Hospitals Should Be Safe From Disasters PDF

Safe Hospitals in Emergencies and
Disasters: Philippine Indicators

Protect hospitals and health facilities
in emergencies and disasters
Second edition
Editors
Dr Carmencita A. Banatin
Dr Marilyn V. Go
Arch Ma. Rebecca M. Peňafiel
Dr Romeo A. Bituin
DRAFT
Health Emergency Management Staff Emergency and Humanitarian Action

Department of Health World Health Organization
Manila Philippines Regional Office for the Western Pacific
Manila Philippines
Safe Hospitals in Emergencies and Disasters: Philippine Indicators 1

Copyright © Department of Health, Republic of the Philippines, 2009
This document is issued by the Health Emergency Management Staff,

Department of Health, Republic of the Philippines, for general distribution. All
rights are reserved. Subject due to acknowledgement of DOH-HEMS, all the
articles in this manual may be freely reviewed, abstracted, reproduced or
translated, in part or in whole, for non-commercial purposes only. If the
entire work or substantial portions will be translated or reproduced,
permission should be requested from the Department of Health-Health
Emergency Management Staff.
Project supported by the European Commission

through its Humanitarian Aid department
http://ec.europa.eu/echo/index_en.htm

Contents
Foreword 5
Francisco T. Duque III
Secretary of Health, Republic of the Philippines
Preface 6
Acknowledgements 7
Technical Working Committee on Safe Hospitals 8
Section I. Introduction
Introduction 10
Safe Hospital 11
Section II. Philippine Indicators
Structural Indicators of Safe Hospitals 12
Non-structural Indicators of Safe Hospitals 16
Functional Indicators of Safe Hospitals 26
Additional Non-structural Indicators for Hospitals with 31

Special Functions
Additional Functional Indicators for Highly Infectious Diseases 34
Section III. National Codes, Policies and Guidelines
The National Building Code of the Philippines (PD 1096) 39

The National Structural Code of the Philippines (5th ed, 2001) 39
Philippine Electrical Code 40
Fire Code of the Philippines (PD 1185) 40
Republic Act 8495 - Philippine Mechanical Code 41
Republic Act 344 - Accessibility Law 41
Republic Act 9275 - Philippine Clean Water Act of 2004 41
Republic Act 9003 - Ecological Solid Waste Management 41
Act of 2000
Administrative Order No. 2008 - 0021 – Gradual Phase-out of Mercury 42
in all Philippine Health Care Facilities and Institutions

Foreword
Every year, many hospitals and health facilities in the country are damaged and destroyed by
disasters to which the Philippines has a very high vulnerability. However, the government
through the Department of Health has been non-stop in its efforts to ensure that our
countrymen are not left without the vital care that they need in the midst of these
catastrophes.
“The price to pay for the failure of health care facilities when disasters happen is too high in
comparison to the cost of making these safe and resilient." Recent disaster experiences in the
Bicol and Visayas regions and in earlier years in the Quezon Province highlight the
tremendous impact that disasters can have on health facilities and local health systems.
The health sector is filled with highly trained, committed, and dedicated personnel who are
ready to deliver healthcare especially in times of great suffering and need. To achieve and
maintain quality of health care during health emergencies, these personnel will have to be
supported by enabling them to work in safe health facilities where they can do what they do
best --- save lives and limit injuries among disaster victims.
Among the objectives of the global campaign for "Hospitals Safe from Disasters" is to
reinforce both the structural and non-structural resilience of health care facilities and to
ensure that they continue to function after a disaster strikes. The first points to structures in
safe geographical locations; while the latter refers to health personnel and emergency
preparedness plans which will keep hospitals operational in the wake of disasters.
By applying current knowledge and exercising strong political leadership, it is possible to

protect health facilities from disasters, even in resource-constrained settings like the
Philippines. The Hyogo Framework for Action calls for government support to ensure that
existing and new health care facilities will be re-structured or engineered to remain functional
at the height of an emergency.
Therefore, I commend the Steering Committee and Technical Working Groups who
painstakingly labored in consolidating indicators into this manual that will guide all Hospital
Administrators in the pursuit of one vision - to make every hospital safe from disaster and
accessible at all times for all disaster victims. Likewise, this Manual signifies the continuing
partnership between the Department of Health, World Health Organization, and other
members of the health sector in making our health system strong, reliable and resilient for the
Filipino people.
FRANCISCO T. DUQUE III, MD, Msc.

Secretary of Health

Preface
This Manual emanated from a research concept by the Department of Health-Health

Emergency Management Staff (DOH-HEMS) to assess hospitals’ structural, non-structural
and functional elements in times of emergencies and disasters. This eventually became a
project entitled, Capacity Assessment of Metro Manila Tertiary Hospitals in Responding to
Emergencies and Disasters," which was funded by the Health Policy Development and
Planning Bureau (HPDPB), coursed to the National Capital Region, and started in October
2008. An Assessment Team was organized to oversee the implementation of the research
project in 25 hospitals in the National Capital Region.
Meanwhile, the Department Personnel Order 0254 series of 2008 mandated the Steering
Committee to provide assistance and technical guidance to the different Technical Working
Groups which determined, defined, and finalized the structural, non-structural, and functional
indicators through a series of write-shops and critiquing sessions. This body came up with a
Manual on Safe Hospitals' Indicators which was supported by the National Center for Health
Facility Development (DOH-NCHFD), the Association of Hospital Administrators and the
World Health Organization - Western Pacific Regional Office (WHO-WPRO).
After the research implementation, the sets of indicators found on the Manual were revisited
and revised through several write-shops with the Technical Working Groups. The output of
which is this second edition. In this new version, the structural, non-structural and functional
indicators which were deemed important and most applicable to the country setting were
retained, while the others were either revised or removed. National codes, policies and
guidelines are also included in this new version as additional resource materials for the
readers and users.
This Manual neither provides nor claims to be the definite and only guide to follow in ensuring
safety in health facilities. Readers are encouraged to other complementary references and
documents. The contributors recognize that this Manual is an evolving reference and may
need to be adapted to different contexts considering that some indicators may not be
necessary, appropriate nor tailored to some hospitals or health facilities.
Health Emergency Management Staff

Department of Health

Acknowledgements
The revision for this second edition of the Philippine Indicators for Safe Hospitals in
Emergencies and Disasters was done through the efforts of the “Assessment Team”
composed of the following individuals: Dr Joseph Bacareza; Dr Jose Edgar Balita; Engr Aida
Barcelona; Dr Romeo Bituin; Ms Josefina Blanco, RN; Arch Allen Buenaventura; Dr
Emmanuel Bueno; Engr Israel Camposano; Mr Elmer Benedict Collong, RMT; Arch Leonard
Cordero; Dr Ma. Paz Corrales; Arch Corazon Cruz; Ms Aida Cuadra, RN; Arch Ferdinand
dela Paz; Dr Alex Dimapilis; Mr Philip Du; Engr Marilyn Ebuen; Arch Christopher Espina; Dr
Jasminda Espiritu; Ms Ma. Belinda Evangelista, RN; Ms Jacinta Garcia; Mr Manny Guevarra,
RN; Engr Eric Gutierrez; Dr Rodrigo Hao; Dr Joseph Juico; Dr Cesar Brence Labastida; Mr
Gerardo Lirag, RN; Engr Jesus Lorenzo; Arch Prosperidad Luis; Engr Nilo Marayag; Dr
Rommel Menguito; Dr Joseph Nocom; Dr Antoinette Pacapac; Ms Celia Pangan, RN; Engr
Jennifer Quintero; Dr Mary Grace Reyes; Dr Myrna Rivera; Dr Epifania Simbul; Dr Alexis Uy;
Mr Willy Veloria, RN;and Engr Vivian Young.
Grateful appreciation also goes to Dr Noel Juban and Prof Nina Carandang for their technical
expertise in conducting the research project; Dr Asuncion Anden and Dr Irma Asuncion for
overseeing the management of the project in the National Capital Region; and Arch Ma.
Rebecca Peñafiel and Dr Nathaniel Carl Tan for their technical inputs to the project.
Acknowledgement is also given to DOH-HEMS administrative staff, especially, Florinda

Panlilio and Glenda Ensigne for the administrative support; Zando Escultura for the cover
design; and Sheila Bonito and Charmeih Pagulayan for the copy editing.
The completion of this Manual is also due to the support of the Emergency and Humanitarian
Action of the World Health Organization - Western Pacific Region through the technical
supervision of Dr Arturo Pesigan, technical assistance of Dr Lester Sam Geroy and
administrative support of Ms Glessie Salajogg. This project was supported by the European
Commission through its Humanitarian Aid department.
Health Emergency Management Staff

Department of Health

Technical Working Committee on Safe Hospitals
Advisers
Dr Mario Villaverde Undersecretary of Health, Department of Health (DOH)
Dr Soe Nyunt-U WHO – Representative to the Philippines
Dr Arturo Pesigan WHO – Western Pacific Regional Office,

Emergency and Humanitarian Action
Steering Committee
Dr Mario Villaverde DOH Policy and Standard Development Team for Service
Delivery (PSDTSD)
Dr Carmencita Banatin DOH – Health Emergency Management Staff (DOH-HEMS)
Dr Criselda Abesamis DOH – National Center for Health Facility Development

(DOH-NCHFD)
Dr Ma. Alicia Lim DOH – Bureau of Health Facilities and Services (DOH-BHFS)
Atty Nicolas Lutero III Jose Reyes Memorial Medical Center
Dr Rosalinda Arandia Quirino Memorial Medical Center
Dr Bernardino Vicente National Center for Mental Health
Dr Shirley Domingo Philippine Health Insurance Corporation (PHIC)
Technical Working Group for Structural Indicators
Arch Ma. Rebecca Peñafiel DOH – NCHFD
Engr Maximo Adan DOH – NCHFD
Arch Christopher Espina UP College of Architecture
Arch Corazon Cruz UST College of Architecture
Engr Fernando Germar UP College of Engineering
Engr Michael Abundo UP College of Engineering
Engr Peter Lim UST College of Engineering
Engr Ricardo Balog UST College of Engineering
Engr. Ronaldo Ison Association of Structural Engineers of the Philippines
Engr Anthony Pimentel Association of Structural Engineers of the Philippines
Engr Jorge Genota Association of Structural Engineers of the Philippines
Arch Herminio Prudente United Architects of the Philippines

Technical Working Group for Non-structural and Functional Indicators
Dr Roland Cortez East Avenue Medical Center
Dr Marilyn Go DOH-HEMS
Dr Arturo Cabanban San Lazaro Hospital
Dr Arnel Rivera DOH-HEMS
Dr Romeo Bituin Dr. Jose Fabella Memorial Hospital
Dr Edmundo B. Lopez Las Piñas General Hospital and Satellite Trauma Center
Dr Joseph Bacareza Bureau of Fire Protection
Arch Prosperidad Luis United Architects of the Philippines
Engr Carlos Bariring DOH-NCHFD
Engr Abraham Castanaga DOH-NCHFD
Engr Ramon Alfonso Tondo Medical Center
Dr Ma. Theresa Vera DOH-BHFS
Engr Bayani San Juan DOH – Bureau of Health Devices and Technology
Engr William Juan Institute of Integrated Electrical Engineers
Technical Working Group for Advocacy
Ms Angelina Sebial DOH – National Center for Health Promotion
Dr Victor dela Cruz Tondo Medical Center
Dr Ricardo DG Lustre Amang Rodriguez Medical Center
Dr Ruben Flores Dr. Jose Fabella Memorial Hospital
Dr Edgardo Javillonar Dr. Jose N. Rodriguez Memorial Hospital
Dr Mario Panay Valenzuela Medical Center
Dr Isabelita Estrella San Lorenzo Ruiz Women’s Hospital
Dr Robert Enriquez National Children’s Hospital
Dr Teodoro Castro Philippine Orthopedic Center

SECTION I
Introduction
Hospitals and other health facilities should be a source of strength during emergencies and
disasters. They should be ready to save lives and to continue providing essential health
services such as laboratories, medicines, treatment and rehabilitation. They should also be
the symbol of hope during these critical times and contribute to the community’s sense of
security and well-being. However, there are circumstances where hospitals and health
facilities are made vulnerable, especially during an emergency or disaster. The hospitals or
health facilities may be damaged or destroyed; or their capacities stretched to the limit by the
surge in number of patients seeking health services and support.
The Hyogo Framework for Action in 2005 emphasizes the importance of "making hospitals
safe from disasters by ensuring that all new hospitals are built with a level of resilience that
strengthens their capacity to remain functional in disaster situations and implement mitigation
measures to reinforce existing health facilities, particularly those providing primary health
care.” The roles of hospitals and health facilities in emergencies and disasters cannot be
underestimated.
The World Health Organization, in support of the World Disaster Reduction Campaign on
Hospitals Safe from Disasters (2008-2009) aims to raise awareness in making hospitals safe
in emergencies and from disasters:
 Protect the lives of patients and health workers by ensuring the structural
resilience of health facilities
 Ensure that health facilities and health services are able to function in the
aftermath of emergencies and disasters, when they are most needed
 Improve the emergency management capacity of health workers and institutions
This Manual defines what a safe hospital is during an emergency or disaster. It also
describes the essentials in supporting safe hospitals. It also lists the structural and non-
structural indicators as well as functional indicators which every hospital and health facilities
should consider as standards to be achieved.
This manual, “Safe Hospitals in Emergencies and Disasters: Philippine Indicators” is a guide
to help assess the vulnerability and resilience of hospitals and health facilities to ensure
patient safety and staff security, and guarantee continuous operations in times of
emergencies and disasters. This manual is intended for people who recognizes the important
role of hospitals and health care facilities during emergencies and disasters. These people
include: hospital administrators, health emergency management staff, and health
professionals.
The sets of indicators listed in this manual were arrived at, after a comprehensive review of
existing codes and guidelines which are related to structures, non-structural elements and
functions of hospitals and health facilities. This manual neither provides nor claims to be the
definite and only guide to follow in ensuring safety in health facilities. This is a work in
progress and subsequent revisions will be made accordingly to ensure that hospitals and
health facilities are safe in emergencies.

Safe Hospital
Safe hospitals are health facilities whose services remain accessible and functioning, at
maximum capacity and within the same infrastructure, during and immediately following
disasters, emergencies or crises.
A safe hospital . . .
…will not collapse in disasters, killing patients and staff
…will be able to continue to function and provide critical services in emergencies
…will be organized, with contingency plans in place and health personnel trained to keep
the network operational
Supporting safe hospitals involves knowledge of the many factors that contribute to their
vulnerability, which includes:
 Buildings: The location and design specifications and the resiliency of the materials
used contribute to the ability of hospitals to withstand adverse natural events.
 Patients: A disaster will inevitably increase the number of potential patients.
 Hospital beds: In the aftermath of a disaster, the availability of hospital beds

frequently decreases even as the demand for emergency care increases.
 Medical and support staff: The loss or unavailability of personnel disrupts the care of
the injured; hiring outside personnel to sustain the response capacity adds to the
overall economic burden.
 Equipment and facilities: Damage to non-structural elements can sometimes surpass

the cost of the structure itself. Even when the damage is less costly, it can still force
the hospital to halt operations.
 Basic lifelines and services: A hospital’s ability to function relies on lifelines and other
basic services such as electrical power, water and sanitation, and waste treatment
and disposal. When some services are affected, the performance of the entire
hospital suffers.
Supporting safe hospitals entails vision and commitment to ensure that they are fully
functional especially in times of emergencies and disasters. There should be involvement of
various sectors such as: planning, finance, public services, architecture and engineering.
Protecting health facilities includes:

 Ensuring risk reduction in the design and construction of all new health facilities
 Improving the non-structural and functional vulnerability of existing health facilities
 Adopting legislative and financial measures to select and retrofit the most critical
facilities to increase levels of protection

SECTION II
Structural Indicators of Safe Hospitals
The structural elements of health facilities, such as foundations, columns, beams, slabs, load-
bearing walls, braces, and trusses, are essential elements that determine the overall safety of
the building. The following is a list of structural indicators for safe hospitals in the Philippines
based on the (1) National Structural Code of the Philippines (NSCP) Revised 2001
Guidelines, (2) National Building Code Revised 2006 Guidelines and (3) Association of
Structural Engineers of the Philippines (ASEP) Recommended Guidelines on Structural
Design Peer Review of Structures. This can be used as a checklist to identify strengths and
vulnerabilities when planning for new construction or reviewing existing hospital or health
facility.
Instruction:
Encircle the thumbs-up sign (means Yes or complies completely with what is asked for) and thumbs-
down sign (means No or may not comply completely with what is asked for) when assessing the
hospital or health facility according to the following indicators. Use the Remarks column to write
essential observations when doing the assessment, especially when the result is No..
1. Buildings must be located in highly

suitable sites and away from areas
that will diminish its accessibility and Remarks
threaten its operations in times of
emergencies.
1.1 Not at the edge of a slope
 
1.2 Not close to a seismic fault line:
1.2.1 High Risk (Zone 1): 5kms
and nearer to the fault line
1.2.2 Medium Risk (Zone 2): over
5kms-10kms to the fault line
 
1.2.3 Low Risk (Zone 3) : over
10kms -15kms to the fault line
1.3 Not near the foot of a mountain
 
1.4 Near bodies of water (creeks, rivers,
sea) provided with water barrier (i.e.
rip-rap, dikes, other forms)
 
1.5 Not on a reclaimed site
 
1.6 Not in flood-prone areas
 
1.7 Not within typhoon zone:
1.7.1 High Risk: 250kph
1.7.2 Medium Risk: 200kph  
1.7.3 Low Risk: 175kph
1.8 Not near active volcano
 
References:
 Risk Maps and Hazard Scoring from the Center for Environmental Geomatics of the Manila
Observatory. Available online at http://www.observatory .ph
 Valley Fault Systems and Distribution of Active Faults and Trenches of the Philippines,
Philippine Institute of Volcanology and Seismology (PHIVOLCS)
2. The design of the hospital structural
system must strictly conform with the
requirements of the National
Structural Code of the Philippines
(NSCP, 2001); especially for wind and
earthquake design (per structural
computations).
2.1 Foundation
 
2.2 Columns
 
2.3 Beams
2.3.1 Underside of arches,
balconies or overhangs free
from structural cracks and  
falling cement plasters
2.3.1 Other fixtures such as
ceiling liner are properly
fastened or attached
 
2.4 Floor and Roof Slabs – Soffit or the
underside of floor slab has no cracks
and leaks
 
2.5 Trusses
 
2.6 Walls and Partitions
 
2.7 Shear Walls
 
2.8 Roof System:
2.8.1 Roofing completely and
securely fastened, welded,
riveted, or cemented
 
2.8.2 Considered roof cover and
insulation materials, slope,
type of connection,
condition, thickness at least
 
gauge 24 or 26
2.8.3 Considered regional
location, e.g. in Bicol areas it
should be heavily fastened  
or anchored
3. The shape and form of the hospital

building must be simple and regular.
3.1 Hospital has simple shape and is
symmetrical in both the lateral and
longitudinal axes (e.g. square or
rectangle) making it resilient when  
subjected to stress such as that
produced by an earthquake
3.2 Number of building floors (storeys)
less than five floors  

3.3 Building form (Elevations)
3.3.1 Not top heavy

 
3.3.2 No cantilevers
 
3.3.3 Balanced massing
 
3.3.4 Balanced loading
 
4. The hospital structural system must
be continually checked and reviewed
during construction and the entire
period of occupancy. Structural
design of building constructed before
2001 should have undergone any of
the following:
4.1 Peer review using Association of
Structural Engineers of the
Philippines (ASEP) guidelines
 
4.2 Rapid evaluation using DPWH
Guidelines  
4.3 Structural certification by qualified
structural engineer  
5. Cracks on the hospital structural
system must be immediately
investigated and addressed especially
if they appear after an earthquake.
Major structural cracks or visible
damages does not appear on any of
the following structural members:
5.1 Foundation (Investigate for any
settlement, tilting of building)  
5.2 Columns (Investigate end and
midpoint columns)  
5.3 Beams (Investigate end support and
mid-span)  
5.4 Floor slabs
 
5.5 Trusses (Investigate sagging,
movement, corrosion, rotting)  
5.6 Walls and partitions
 
5.7 Shear Walls
 

6. As-Built/As Found Plans of all
hospital buildings must be kept on
record and readily available for
reference purposes.
6.1 Architectural plans
 
6.2 Structural Plans including structural
computations  
6.3 Electrical Plans including electrical
computations  
6.4 Sanitary Plans
 
6.5 Mechanical Plans
 
6.6 Electronics and Communications
Plans  
7. Building Permit and Occupancy
Permit issued by the building official
are prerequisites for the start and
occupancy respectively of any new
building construction or renovation;
therefore should have the following:
7.1 Building Permit per Project
 
7.2 Occupancy Permit per Project
 
7.3 Fire Safety Permit
 
7.4 Elevator Permit where applicable
 
7.5 Generator Permit where applicable
 
7.6 Other Permits as needed
 

Non-Structural Indicators of Safe Hospitals
The non-structural elements are all other elements that, without forming part of the resistance
systems, enable the facility to operate. They include architectural elements, equipment and
contents and services or lifelines. In the case of hospitals, nearly 80% of the total cost of the
facility is made up of non-structural components (WHO 2008).
The following are the indicators for the architectural elements, equipment and contents and
services or lifelines. As with the structural indicators, this list can be used to identify strengths
and vulnerabilities when planning for new construction or reviewing existing hospital or health
facility.
Instruction:
essential observations when doing the assessment, especially when the result is No..
1. Safety of Ceilings Remarks

1.1 Ceiling materials such as fiber cement ,
gypsum board, or glass securely fastened  
1.2 Ceilings made of wood are coated/treated
with fire retardant paints and termite-
controlled
 
1.3 Ceiling materials not made of asbestos
 
1.4 Ceiling accessories or light fixtures
adequately fastened and supported  
2. Safety of Doors and Entrances
2.1 Doors securely attached to jambs
 
2.2 Any glass panel in doors is transparent
wired glass mounted in steel frames  
2.3 In the event of power failure, power-
operated doors may be opened manually to
permit exit travel
 
2.4 Doors are either double swing or swing-out:
2.4.1 Double swing – main doors,
ER/OR/DR/ICU/Nursery/Radiology/
patients’ rooms, Dietary, kitchen,
laundry, linen and other support
 
areas
2.4.2 Swing-out – toilets and exit doors
 
2.5 Each single door with a width of not less
than 112 cm. and not more than 122 cm.
(Note: if power operated doors – in the
event of power failure the door may be
 
opened manually to permit exit travel)
2.6 Doors in rooms below 30 persons occupant
load capacity – single door – 112 cm wide  
2.7 Doors in rooms more than 30 persons
occupant load capacity (conference rooms,
function rooms),112 cm wide, remotely  
located from each other, swing out

2.8 Smoke partition doors located along
hallways and corridors should be double
swing, per groups of rooms/section, for  
compartmentation
2.9 In high rise buildings/structures, the interior
vertical exit stairwell/staircase, is a
pressurized fire exit or smoke proof fire exit,  
suitably sealed against smoke, heat and fire
2.10 Locks installed on patient wards so
arranged that they can be locked only
from the corridor side. Such locks
arranged to permit exit from room by a
 
simple operation without the use of key
2.11 Any device or alarm installed to restrict
the improper use of a means of egress so
designed and installed that it cannot, even
in case of failure, impede or prevent
 
emergency use of such means of egress
2.12 With manual door closer - Operating
Room (OR), Intensive Care Unit (ICU),
Recovery Room (OR), Delivery Room
(DR), Labor Room (LR), Isolation Rooms
 
(IR) and other sterile areas
2.13 A door designed to be kept normally
closed as a means of egress, such as a
door to a stair or horizontal exit, provided
with a reliable self –closing mechanism,
and shall not at any time be secured in
the open position. A door designed to be
 
kept normally closed shall bear a sign as
follows: FIRE EXIT, KEEP DOOR
CLOSED
3. Safety of Windows and Shutters

3.1 Windows have wind and sun protection
devices (e.g. sun baffles)  
3.2 Window grilles to secure the safety of the
patient, provided with fire exit opening  
3.3 Windows are leak-proof
 
3.4 Windows which could be mistaken for doors
have protective barriers or railings  
3.5 All glass panels or windows are made of
tempered glass or with appropriate
thickness or provided with protective films
 
4. Safety of Walls, Divisions and Partitions
4.1 Exterior walls meet the fire resistance rating
of 2 hours  
4.2 Interior walls made of fire-resistive materials
and from floor to floor  
4.3 Smoke-proof stairs, lobbies and vestibules
are made of non-combustible materials  
4.4 Partitions for fire zones are fire-resistive,
floor-to-floor and compartmented  

5. Safety of Exterior Elements (cornices,
ornaments, façade, plastering etc.)
5.1 Securely fastened on walls
 
5.2 Hanging lighting fixtures properly anchored
 
5.3 Electrical wires and cables properly
fastened/secured  
6. Safety of Floor Coverings
6.1 Non-slippery floor without crevices in all
clinical/service areas  
6.2 Durable floor materials
 
6.3 Fire-resistive interior floor materials
 
7. Safety of Lifeline Facilities
7.1 Electrical System
7.1.1 Electrical system must conform with
the Philippine Electrical Code
(PEC) requirements for health
facilities except for some provisions  
as may be required by the end-
users
7.1.2 Emergency generator has the
capacity to meet 100% of hospital
demand (provision for back-up
electrical system to include aircon
 
units, and stockrooms)
7.1.3 Generator housing or power house
made of reinforced concrete  
7.1.4 Generator housing or power house
elevated from the ground line  
7.1.5 Generators and other vibrating
equipment can be fixed by special
brackets which allow some
movement but prevent them from
 
overturning
7.1.6 Non-vibrating and silent type
generators  
7.1.7 Exhaust system made of critical
type silencer or hospital grade  
7.1.8 Provided with generator automatic
transfer switch (ATS)  
7.1.9 Protected control panel, with
electrical surge suppressor  
7.1.10 Ground fault circuit interrupters
(GFCIs) provided in outlets in
bath/shower rooms and in wet or  
damp locations
7.1.11 All convenience outlets (COs)
provided with grounding pole/type  
7.1.12 Ducting system/conduits – Polyvinyl
Chloride (PVC) for power and
lighting; Rigid Steel Conduit (RSC)
 
or Intermediate Metal Conduit (IMC)
for fire alarm and detection
systems, telephone, intercom,
Closed-circuit (CCTV), Cable TV
(CATV), computer network data
lines
7.1.13 Adequate lighting in all areas of the
hospital  
7.1.14 Exterior electrical system installed
underground  
7.1.15 Functional electrical and
emergency lights with battery back-
up in all areas
 
7.1.16 Energy-saving Compact
Flourescent Lighting (CFL)  
7.1.17 Non-mercury bulb/lights
 
7.1.18 Automatic monitoring system
installed (Extension wires/cord
unplugged when not in use)
 
7.1.19 All non-current carrying metallic
parts of the electrical system (i.e.
electrical enclosures, boxes,
gutters, ducts, trays, etc.)
 
adequately grounded
7.1.20 Perimeter/Exterior lighting system
installed in the hospital grounds  
7.1.21 All electrical systems/rooms
protected with appropriate chemical
type automatic fire suppression  
units
7.1.22 Explosion-proof switch and outlets
for hazardous areas  
7.1.23 Antennas and lightning rods
protection terminals with
bracing/support for safety
 
7.1.24 Lightning arrester provided
 
7.2 Communication System
7.2.1 Radios have back-up direct current
power source (battery)  
7.2.2 Presence of back-up
communication system  
7.2.3 Communication equipment and
cables secured with anchors and
braces
 
7.2.4 Alarm signalling system arranged
so that the normal operation of any
required alarm initiating device will
automatically transmit an alarm to
the nearest fire station or to such
 
other outside assistance as may be
available
7.2.5 Exterior communication systems
installed underground  

7.3 Domestic Water Supply System
7.3.1 Water storage tank has sufficient
reserve to satisfy the hospital
demand for 3 days at all times
 
7.3.2 Water storage tank has safe
location and support system  
7.3.3 Alternate water source provided:
deep well, mobile water storage
tank, or fire truck delivery
 
7.3.4 Fusion-weld pipes or galvanized
iron pipes, valves, and fittings are
free from breakage, leaks and free  
from harmful agents
7.4 Medical and Industrial Gases (oxygen,

nitrous oxide, etc.) System
7.4.1 Hospitals using pipe-in medical gas
should have minimum storage of 3
days
 
7.4.2 Hospitals using individual cylinders
should have minimum storage of 3
days
 
7.4.3 Tanks, cylinders and related
equipment anchored  
7.4.4 Alternative sources of medical
gases available  
7.4.5 Medical gases appropriately located
and secured from theft, vandalism
and pilferage
 
7.4.6 Ensured the safety of medical gas
provided with an audio-visual alarm
distribution system (valves, pipes,  
fittings)
7.4.7 Functional pressure gauge and
fittings  
7.4.8 Use of standard copper tubings for
medical gas  
7.4.9 Undergoes regular testing
procedures  
7.4.10 Medical gas pipes embedded in
walls are provided with pipe sleeves  
7.4.11 Non-interchangeable piping
connection  
7.4.12 Provided zone/shut off valves in
case of leaks, (e.g., in case of fire
at the OR complex, zone valve can  
be shut off)
7.4.13 Secured back-up oxygen tanks in
case of emergency patient
evacuation
 
7.4.14 Industrial gases located outside the
building and provided with
automatic shut off device (e.g. LPG)
 
7.4.15 Tanks bear an intact safety seal
from the supplier  
7.4.16 Explosion venting system provided
outside the building for hazardous  
processes or storage area, such as
boiler room, motor pool, electrical
rooms, and housekeeping rooms.
7.4.17 Automatic gas leak detection
system interconnected with the
automatic fire alarm system
 
7.5 Fire Suppression System
7.5.1 Detection, alarm and extinguishing
systems are interconnected/
interphased
 
7.5.2 Fire Alarm system is a combination
of automatic and manual system  
7.5.3 Fire alarm system is monitored by
Fire Service Station or Accredited
monitoring agency
 
7.5.4 Heat and Smoke Detection installed
in all areas  
7.5.5 Smoke detectors must be spaced
not further apart than nine meters
on center and more than four and  
six-tenths (4.6) from any wall
7.5.6 Each room provided with portable
fire extinguishers  
7.5.6.1 For general services areas,
ABC fire extinguishers used  
7.5.6.2 For electronic and electrical
equipment, Carbon Dioxide
(CO2), Hydrochloro-
fluorocarbon (HCFC),or
 
Fluoroethane 36 used
7.5.7 Provided with wet standpipe system
with complete accessories for
building more than 5-storey
 
7.6 Emergency Exit System
7.6.1 Every floor of the building must
have at least 2 emergency exits
remote from each other
 
7.6.2 Revolving Doors and Elevators are
not considered emergency exits  
7.6.3 Fire Exit Doors are fire resistive,
swing-out type, self-enclosing, and
with panic bar hardware (of 7  
kilograms or less pressure)
7.6.4 The floors of beams of egress are
illuminated at all points including
angles and intersections of
corridors and passageways,
landings of stairs and exit doors  
with bulbs of not less than one
thousandth (0.001) lumens per
square centimetre
7.6.5 Illumination system of the exits is
not battery-operated  
7.6.6 Emergency lighting facilities
maintain the specified degree of
illumination in the event of failure of
 
the normal lighting for a period of at
least half of an hour
7.6.7 Illuminated “EXIT” signs –
distinctive in color, reliable source,
located just above the door frame
 
7.6.8 Size of Exit Signs – plainly legible
letters not less than fifteen
centimetres high with the principal
strokes of letters not less than
 
nineteen millimeters wide
7.6.9 Luminous directional exit signs
located one foot above floor level
leading to the nearest fire escape  
route
8. Heating, Ventilation and Air Conditioning

(HVAC) Systems in Critical Areas
8.1 Provide adequate bracing for pipes and
ducts  
8.2 Leak-free pipes, valves, and fittings
 
8.3 Anchored central heating and/or hot water
equipment  
8.4 Anchored air-conditioning equipment
 
8.5 Safety enclosures or guards for rotating
parts of HVAC equipment  
8.6 Fire-stopping materials for all pipes and
ducts  
9. Medical and Laboratory Equipment and
Supplies used for Diagnosis and Treatment
9.1 With color coded sign: FOR PRIORITY IN
SAVING DURING EVACUATION  
9.2 Medical Equipment in operating rooms and
recovery rooms  
9.2.1 Equipment in the operating room
must be anchored or fastened  
9.2.2 Lamps, equipment for anesthesia
and surgical tables are secured and
that table on cart wheels are locked
 
9.3 Radiological Equipment and Other
Support Devices on the Radiology
Department (X-ray units, ultrasound
scanners, CT scanners, MRI scanners)
9.3.1 Heavy and movable equipment
anchored or bolted on the floor (X-
ray machine) or to the wall
 
9.3.2 Available steel frames for securing
of equipment  
9.3.3 Adequately shielded room
(radiation protection, radio-
frequency, magnetic fields, etc.)
 
9.3.4 Air conditioned room with controlled
humidity  
9.3.5 Safe from flooding
 
9.4 Laboratory Equipment and Other
Support Devices for the Laboratory
Department/ Services
9.4.1 Supplies and contents of
laboratories secured on shelves
and in racks. (Anchor the cabinets  
to the walls and strap the shelves)
9.4.2 Safe and secured storage of culture
organisms/media  
9.4.3 Available standard decontamination
area (fixed/mobile)  
9.4.4 Waste water connected to
neutralization tank before disposal
to sewerage treatment plant
 
9.4.5 Fume hood provided (depends on
level of laboratory)  
9.4.6 Material Safety Data Sheet (MSDS)
available for all chemical substance  
9.5 Medical Equipment in Emergency
Rooms
9.5.1 Each bed is provided with wheel
lock or anchor  
9.5.2 Equipment and accessories needed
for treatment and placed near the
bed are supported, anchored or  
fixed
9.5.3 Supplies and contents of medical
cabinets secured on shelves and in
racks. (Anchor and strap the  
shelves to the wall)
9.6 Medical Equipment in ICU Areas

lock or anchor  
9.6.2 Equipment and accessories are
supported, anchored or fixed  
9.6.3 Anchor bolts should be provided on
the walls in appropriate locations so
that the equipment can be removed
and fixed in a safe place when not
 
in use
9.7 Medical Equipment in the Pharmacy

Departments
9.7.1 Supplies and contents of pharmacy
cabinets are secured on shelves
and in racks. (Anchor the cabinets  
to the walls)
9.7.2 Proper storage for hazardous
materials free from leaks  
9.7.3 Air-conditioned room or well
ventilated  

9.8 Medical Equipment in the Sterilization
Units
9.8.1 Supplies and contents of
sterilization unit cabinets should be
secured on shelves and in racks.  
(Anchor the cabinets to the walls)
9.8.2 Heavy and movable equipment
anchored or bolted to the floor or to
the wall (e.g., autoclave)
 
9.9 Medical Equipment in the Wards
lock or chains  
9.9.2 Equipment and accessories must
be supported, anchored or fixed  
9.9.3 Equipment on roller trolleys must
have proper anchoring system using
hooks and chains, and can be
attached to beds or walls (ECG,
monitors, suction units, ventilators,
 
incubators, BP monitors,
resuscitation equipment, etc.)
9.9.4 Patients’ charts must be secured
(esp. if you have to evacuate that
ward in times of emergencies) for
proper / continuous management of
 
patients
9.10 Equipment and Other Support Devices

in Nuclear Medicine Department and
Radiation Therapy Units (including
Chemical/Poisoning)
9.10.1 Adequately shielded room
 
9.10.2 Airconditioned room
 
9.10.3 Proper storage, handling and
disposal of chemicals and
radioactive materials and wastes
 
9.10.4 Equipment and accessories needed
for treatment and placed must be
supported, anchored or fixed
 
9.10.5 Use of Proper Personal Protective
Equipment (PPE)  
9.10.6 Available standard decontamination
area (fixed/mobile)  
9.10.7 Waste water connected to “delay to
decay” tank before disposal to
sewerage treatment plant
 
9.10.8 Use of Proper Illumination
 
9.10.9 Independent circuit breaker
 
9.10.10 Has a separate facility for the
processing of the reagents/
chemical substance, radio-  
pharmaceuticals and other

diagnostic kits
9.10.11 Asbestos free

 
9.10.12 Proper anchorage of equipment
and the materials used for the
attachments do not cross react with  
the chemical agents
9.10.13 Presence of the following safety
equipment:
 Shields  
 Protective clothing  
 Tools for remote handling  
 Containers for radioactive  
materials
 Dose rate monitors with alarm  
 Contamination meters  
 Signs, labels, records
 
 Emergency kits
 
9.10.14 Security
 Provided with Close Circuit TV
(CCTV) cameras with recorder  
 Roving guard available  
 Secured entrance and exit points
 Provided with equipment for  
inspection such as metal  
detectors
10. Safety of Personnel and Patients

10.1 Available PPEs for universal precaution
(gloves, masks, gowns)  
10.2 Available sterilizing unit for equipment and
supplies  
10.3 Available Information Education
Communication (IEC) materials for
patients and personnel on what to do
during emergencies/disasters
 

Functional Indicators of Safe Hospitals
Instruction:
essential observations when doing the assessment, especially when the result is No.
1. Site and Accessibility Remarks
1.1 Hospital is located along/ near good roads

readily accessible to the community with  
adequate means of transportation
1.2 Hospital reasonably free from undue noise,

smoke, dust, foul odor, flood, and not
located near railroads, freight yards,  
children's playgrounds, airports, industrial
plants, disposal plants.
1.3 The location of the hospital shall comply

with all zoning regulations and ordinances
 
1.4 There shall be no road obstructions leading
to the hospital  
1.5 There should be access to more than one
road (alternative routes)
 
1.6 There should be separate ingress and
egress routes  
1.7 Well paved access roads should be
properly identified/labelled  
1.8 Available, safe and well lighted parking lots  
1.9 Provide available parking lots for the
disabled near the main entrance
 
1.10 Available covered walk way, to
interconnect service areas  
1.11 Directional signages are available and
properly fastened  
1.12 Outdoor stairs must have enclosed and
protected openings  
1.13 All entrances, especially main and
emergency entrances, shall be provided
with canopies for protection from the  
elements
1.14 Provide entrance ramps using ratio of 1:12  

1.15 Secured and controlled of entry points  
2. Internal Circulation and Inter-Operability
2.1 Proper zoning of areas  

2.1.1 Departments most closely linked to
the community are located nearest
to the entrance (e.g., OPD, ER, etc)
 
2.1.2 Departments that receive their
workload from the wards or inner
zones should be located closer to
these zones (Radiology,
 
Laboratory)
2.1.3 In-patient departments should be in
the inner zones  
2.2 General service areas are located in
separate structures such as power plant,
boilers, water storage facilities, laundry  
area, and pump house
2.3 Areas to be converted to spaces for
patients during disasters properly identified
with adequate lighting, electrical outlets,  
water supply and toilets/bathrooms
2.4 Diagnostic areas with heavy equipment are
preferably at the ground floor but safe from
flooding
 
2.5 Nurses at the Stations can oversee the
wards and are accessible to the patients  
2.6 Gender sensitive wards (female, male) and
sanitary toilets  
2.7 Morgue is located separately from the
service areas  
2.8 Corridors, hallways and aisles are 2.45
meters in width  
2.9 Use of ramps as access to 2nd and 3rd floors
only  
2.10 Use of elevators as access for 4th floor
and above  
2.11 Use of stairways with safe and adequately
secured balusters and railings  
3. Basic Equipment and Supplies
3.1 Basic equipment should be available per
ward at least two sets  
3.2 Basic equipment should be available at
treatment area at least two sets  
3.3 Basic emergency supplies available
 
3.4 Diagnostic and therapeutic basic equipment
are functional and properly labelled  
3.5 Stock pile of medical supplies good for at
least one week  
3.6 Basic PPEs are available at the ER
 
3.7 PPEs are available in all service areas
 
4. Hospital Emergency Preparedness,
Response and Recovery Plan approved by
the Chief of Hospital / Director,
disseminated, tested and updated
4.1 Operational Plan and Contingency Plans for
Internal or External Disasters
4.1.1 The hospital has available,
accessible, tested, updated and
disseminated Hospital Emergency
Preparedness, Response and
Recovery Plan which contains  
Hazard Prevention and Mitigation
Plan, Vulnerability Reduction Plan
and Capacity Development Plan.
4.1.2 The hospital has contingency plans
for medical treatment during
different types of disasters such as
Typhoon, Floods, Earthquake, Fire,
Disease outbreaks, Emerging and
Re-emerging Infections/Diseases,
Biological, Chemical, Radio-nuclear
 
terrorism, Control of Infections
acquired during hospitalization,
pathogens with epidemic potential,
etc.
5. Hospital Emergency Management Systems,

Procedures and Protocols written and
attached/incorporated in the Plan 4.1
5.1 SOP/Guidelines on infection control
 
5.2 Decontamination procedures/ guidelines
 
5.3 SOP for internal and external referral of
patients  
5.4 Emergency response procedure/ guidelines
 
5.5 Treatment guidelines/protocols
 
5.6 Special administrative procedures for
disasters  
5.7 Procedures for resource mobilization
(funds, logistics, human resources) to
include shifting of duties during  
emergencies or disasters
5.8 SOP for admission to Emergency
Department during emergency/disaster  
5.9 Procedures to expand services, spaces and
beds, in case of surge of patients  
5.10 Procedures to protect patients’ records
 
5.11 Procedures for regular safety inspection
of equipment by appropriate authority and
preventive maintenance
 
5.12 Procedures for hospital epidemiologic
surveillance  
5.13 Procedures for preparing sites for
temporary placement of dead bodies for  
forensic medicine
5.14 Procedures for transport and logistic
support  
5.15 SOP/guidelines for food and supplies of
hospital staff during emergency  
5.16 Measures to ensure well being of
additional personnel mobilized during
emergency
 
5.17 Guidelines for mental health and psycho-
social support  
5.18 Guidelines on drills / simulation exercises
 Fire
 
 Other disasters  
5.19 SOP for handling of volunteers especially
during emergencies/disasters  
5.20 SOP for hospital security system during
emergencies or disasters  
5.21 Health care waste management program
during emergencies or disasters  
5.22 Fire Safety Program
5.22.1 There must be an organized “Fire
Brigade” which has undergone
seminar/training on Fire Drill/ Fire
 
 
Evacuation Drill/ Earthquake Drill
5.22.2 Conduct of regular Fire Drills/ Fire
Evacuation Drill
5.22.3 Conduct of fire mitigation
prevention and suppression training
 
5.22.4 Fire fighting equipment available
5.22.5 Conduct of preventive maintenance
 
of fire fighting equipment
5.22.6 Available “Fire Exit Plan” and
 
provision of Fire exit/evacuation
plan in conspicuous places at every  
floor level
5.23 User’s/Operations manual for all medical
equipment  
6. Availability of Back-up System for the
following critical services
6.1 Back-up generators  
6.2 Alternate source of drinking water  
6.3 Fuel reserves  
6.4 Medical gases
6.5 Wastewater Treatment  
6.6 Solid Waste Treatment  
 
7. Human Resources
7.1 Organization of Hospital Disaster
Committees and Emergency Operation
Center
7.1.1 Crisis Management Committee –
Committee lower than the
Executive Committee, with
technical expertise, who could give
advice to the Executive Committee
 
regarding crisis/ emergency/
disaster management

7.1.2 Emergency Response Team led by
a designated Hospital Emergency
Management Coordinator and
composed of Physicians, Nurses,
Emergency Management  
Technician (EMT) trained staff,
Paramedics, trained Ambulance
Driver on emergency/disaster
7.1.3 Health Emergency Planning Group –
responsible for the development of
Health Emergency Preparedness,
Response and Recovery Plan and
 
other hospital response plans
7.1.4 Safety Committee headed by a
Safety Officer. The committee is in
charge of promoting safety in the  
hospital from all types of hazards
7.1.5 Hospital Operation Center headed
by the Hospital Emergency
Management Coordinator (in-
charge of monitoring incidents of
emergency or disaster, dispatching
of response teams, mobilizing other
resources for emergency)
operational 24 hrs/day 7days/week.
 
It has a designated office/unit with
personnel equipped with computer
system, directories, communication
facilities (with alternate in case the
system bogs down)
7.2 Capability Building of Personnel

7.2.1 100% of health workers trained in
Basic Life Support and Cardio-
pulmonary Resuscitation
 
7.2.2 100% of health workers trained in
Standard First Aid  
7.2.3 Emergency Room medical staff
trained in Advance Cardiac Life
Support and Pediatric Advance  
Cardiac Life Support
7.2.4 Hospital Responders trained in
Emergency Medical Responders
Course Incident Command System  
(ICS), Mass Casualty Incident (MCI)
7.2.5 Hospital managers are trained in
Hospital Emergency Incident
Command System (HEICS)
 
7.3 Drills and Exercises
7.3.1 Conducts of Fire drills at least twice

a year  
7.3.2 Conducts of simulation drills or
exercises at least once a year  
8. Monitoring and Evaluation
8.1 Conducts post-incident evaluation of

emergencies or disasters (responded to)  
Additional Non-Structural Indicators for Hospitals
with Special Functions
Instruction:
1. Hospital For Highly Infectious Diseases Remarks
1.1 Isolation Room/ Biological Unit/Negative

Pressure Room
1.1.1 Closed, air tight windows and doors
 
1.1.2 Glass transparent doors for the ante
room and the room of the patient,
tightly closed
 
1.1.3 Automatic shut off doors, swing type
of the ante room and the room of the
patient, tightly closed
 
1.1.4 Leak proof ceiling, windows and doors
 
1.1.5 With signage “ISOLATION”
 
1.2 Divisions/Partitions
1.2.1 Isolation room has an ante room for
dressing with Personal Protective
Equipment (PPE)
 
1.2.2 Ante room has lavatory and PPE rack
 
1.3 Floor Covering
1.3.1 Reinforced concrete
 
1.3.2 Non-slippery floor tiles without
crevices  
1.4 Attachments
1.4.1 Heating, Ventilation and Air
Conditioning (HVAC)  
• With air-conditioning
• With electric fan  
1.4.2 Pipes/Medical Gases
• Closed, built in pipes  
1.4.3 Fixtures and Equipment
• No nebulizer  
• No Oxygen tank; to be used only in
“life and death situation”  
• No suction machine (dedicated)
• Minimized dedicated equipment:
 
only life saving equipment  
• Lavatory of ante room with foot
operated trash bin, soap dispenser,
and disinfectant dispenser; while  
the faucet is sliding that can be
operated/ opened by pushing of the
elbow  
• Color coded trash bins
• Refrigerator near the Nurses’
 
Station for storage of biological
specimens and culture media
1.4.4 Electrical Lighting
• Well lighted
 
• Back-up emergency lights  
1.5 Lifeline Facilities (Critical Systems)
1.5.1 Communication System
• Dedicated 2 telephone lines for
inside and outside communication
 
1.5.2 Water Supply System
• Safe and adequate water supply in
all areas  
• Water tank storage has sufficient
reserve to satisfy the hospital
demand for three days
 
• Water containers for storage in the
ante room
 
1.5.3 Medical Gases, pipes (oxygen,
nitrous oxide, etc.)
• Sufficient storage for minimum of 15  
day supply
• Securely anchored tanks, cylinders  
and related equipment
• Protection of medical gas tanks
and/or cylinders and related  
equipment
• Functional pressure gauge  
• Leak proof
• Medical gas pipes not embedded in
 
walls  
• Individualized piping system  
• Automatic shut off mechanism in
case of leaks
 
1.5.4 Emergency Exit System
• Exclusive Emergency Exit
• Illuminated “EXIT” signs –
 
distinctive in color (Reliable source
–five thousand lumens (0.005) per
 
square centimeters
• Provide luminous directional exit
signs located one foot or below
floor level
 
1.6 Heating, Ventilation and Air Conditioning
Systems
1.6.1 Negative pressure room
 
1.6.2 Exhaust system with filter that exits
into the open air far from human
activity
 
1.6.3 Airtight
 
2. Operating Room and Recovery Room
2.1 Medical and Laboratory Equipment and

Supplies used for Diagnosis and
Treatment

2.1.1 Medical Equipment in Operating
Room and Recovery Room
• Dedicated equipment mounted on
 
rollers or roller trolleys must be
anchored or fastened near the
operating table during operations
and can be removed afterwards
• Lamps, equipment for anesthesia
and surgical tables are secured and
table or cart wheels are locked
 
• Equipment on roller trolleys must
have proper anchoring system
using hooks and chains, and can be
attached to beds or walls (ECG,  
monitors, suction units, ventilators,
incubators, BP monitors,
resuscitation equipment, etc.)
2.1.2 Safety of Radiology Equipment
• Dedicated portable mobile X ray
machine that is battery operated
 
3. Laboratory Room (P3 Laboratory and Bio-
safety and Bio-security)
3.1 Safety of Laboratory Equipment

3.1.1 Safe washing area
3.1.2 Available standard decontamination  
area, (fixed/mobile)
3.1.3 Hospitals maintain lab as per their
 
category (Category 3)  
3.1.4 Manual on collection, transport,
storage, and handling of specimen  
3.2 Safe Laboratory Room
3.2.1 Adequate Facilities
• Good and proper ventilation  
• Non-slip surfaces (floor & working
areas)  
• Hand-washing facilities
 
3.2.2 Safety Equipment
• Personal Protective Equipment
- Gowns  
- Goggles
- Mask
 
- Gloves
• Safety devices on laboratory
• Safety Laboratory Equipment –
Biosafety Cabinet Class II  
3.2.3 Emergency Equipment  
• Fire extinguishers
• Emergency showers  
• Eye wash station  
3.2.4 Appropriate Procedures
• Good housekeeping  
• Personal hygiene (handwashing)  
• Laboratory safety protocol
 

3.2.5 Proper Storage Area
(secured/anchored)
• Properly stored ordinary
reagents/chemicals
 
• Non-corrosive building materials for
acid-containing chemicals and
 
reagents
• Dedicated storage for pathogenic
organisms accessible only to
responsible people
 
3.2.6 Proper Laboratory Holding
• P3 laboratory - negatively
pressurized environment for highly  
contagious organisms
3.2.7 Decontamination Area
• Fixed autoclave  
• Mobile autoclave  
3.2.8 Knowledgeable Workers
• Experienced  
• Trained  
IF POSSIBLE: All laboratory doors should be labeled
with emergency contact information. If an accident occurs
during office hours, respondents need to know the names
and telephone numbers of people responsible for
laboratory operations. Properly trained and experienced
laboratory workers have the greatest ability to control
laboratory risks.
4. Emergency Room
4.1 Safety of Medical Equipment in Emergency
Room
4.1.1 Separate ER  
4.1.2 Dedicated supplies and equipment for
diagnosis and treatment  
4.1.3 Disposable PPEs (masks, goggles,
gowns, caps, gloves, booties)  
5. Security and Safety
5.1 Provision of Close Circuit TV (CCTV)  
 
cameras with recorder
5.2 Secured entrance and exit points
5.3 Available appropriate PPEs (gloves, N95
masks, goggles, gowns, booties, caps)  
5.4 Available dedicated sterilizing equipment
and supplies  
5.5 Dedicated staff assigned in Isolation
Room/Biological Unit  
5.6 Signages for restricted areas
 

Additional Functional Indicators for Highly
Infectious Diseases
Instruction:
1. Site and Accessibility Remarks
1.1 Properly identified/labeled Isolation

Room/Biological Unit
1.2 Directional signages available and properly
 
fastened
1.3 Admitted cases have separate entrance to
 
the Isolation room/ER from the rest of the
hospital patients and personnel
 
2. Internal Circulation and Inter-Operability
2.1 There is a dedicated Isolation Room/
Biological Unit for highly infectious cases
(i.e. SARS, Avian Flu)  
2.2 There is a dedicated ER/Consultation Room
for highly infectious patients away from the  
usual ER and OPD
2.3 Presence of decontamination areas near
the entrance at the ER, at the laboratory,
 
and at the Isolation Room/Biological Unit
2.4 Nurses at the Stations can oversee the
patients inside the Isolation Room/Biological
 
Unit
2.5 Gender based wards (female, male) and
common sanitary toilets  
2.6 Observe proper zoning: Isolation
Room/Biological Unit must be secured,
regulated, and located in the hospital away
from the busy wards  
2.7 Identified safe perimeter for patients and
personnel with proper signage (3 meters
away from the door of Isolation Room/
Biological Unit)
 
3. Equipment and Supplies
3.1 Dedicated equipment and supplies for the  
Isolation Room/Biological Unit/ER
3.2 Dedicated portable X ray, ventilators,  
diagnostic and treatment tools (i.e
stethoscope, laryngoscope, BP apparatus,
etc)
3.3 Laboratory has bio-safety cabinet with hood
 
3.4 Available special PPEs like N95 masks,
goggles, caps, gowns, gloves, booties, all of
 
which are disposable  
3.5 Hand lotion and disinfectants
3.6 Proper waste disposal materials/supplies  
4. Hospital Plans
4.1 Hospital Contingency Plan for Highly
Infectious Disease Outbreak
 
4.2 Hospital Contingency Plan for Bioterrorism
4.2.1 SOP/Guidelines on Infection  
Control  
4.2.2 Decontamination Procedures/
Guidelines  
4.2.3 Bio-safety and Bio-security
Guidelines
 
5. Hospital Emergency Management Policies,
 
Guidelines, Procedures, and Protocols
5.1 SOP for internal referral of patients
5.2 Treatment Guidelines/Protocols for
Emerging/Re-emerging Infections
5.3 Procedures for hospital epidemiologic
 
Surveillance
5.4 Procedures for preparing sites for temporary
 
placement of dead bodies for highly
infectious disease
 
5.5 SOP/Guidelines for food and supplies of
dedicated hospital staff during emergency
 
6. Hospital Systems
6.1 Logistics Management System
6.1.1 System for prioritizing hospital
personnel to be given prophylactic/
therapeutic drugs for highly infectious
 
diseases in times of drug scarcity
6.1.2 Surveillance System
• Established hospital disease
surveillance system for the patients  
and personnel
6.1.3 Water Supply System
• Presence of adequately safe water
at all times even during emergency
for hygienic purpose, for flushing
 
toilets and other utilities
• Presence of alternate source of
water in case the main supply is cut  
off
• Identified agencies responsible for
timely restoration of water service  
• Supplementary pumping system in
case system fails or services  
disrupted
6.1.4 Electrical System
• Presence of emergency power
generator or alternative power for  
emergency lighting and operation of
essential equipment
6.1.5 Security System
• Dedicated security personnel  
• Tightened security of the Isolation
Room/Biological Unit, being a  
restricted area
• Only authorized personnel are
allowed to enter
 
• Separate entrance or access route  
• With proper signages
 
6.1.6 Transportation and Communication
System
• Available back-up communication
facilities (cellular phone, handheld
radios satellite communication
facilities,etc)
 
• Dedicated ambulance for highly
infectious patients with glass
separator between the driver and
the patient compartment equipped
with proper
 
decontamination/disinfection
supplies and materials
6.1.7 Public Information System
• Presence of established Public
Information Center where public  
can go to request information
concerning family members
• Public Information Center is
coordinated by a social worker and
 
staffed by personnel or volunteers
• Available public awareness and
public education campaign with
 
advisories, IECs, warning
messages
• Designated spokesperson for risk
communication
 
• Procedures for communicating
with the public and media
6.1.8 Hospital Emergency Incident
 
Command System (HEICS)
• The Chief of Hospital as the
Incident commander and other staff
to fill up the position of the Incident
 
Command Structure
• System of activating and
deactivating the Incident Command
System
 
• System of activating the Hospital
Response Plan  
• Hospital Early Warning and Code
 
Alert System in order for hospital to
prepare and mobilize resources in
response to early warning signs or
signals
• System of recalling staff and
positioning them for possible
response to emergencies
 
• System of activating and
deactivating the Code Alert System
6.1.9 Information Management System
 
• Preparation of a census of
admitted patients and those
referred to other hospitals
 
• Proper recording and reporting
using standard forms
• Ways of sharing information with
 
proper authorities  

7. Operational Plan and Contingency Plans for
internal or external disasters
7.1 The hospital must have available,
accessible, tested, updated and
disseminated Hospital Emergency
Preparedness, Response and Recovery
 
Plan and Contingency Plan for Highly
Infectious Diseases (SARS, AI) This plan
includes the developed systems,
guidelines, SOPs and protocols for
emergency management
7.2 Procedures to activate and deactivate the
plan
 
8. Plans for the Operation, Preventive
Maintenance, and Restoration of Critical
Services
8.1 Electrical supply and back-up generators  
8.2 Drinking water supply  
8.3 Fuel reserves  
8.4 Medical gases  
8.5 Standard and back-up communication  
systems
 
8.6 Wastewater Treatment
8.7 Solid waste Treatment  
8.8 Fire suppression system  
9. Human Resources
9.1 Organization of Hospital Disaster
Committees and Emergency Operation
Center
9.1.1 Crisis Management Committee  

9.1.2 Dedicated trained and competent
staff in managing highly infectious
cases

security personnel
 
Ambulance drivers
 
maintenance/utility personnel
 
Safety Committee members  
9.1.7 Dedicated trained, competent, and
active Infection Control Committee  
9.1.8 Hospital Operation Center staff
(headed by the Hospital HEMS
Coordinator) to be operational 24  
hours a day and seven days a week
9.2 Capability Building of Personnel
9.2.1 100% of staff trained on
management of highly infectious
 
diseases

10. Availability of medicines, supplies,
instruments, and other equipment dedicated
for highly infectious diseases (SARS, AI)
10.1 Emergency Medicines at the Emergency
Room and in the critical service areas (OR,  
RR, ICU, NICU, etc)
10.2 Items for treatment and other supplies  
10.3 Instruments for emergency procedures
10.4 Medical gases
 
10.5 Ventilators  
10.6 Electro-medical equipment  
10.7 Life support equipment  
10.8 Personal Protective equipment for  
epidemics (disposable)  
10.9 Crash cart for cardio-pulmonary arrest
10.10 Triage tags and other supplies for
 
managing mass casualties  
11. Monitoring and Evaluation
11.1 Conduct of post-incident evaluation of  
 
emergencies or disasters responded
11.2 Conduct of drills

SECTION III
These are the Codes, Policies and Guidelines from which the indicators in this manual are
based on. Hospitals and health facilities are advised to have a copy of these materials for
reference.
The National Building Code of the Philippines (PD 1096)

The National Building Code of the Philippines, also known as Presidential Decree No. 1096
was formulated and adopted as a uniform building code to embody up-to-date and modern
technical knowledge on building design, construction, use, occupancy and maintenance. The
Code provides for all buildings and structures, a framework of minimum standards and
requirements to regulate and control their location, site, design, quality of materials,
construction, use, occupancy and maintenance.
The National Structural Code of the Philippines (5th ed, 2001)

The purpose of this code is to provide minimum standards to safeguard life or limb, property
and public welfare by regulating and controlling the design, construction, quality of materials
pertaining to the structural aspects of all buildings and structures within its juroisdiction.
The provision of this code shall apply to the construction, alteration, moving, demolition,
repair, maintenance and use of any building or structure within its jurisdiction, except work
located primarily in a public way, public utility towers and poles, hydraulic flood control
structures, and indigenous family dwellings.
The Fifth edition has the following significant revisions:
In Chapter 1. General Design Requirements, major changes in this section include

provisions where building owners are required to get the services of independent recognized
structural engineers to perform design review for certain structures, and the installation of
recording accelographs for every building over six storeys (with floor area of 5,500 square
meter or more), and every building over ten storeys in height regardless of fool area.
In Chapter 2. Minimum Design Loads, revisions of load combinations were made to adopt
the new strength-based seismic forces, and special load combinations to reflect the provision
of the 1997 Uniform Building Code (UBC). Near-source factors are specified in seismic zone
4 to recognize the amplified ground motions that occur close to known acyive faults. The
Philippine Institute of Volcanology and Seismology (PHIVOLCS) issued the maps showing the
active faults throughout the country as reference for determining near-source factors. Also
basic wind speed are revised based on statistical studies of PAGASA data over 30 years and
recommendations of the sub-committee on Design Loads and Lateral forces and on the
ASCE 7 – 95 provisions.
In Chapter 4. Structural Concrete, includes significant changes in several aspects of

reinforced concrete design. Shear-governed concrete walls are designed for increased forces
and special detailing requirements are clarified and improved, many of which reflect changes
in American Concrete Institute (ACT 318-99).
In Chapter 5. Steel, recommendations to adopt AISC's 1997 Edition of the Seismic Provision
for Structural Steel Buildings (AISC Seismic '97) incorporates on-going development of
seismic design and much of the current knowledge on design and quality assurance following
intensive research and testing in the U.S. Significant issues associated with moment frames
and AISC's Seismic Provisions are also addressed. Likewise, important issues and
considerations on braced frames, eco-centric braced frames, and truss moment frames
following much research and development in recent years are also discussed.

Philippine Electrical Code
Purpose:
 Practical Safeguarding. The purpose of this Code is the practical safeguarding of
persons and property from hazards arising from the use of electricity.
 Adequacy. This Code contains provisions that are considered the minimum
requirements necessary for safety. Compliance therewith and proper maintenance
will result in an installation that is essentially free from hazard but not necessarily
efficient, convenient, or adequate for good service of future expansion of electrical
use.
 Intention. This Code is not intended as a design specification nor an instruction
manual for untrained persons.
Volume 1 – Installation for Voltages up to 600 volts
Scope: Public and Private Buildings, Electric Generating Plants, Industrial Plants,
Transformer Stations, Permanent and Temporary Substations, Airfields, Railways
Switchyards, yards, Carnivals and other Lots, Quarries and Mines, Watercraft,
Dockyards, Trailers, Mobile Homes and Recreational Vehicles, Offshore Facilities
Article 1. Definition of Terms, Requirements for Electrical Installations

Article 2. Branch Circuit Feeder and Service Calculations, Over-current Protections,
Surge Protection
Article 3. Wiring Methods and Materials (Raceways, Boxes, Wires and Cables)
Article 4. Wiring Methods for Equipment for General Use (Fixed appliances such as
Space Heating, Motors, Air Conditioning and Refrigeration Equipments
rated 30 volts and above)
Article 5. Wiring Methods and Materials for Special Occupancies classified
Hazardous Locations (Health Care Facility, Gasoline Dispensing and
Service Stations, Air Craft Hangars, Marinas, Movie Theaters)
Article 6. Wiring Methods and Materials for Special Equipment (Lifting and Moving
Equipments, Vehicle Charging System, Electric Welders, Audio and
Amplification Equipments, Information Technology, X-Ray, Induction and
Dielectric Heating, Electrical System, Solar Photovoltaic System, Fire
Pumps, Air Field Lighting
Article 7. Wiring Methods and Materials for Emergency System
Article 8. Wiring Methods and Materials for communication System
Article 9. Tables
Article 10. Wiring Methods and Materials for Watercrafts
Volume II – Installation for Voltages more than 600 volts
Scope: Covers Overhead and Underground Transmission, Distribution and Communication

lines as well as Conductors and Equipments in Electric Supply and Generating Power
Stations. It does not cover installation for commercial and industrial establishment
which do not require the sole control of access to the installation by a properly
qualified person.
Fire Code of the Philippines (PD 1185)

The Fire Code of the Philippines (PD 1185) sets the uniform standards and regulations for the
prevention and suppression of fires; for incorporating fire safety design and constructions; and
for the provision of protective and safety devices in buildings, facilities, and structures in order
to effect a meaningful reduction in death and injury to persons, and loss and damage to
property by fire.

Republic Act 8495 – Philippine Mechanical Code
Republic Act 8495, also known as the Mechanical Engineering Act of 1998 or Mechanical
Code, is the law regulating the practice of mechanical engineering in the Philippines. Its
purpose is to set minimum standards for the design, construction and quality of materials
pertaining to the mechanical works, processes, and equipment of all building, structures,
mechanical plants, to safeguard life or limb, property and public welfare.
Republic Act 344 - Accessibility Law

An Act to enhance the mobility of disabled persons by requiring certain buildings, institutions,
establishments and public utilities to install and incorporate in such buildings, establishments,
institutions or public utility, such as architectural facilities or structural features that shall
reasonably enhance the mobility of disabled persons, such as sidewalks, ramps, railings and
the like.
Republic Act 9275 - Philippine Clean Water Act of 2004

The “Philippine Clean Water Act of 2004” or R.A. 9275 aims to pursue a policy of
economic growth in a manner consistent with the protection, preservation, and revival of the
quality of our fresh, brackish, and marine waters. To guarantee effective water utilization and
conservation, the Clean Water Act of 2004 has set the standards that would determine how
clean is water; how to achieve it and how important is the role of every citizen, in the public
and private sectors in regulating and minimizing pollution, maintaining environmental policies,
waste managing, environmental education and information recognizing the impacts of human
activity to the health of the water bodies.
Republic Act 9003 - Ecological Solid Waste Management

Act of 2000
Republic Act 9003 sets the guidelines and targets for solid waste avoidance and volume
reduction through source reduction and waste minimization measures, including composting,
recycling, re-use, recovery, green charcoal process, and others, before collection, treatment
and disposal in appropriate and environmentally sound solid waste management facilities in
accordance with ecologically sustainable development principles. It is equipped with the
proper machinery to carry on the task stated by the law, through the National Solid Waste
Management Commission.
The Act in a nutshell is about- Segregation, Storage and Collection systems; Selection of
Vehicle for Solid Waste Collection; Designing and Planning a Collection System; Operation of
a Transfer Station; Intelligent Service Contracting; Public Education and Awareness; and the
critical part is the Policy Formulation of the Act as well as its enforcement. Under the latter is
the Solid Waste Management Financing, Incentives and Cost Recovery, wherein the money
aspect and proceedings of the Act is discussed.

Administrative Order No. 2008 - 0021
Subject: Gradual Phaseo-ut of Mercury in all Philippine Health Care Facilities and
Institutions
The Department of Health (DOH) provides the following policies and guidelines for the
gradual phase-out of mercury in all Philippine health care facilities. Recognizing the
unnecessary risks posed by the continued use of mercury-containing products in the health
care system, the DOH hereby orders that:
1. All Hospitals shall immediately discontinue the distribution of mercury thermometers
to patients through the distribution of hospital admission/ discharge kits.
2. All Hospitals shall follow the guidelines for the gradual phase-out of mercury in
health care facilities described in this document in the timeline specified.
3. All new Health Care Facilities applying for a License to Operate shall submit an
inventory of all mercury-containing devices that will be used in their facilities and a
corresponding mercury elimination program.
4. All other Health Care Facilities other than hospital shall make a Mercury
Minimization Program based on the guidelines set by the Administrative Order.

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Safe Hospitals in Emergencies and

Disasters: Philippine Indicators

Health Emergency Management Staff Emergency and Humanitarian Action

Safe Hospitals in Emergencies and Disasters: Philippine Indicators 1

This document is issued by the Health Emergency Management Staff,

Project supported by the European Commission

Safe Hospitals in Emergencies and Disasters: Philippine Indicators 2

Technical Working Committee on Safe Hospitals 8

Section II. Philippine Indicators

Structural Indicators of Safe Hospitals 12

Non-structural Indicators of Safe Hospitals 16

Functional Indicators of Safe Hospitals 26

Additional Non-structural Indicators for Hospitals with 31

Additional Functional Indicators for Highly Infectious Diseases 34

Section III. National Codes, Policies and Guidelines

The National Building Code of the Philippines (PD 1096) 39

Safe Hospitals in Emergencies and Disasters: Philippine Indicators 3

By applying current knowledge and exercising strong political leadership, it is possible to

FRANCISCO T. DUQUE III, MD, Msc.

Safe Hospitals in Emergencies and Disasters: Philippine Indicators 4

This Manual emanated from a research concept by the Department of Health-Health

Health Emergency Management Staff

Safe Hospitals in Emergencies and Disasters: Philippine Indicators 5

Acknowledgement is also given to DOH-HEMS administrative staff, especially, Florinda

Health Emergency Management Staff

Safe Hospitals in Emergencies and Disasters: Philippine Indicators 6

Dr Mario Villaverde Undersecretary of Health, Department of Health (DOH)

Dr Soe Nyunt-U WHO – Representative to the Philippines

Dr Arturo Pesigan WHO – Western Pacific Regional Office,

Dr Carmencita Banatin DOH – Health Emergency Management Staff (DOH-HEMS)

Dr Criselda Abesamis DOH – National Center for Health Facility Development

Atty Nicolas Lutero III Jose Reyes Memorial Medical Center

Dr Rosalinda Arandia Quirino Memorial Medical Center

Dr Bernardino Vicente National Center for Mental Health

Dr Shirley Domingo Philippine Health Insurance Corporation (PHIC)

Technical Working Group for Structural Indicators

Arch Ma. Rebecca Peñafiel DOH – NCHFD

Engr Maximo Adan DOH – NCHFD

Arch Christopher Espina UP College of Architecture

Arch Corazon Cruz UST College of Architecture

Engr Fernando Germar UP College of Engineering

Engr Michael Abundo UP College of Engineering

Engr Peter Lim UST College of Engineering

Engr Ricardo Balog UST College of Engineering

Engr. Ronaldo Ison Association of Structural Engineers of the Philippines

Engr Anthony Pimentel Association of Structural Engineers of the Philippines

Engr Jorge Genota Association of Structural Engineers of the Philippines

Arch Herminio Prudente United Architects of the Philippines

Safe Hospitals in Emergencies and Disasters: Philippine Indicators 7

Dr Roland Cortez East Avenue Medical Center

Dr Arturo Cabanban San Lazaro Hospital

Dr Arnel Rivera DOH-HEMS

Dr Romeo Bituin Dr. Jose Fabella Memorial Hospital

Dr Joseph Bacareza Bureau of Fire Protection

Arch Prosperidad Luis United Architects of the Philippines

Engr Carlos Bariring DOH-NCHFD

Engr Abraham Castanaga DOH-NCHFD

Engr Ramon Alfonso Tondo Medical Center

Dr Ma. Theresa Vera DOH-BHFS

Engr William Juan Institute of Integrated Electrical Engineers

Technical Working Group for Advocacy

Ms Angelina Sebial DOH – National Center for Health Promotion

Dr Victor dela Cruz Tondo Medical Center