian needs are
beyond local capacity to meet; a serious disruption of 1. Prevention
the functioning of a society, causing widespread
Avoiding a disaster at the 11th hour
human, material or environmental losses which Includes activities which actually eliminate or reduce
exceed the ability of the affected society to cope
the probability of unavoidable disasters
using only its own resources.
2. Mitigation
14. Risk
Any activity that reduces either the chance of a
Potential consequences of a hazard interacting with a hazard taking place or a hazard turning into disaster
community: It includes building codes; zoning and land use
Hazards can cause the following: management; regulation and safety codes;
o Death preventive health care; and public education.
o Injury Risk Reduction- anticipatory measures & actions
o Disease that seek to avoid future risks as a result of a
o Secondary Hazards disaster.
o Contamination To lessen impact, almost the same as mitigation
o Displacement Dont use candles to prevent fire (Payatas),
o Breakdown insecurity dont build near fault lines, put in
o Damage to infrastructure countermeasures for a possible earthquake,
o Breakdown in essential services
build flood gates
o Loss of property
o Loss of income
3. Preparedness
15. Vulnerability Plans to save lives or property and help the response
and rescue service operations
Factors which determine the type and severity of the
Covers implementation/operation, early warning
consequences (or risks)
systems and capacity building so the population will
react appropriately when an early warning is issued.
16. Capacity eg. training of people on what to do during an
Ability to manage the determinants of risks or risk emergency, forming disaster brigades, having
modifiers of an emergency; combination of available necessary equipment (sprinklers, smoke
strengths and resources. detectors)

17. Community 4. Response

People What you actually do during the disaster
Environment Includes actions taken to save lives, prevent damage
Properties to property and to preserve the environment during
Services emergencies or disasters
Livelihood Implementation of action plans

B. Important Concepts 5. Rehabilitation and Recovery

The most important are the first two (prevention and
Risk = Hazard X Vulnerability / Capacity mitigation, and preparedness), how well you are

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 prepared for the emergency. What measures the (Nuclear
community did to lessen the risk. Hazard)

B. National Disaster Response Plan C. Alert System

National Disaster Risk Reduction & Management To prepare for these eventualities, DOH has
Council (NDRRMC) (formerly the NDCC or National mandated a response (CODE SYSTEM: code white
Disaster Coordinating Council via the RA 10121) is code blue code red), which will help prevent the
the government agency tasked to create the National injured individuals from dying.
Disaster Response Plan
o It is under Department of National Defense 1. Code White
(DND) thus the secretary of DND serves as the
Conditions for adopting this code:
chairperson of NDRRMC. Lowest level, all health personnel on duty should
o The members are the secretaries of DOH,
stand by and prepare for patient surge.
DENR, DILG (MMDA is under DILG), Several Strong possibility of a military operation e.g.
branches of government work hand-in-hand as coup attempt/armed conflict which has a national
members of the NDRRMC like the DOH, DOST, implication.
DND, DENR, DOT, CHED, etc. Any planned mass action or demonstration
o There must be a disaster risk reduction council which has national implication
at the regional, provincial, city, municipal, and Forecast typhoons (Signal no. 2 and up)
until the barangay level as mandated by the local National or local elections and other political
government code. This includes the formation of exercises
disaster brigades and evacuation areas. National events, holidays or celebrations with
potential for MCI
Table 1. Types of Disasters considered in the NDRP Notification of reliable information of
Part No. Type of Disaster Reference terrorists/attack activities
I Hydro- Target Hazards: Any other hazard that may result in emergency
Meteorological Floods, Typhoons, Unconfirmed report of reemerging diseases e.g.
Hazards Storm Surges, bird flu, SARS
Tornadoes, Landslides In code white, DOH hospitals will already activate the
due to heavy rain emergency systems. The whole system promotes the
II Seismic Hazards Target Hazards use of incident command system and operation
Earthquake, centers.
Landslides due to
earthquake 2. Code Blue
III Tsunami Hazards To be prepared Any conditions mentioned in Code White plus any of
IV Volcanic Hazards To be prepared the two below:
V Epidemic Outbreak To be prepared based Code blue you, have to activate the incident
(Pandemic) on 4 day Pandemic command system already.
Exercise by USAID Health personnel who are not on duty are ask to
Others Fire, Maritime, Shall be consistent go back to the hospital.
Transportation with The National Mobilization of DOH resources is needed
Crisis Management (manpower, materials, etc)
Pollution Cora Manual 30-50% of the health facilities in the area are
Hazards affected or damaged
Civil No capability of the LGU and/or lack or
Disturbance resources of the region to respond to the
and Armed affected area
Conflict Magnitude of disaster based on geographic
Drought and coverage and number of affected population is
Pest more than 30%
Infestation Any mass casualty incident with 50-100
Hazards casualties (mortalities plus injuries) irrespective
Others of color code.

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 High case fatality rate for epidemic or
confirmed/documented report of reemerging
diseases e.g. bird flu, SARS
In code blue, deployment of ambulance with medical
team (such as surgeons, etc.) to the affected area or
site.
3. Code Red
Any natural, man-made, technological or societal
disaster where all of the following are present:
Declaration of disaster in the affected area
100 or more casualties in the area
Health personnel in the region not capable of
handling entire operation
Mobilization of health sector needed
Mobilization of key offices of DOH
Uncontrolled human to human transmission of
SARS/avian flu in any region
IV. DEALING WITH DISASTER
A. Determining Priority for Case Management
During a disaster, patient is classified and this is
based on the severity of the injury and need of
Emergency Medical Service and evacuation.
Figure 2. Color Tags for Prioritization of Care
1. Priority for In-Hospital Care (from Guidelines for
Health Emergency Management of DOH 2008)
RED Immediate: Priority One (Life-threatening
Conditions)
o The condition is life-threatening and the patient
requires immediate attention and transport.
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Editors: Bibera
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o The following conditions should be present for a
Mass Casualty Incident (MCI) victim to be
classified Priority One:
Obstruction or damage to airway
Disturbance of breathing respiration
above 30/min
Disturbance in circulation capillary refill
greater than 2 seconds or carotid pulse
weak, irregular or absent, radial pulse
absent
Does not follow commands or altered level
of consciousness
Need for life saving measures (BLS and
ATLS) and urgent hospital admission
Victims whose injuries demand definitive
treatment in the hospital but which
treatment may be delayed without
prejudice to ultimate recovery
YELLOW - Urgent: Priority Two
o Patient has passed primary survey, but with
major system injury, may delay transport to one
hour.
o Any one of the following conditions could place
a victim into a Priority Two category:
Needs to be treated within one hour;
otherwise they will become unstable
Severe burns; burns involving hands, feet
or face (not including the respiratory tract);
burns complicated by major soft tissue
trauma
Hospital admissions is required
Moderate blood loss; back injuries with a
normal level of consciousness
GREEN Delayed: Priority Three
o 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.
o The following injuries are examples:
Minor injuries not threatened by airway,
breathing and circulatory instability.
Minor fractures, minor soft tissue injuries,
minor burns
May or may not be admitted.
BLUE Near Dead: Priority Four
o Victims who are clinically dead. Those tagged
blue in the field are to be returned for re-triaging
when time and physical conditions of area
allow, e.g., collapsed structure, etc.
BLACK and WHITE Dead: Last Priority
o Patient is dead.
o Those who die while awaiting treatment, and
those in cardiac arrest following trauma.
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 o For Moslem communities, white tag will be used 1. Triage
for dead Moslems. It is the process of sorting victims that need
immediate transport to a health facility for immediate
B. Basic Colors care.
Two sites for triage:
On site or on scene where the disaster
happened and the colored tagging is for priority
of evacuation
ER the tagging is for prioritizing the ones with
Table 3. Color Tags in Disaster Management.
life threatening condition
Color tag Priority Response The aim is to quickly identify victims needing
Red 1st priority cases Transfer as soon as
immediate stabilization or transport, and the level of
possible to tertiary
care needed, by assessing ABCs (airway, breathing,
facilities in an equipped
and circulation).
ambulance with medical The basis for classification includes; urgency,
escort survival, care resource availability and capability.
Yellow 2nd priority cases After evacuation of Red, Not a first come first serve basis
Without life threatening Beside the triage area is the holding area, where
problem those that need to be evacuated are brought to
Green 3rd priority cases walking wounded to for secondary evacuation.
admitting section / OPD This system may seem heartless, but it is used to
Blue 4th priority cases To be returned for re- ensure that those that need the most urgent care are
triage given the ample resources to survive. Not everyone
Black / white Last priority cases To morgue, forensic will be able to get equal treatment, but that is
services, public health what is needed when a disaster strikes.
and psychosocial
interventions to relatives
/ kin

C. Mass Casualty Management System

In an event of a mass casualty incident, a hospital
will establish a triage where they will assess the
victims and then segregate them into basic three
classifications:
Red the fatally injured, immediately brought to
the operating theatre.
Yellow injured requiring treatment.
Green the walking injured, can survive without
treatment.

Figure 4. Algorithm of Prioritization of Care.

(2018A) Patients are sorted out in the triage area.

They are classified into red, yellow and green. Those
tagged red require immediate/emergency care.
Those tagged yellow require urgent care. Those
tagged green require least medical attention. The red
victims have life threatening injuries. The yellow
victims have severe injuries but not life-threatening
Figure 3. Establishing a mass casualty management but require medical attention. If the yellow victims are
system not attended within an hour, they will deteriorate and
they would die. There is another holding area to

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 those who will be evacuated. Some of them are
managed onsite or some need to be evacuated.
D. Basic Hospital Emergency Incident Command
System (HEICS) Structure
The incident command system is headed by the
Incident Commander, which is usually the medical
director or the chief of the hospital.
NDRRMC and DOH uses this
Other positions in the HEICS under the Incident
Commander includes:
Public Information Officer provides the
essential official information to the media
Liaison Officer connects to external agencies
in response efforts
Security Officer identifies potential threats
and takes steps to ensure continued safety of
the facility, its employees, and patients.
The HEICS structure is composed of mainly four key
groups:
Operations (where we as the medical group
falls under) organizes and directs essential
activities from the Command Center and
facilitate proper hospital staffing.
Logistics directs maintenance and supply
operations to ensure patient care, supplies,
equipment, and utilities for essential hospital
functions.
Planning Develops action plan for operations
sustainment after the disaster incident.
Administrative and Finance tracks
expenditures for repayments and special
purchases.
Why use the HEICS?
So that all structures between hospitals are
uniform. When hospitals need to combine their
resources, there is a universal language that
enables them to work regardless of diverse
situations.
Figure 5. Basic Hospital Emergency Incident Command
System (HEICS) Structure
V. MINI QUIZ
1. From a disaster management perspective, a situation
becomes an emergency when:
a. More than 50 people are injured or killed.
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Editors: Bibera
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b. It has the potential to disrupt community life.
c. There is an actual threat to the public safety or
health.
d. A certain disease has a high mortality.
2. A passenger bus crashed into a chapel resulting in
100 people injured and 25 more killed. The chapel
caught fire after the crash and some other people
were trapped inside. The twon has a 12-bed
secondary hospital manned by a doctor, 2 nurses, an
aide, a medical technologist, an X-ray technician, a
pharmacist, and a janitor. There are two other
doctors in town. The nearest fire station is in the next
town 75 km away. This is a/an:
a. Emergency
b. Man-made hazard
c. Disaster
d. Major accident
3. In the above case (2), if you were the physician on
duty, how would you deal with the situation:
a. Go to the crash site with a nurse and treat the
patients there.
b. Triage the victims as they arrive in the hospital.
c. Treat the victims on a first-come-first-served
basis.
d. Treat only the first 12 victims and send the rest
to the next town.
4. HIV cultures kept in a laboratory for medical research
is an example of what type of hazard
a. Natural
b. Societal
c. Technological
d. Biological
5. Which of the following statements is correct:
a. The presence of the Dario River behind UERM
Memorial Hospital does not affect its
vulnerability to flooding.
b. Retrofitting a building decreases the risk of
damage from a fire.
c. Having regular drills decreases the risk of injury
and death in case of an earthquake.
d. Storing pain, thinner, paper and linen in one
storeroom decreases the fire hazard.
6. People are coming in droves and forcing their way
into the venue (with a limited seating capacity) of a
variety show that offers a lot of cash and other prizes
to its audience may pose what type of risk?
a. Secondary hazards
b. Injury
c. Damage to infrastructure
d. All of the above
7. Which of the following is a measure for increasing
preparedness against fire:
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 a. Installation of fire detection and alarm system a. Green
b. Use of fire retardant materials during b. Yellow
construction c. Red
c. Installation of fire-rated doors in strategic places d. Black
d. Not storing flammable materials in the premises

8. Training a team in firefighting and equipping them Answers:

with the proper personal protective and firefighting 1. C - Emergency: Actual threat to public safety and/or
equipment is a form of: health
a. Prevention
b. Mitigation 2. C Disaster: A civil emergency in which
c. Preparedness
humanitarian needs are beyond local capacity to
d. Response
meet
9. Restoring health services, facilities, and systems is
part of:
a. Recovery and reconstruction 3. B In an event of a mass casualty incident, a
b. Response hospital will establish a triage where they will assess
c. Preparedness the victims and then segregate them.
d. Mitigation
4. D
10. In the incident command system, the medical team is
directly under the:
a. Incident commander 5. C
b. Operations chief
c. Logistics chief A increased vulnerability
d. Ancillary services director B not always true
C well trained disaster response team higher
11. In an emergency scenario, the bases for prioritizing capacity lower risk
the casualties include: D decreased vulnerability
a. Time of arrival, extent of injury, availability of
care resources 6. B
b. Urgency of care needed, survival probability,
availability and capability of care resources 7. A
c. Order of arrival, urgency of care needed, extent
of injury Preparedness e.g. training people on what to do
d. Time and order of arrival, availability and during an emergency, forming disaster brigades,
capability of care resources having necessary equipment (sprinklers, smoke
detectors)
12. It is the process of sorting victims needing immediate
care in a mass casualty situation:
8. C (see above)
a. Screening
b. Patient selection
9. A
c. Triage
d. Prioritization
A synonymous to restoration
13. The aim of sorting victims needing immediate care is B- what you actually do during emergency
to: C - preparedness
a. Quickly identify victims needing immediate D prevention and countermeasures
stabilization and the level of care needed
b. Conserve limited medical resources 10. B
c. Avoid medicolegal problems
d. Optimize available healthcare providers 11. B

14. A man in his 20s is brought to first aid station after a In triage, the basis for classification includes urgency,
violent station after a violent dispersal of a rally survival, care resource availability and capability
unconscious and unresponsive. This victim is
classified as 12. C
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13. A

In triage, the aim is to quickly identify victims needing

immediate stabilization or transport, and the level of
care needed, by assessing airway, breathing and
circulation

14. C

Red respiration aboe 30/min, altered level of

consciousness

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