DISASTER

PREPAREDNESS

Jorge M. Concepcion, MD
General Surgery & Trauma
 OBJECTIVES
At the end of this session, the participant is
expected to be able to:

– Understand principles of disaster preparedness

and management

– Learn the Philippine Disaster Management system

– Principles of “triage”
…are natural or man-made events
wherein communities experience
severe danger and incur loss of
lives and properties causing
disruption in its social structure
and prevention of the fulfillment of
all or some of the affected
community’s essential
Disaster: 'Any occurrence that causes

damage, economic disruption, loss of

human life and deterioration in

health and health services on a scale

sufficient to warrant an extraordinary

response from outside the affected area or

community.‘ (WHO)
 Disaster
The most important aspects to remember about a disaster
are:

Disasters interrupt the normal functioning of a community

Disasters exceed the coping mechanisms (capacity) of the

community

External assistance is needed to return to normal

functioning of a community
Hazard
A source of danger; an
extreme event; possibility of
incurring loss or misfortune
 Natural Hazards
• Earthquakes
• Floods, sea surges,
tsunamis (seismic
sea waves)
• Volcanic eruptions

• Hurricanes/typhoons,
thunderstorms
• Droughts
• Epidemics
• Fires, wildfires
 Man-made Disasters
• Hazardous
chemicals incidents
• Conventional
warfare
• Building collapse
• Civil disturbance

• Nuclear, biological or
chemical incidents
• Explosion
• Aircraft crash

Fill in the Blank

Community
Hazard + Community

= DISASTER
Multiple Casualty Incident (MCI)

Any event resulting in a number of

victims large enough to disrupt the normal
course of emergency health care services.

– Establishing a Mass Casualty Management System (PAHO-OPS,

1995, 58 p.)
Multiple Casualty Incident

“An epidemic of
injuries”
But if a hospital is unable to handle day to
day emergencies in the ED, it will not be
able to cope with demands of multiple
casualty incidents

If Your Daily Emergency Management

Is Bad  Don’t Expect To Be Able To
Manage Disasters Properly

Disaster Management Is An
Escalation Of The Daily Emergency
Response
 The Philippine Archipelago occupies the western ring of the Pacific
Ocean (Western Segment of the Pacific Ring of Fire), a most active part of
the earth that is characterized by an ocean-encircling belt of active
volcanoes and earthquake generators (faults).
Mt. Pinatubo
The biggest volcanic
eruption of the century June
1991 800 – dead
P10.6B - damage
 MCI RESPONSES:

LEVEL I – LOCAL EMERGENCY RESPONSE

PERSONNEL AND ORGANIZATION
ARE ABLE TO CONTAIN THE DISASTER

LEVEL II – REGIONAL EFFORTS AND MUTUAL

AID FROM SURROUNDING
COMMUNITIES

LEVEL III – REQUIRING NATIONAL OR

INTERNATIONAL ASSISTANCE
MANOR HOTEL FIRE
TRAGEDY
August 18, 2001

LUNG CENTER BLAZE

May 17, 1998

THE OLD ORPHANAGE

December 3, 1998

THE OZONE DISCO

March 1996
Environmental/Technological
Hazards

Payatas Dump Site Tragedy

July 10, 2000
224 dead – 38 missing
Hydro-Met Hazards

Ormoc, Leyte, Nov 6, 1991

5,101 dead – 292 injured
 Christmas 1987 M/V Dona Paz
collided w/ oil tanker Vector. The
world’s worst peacetime sea
tragedy.
4,342 confirmed dead.
 Valentine bombing
Rizal Day Bombings February 15, 2005
Dec 30, 2000 -10 AM
Manila: Two more people have died from injuries
5 Bombing incidents in Metro suffered in a series of explosions in the Philippines
Manila claimed by a group linked to Al-Qaeda, police said
today.
22 dead
The deaths bring to 12 the number of people killed in
104 injured the Valentine's Day bombings in three Philippine
cities, with 136 people listed as injured.

The number killed when a bomb rigged to a tricycle

exploded outside a mall in the southern city of
General Santos yesterday, has risen to five from
three. - Sapa-AFP
April 19, 2000
Air Philippines Flight 541 crashed in the mountains of
Mindanao
All 120 passengers and crew died
Tsunami
Tsunami response: Aceh, Indonesia
The Philippine
Disaster
Management
System
LEGAL AUTHORITY

PD 1566
JUNE 11, 1978
Strengthening the Philippine
Disaster Control Capability and
Establishing the National Program
on Community Disaster
Preparedness
OFFICE OF CIVIL
DEFENSE
 The operating arm
and secretariat of
the National
Disaster
Coordinating
Council.
 PD 1566, Sec. 1
Declaration of Principles

RESPONSIBILITY FOR LEADERSHIP

RESTS ON THE PROVINCIAL GOVERNOR,
CITY MAYORS, AND MUNICIPAL
MAYORS, (AND BARANGAY CHAIRMAN),
EACH ACCORDING TO HIS AREA OF
RESPONSIBILITY.
 PD 1566, Sec. 1
Declaration of Principles

IT IS THE RESPONSIBILITY OF
ALL GOVERNMENT
DEPARTMENTS, BUREAUS,
AGENCIES AND
INSTRUMENTALITIES TO HAVE
DOCUMENTED PLANS OF THEIR
EMERGENCY FUNCTIONS AND
ACTIVITIES.
 THE NDCC MEMBERS
Secretary, Nat’l Defense - Chairman
Secretary, Int.& Local Govt- Member
Secretary, Public Works- Member
Secretary, Health - Member
Secretary, Social Welfare- Member
Secretary, Agriculture- Member
Secretary, Education- Member
Secretary, Finance- Member
Secretary, Labor & Employment-Member
Secretary, Trade & Industry- Member
Secretary, Trans. & Comm. - Member
Secretary, Science & Tech. - Member
Secretary, Budget- Member
Secretary, Justice- Member
Secretary, Natural Resources- Member
Director, Phil. Info. Agency- Member
Sec-Gen - Phil Nat’l Red Cross- Member
Chief of Staff, AFP- Member
Administrator, Office of Civil Defense -
Member and Executive Officer
 ALL DCC LEVELS
PRESIDENT
DECISION DAMAGE & NEEDS
ASSESSMENT

SEARCH & RESCUE

SND
EMPLOYMENT
FIRE SUPPRESSION

EMERGENCY
MEDICAL SERVICE
OCD ASSESSMENT CONTROL
EVACUATION &
RELIEF

GEOPHYSICAL
PHIVOLCS VOLUNTEER GROUPS &
AUXILLIARIES
HYDRO-
METEOROLOGICAL
PAGASA
TERRORISM
AFP
SURVEILLANCE FEEDBACK/
PLANS
EPIDEMICS
DOH
CIVIL DISTURBANCE
PNP

INFESTATION DA
 NDCC EMERGENCY MANAGEMENT
FRAMEWORK
vulnerability
reduce risk, risk assessments, plans,
reduced
vulnerability & arrangements, training &
hazard exercises

hazard/risk
analysis

Prevention Preparedness
mostly back
to normal disaster /
emergency

Rehabilitation Response
situation
stabilized
“healing”, repair,
reconstruction &
recovery

no longer direct threat to

life/safety and property
San Francisco, S. Leyte,
Dec.15-23, 2003
207 dead – 54 injured – 1 missing
P508.4M - cost of damage
• 22 Typhoons every year
• 5 will be destructive
 As of January 06, 2005
PROFILE TY “UNDING” TS “VIOLETA” TD “WINNIE” TY “YOYONG” TOTAL EFFECTS

Affected
Regions 3 2 5 8

Province 13 4 8 35

Mun/Cities 68 16 56 342

No. of Brgys 1,180 83 645 3,196

Families 144,553 21,151 170,036 383,575 719,315

Persons 759,045 99,461 845,429 1,939,835 3,643,770

Casualties
Dead 71 31 893 73 1,068

Injured 160 187 648 168 1,163

Missing 69 17 443 24 553

Damaged Houses
Totally 36,011 369 8,889 11,322 56,591

Partially 91,803 900 12,578 61,972 160,285

Estimated Cost of Damages (In Million Pesos)

School Facilities 461.846

Buildings 412.065

Desk/Armchairs 5.808

Textbooks 28.334

Other Equip’t. 15.639

Transmission Facilities NO BREAKDOWN 34.300

Health Facilities NO BREAKDOWN 72.900

What roles do the hospitals
play during disaster?


 
 
 
  



 Hospital Roles in a
Disaster
• Provision of Disaster Medical
Teams
• Acting as the receiving hospital for
casualties from a disaster
• Triage in multiple/mass casualty
incidents
• Receiving hospital for patients
transferred from other disaster
affected health-care facilities
 Disaster Management
HEICS (Hospital Emergency Incident
Command System)  USA

MIMMS (Major Incident Medical

Management Support)
 UK & Europe

HOPE (Hospital Preparedness For

Emergencies & Disasters) 
Asia & Developing Countries Specific
HOPE (Hospital Preparedness For
Emergencies & Disasters)
Asia & Developing Countries Specific
ACTIVE FAULTS AND TRENCHES
 Geologic Hazards

• 5 quakes/day
• 1,825 quakes/year

July 16, 1990; Intensity 8

1,666 dead – 3,500 injured
P11B cost of
damage in property P1.2B in
 Components EMS System

• Triage
• On-site care
• Initial resuscitation and
treatment
EMERGENCY DEPARTMENT
• Medical transport
• Definitive care or Trauma
Center
 Triage
• Assess victims’ vital signs and
condition
• Assess their likely medical
needs
• Assess their probability of
survival
• Assess medical care available
• Prioritize the definitive
management
• Color tag
 TRIAGE
• Triage categories are:

a)Immediate – RED

b)Delayed – YELLOW

c)Walking wounded – GREEN

d)Dead and dying – BLACK

 START Triage
Simple Triage And Rapid Treatment
Observe:
Respiration
Circulation
Mental Status
 Categories
1. Deceased (BLACK)
No ventilations present after
clearing airway
2. Immediate (RED)
RR >30/min
delayed capillary refill(>2 secs)
unable to follow simple
commands
3. Delayed (YELLOW)
4. Minor (GREEN)
“Walking wounded”
 Secondary Assessment of
Victim Endpoint
• System of triage that strives to provide care to
those in the field
– who are most likely to benefit when faced with
extremely limited emergency medical support
systems
• SAVE is used along with the START system
– help triage and stratify treatment of multiple victims
especially when access to definitive hospital-based
care is delayed or unavailable
 SAVE
• The triage categories in SAVE are divided
into three categories:
– Victims who will die regardless of the amount
of care they receive
– Victims who will survive regardless of any
treatment measures
– Victims who will benefit tremendously from
limited field interventions
 BLACK GREEN

Triage
Evacuation
Area

RED YELLOW

TRIAGE component in emergency

management flow
 HOSPITAL RECEPTION
A&ED Command Post
Red Area

RED Operating Theatre

Triage YELLOW Yellow Area

GREEN Green Area

Victims Flow
 Aim of Triage

To achieve the
greatest good for the
greatest number of
casualties
“NOT FIRST COME, FIRST SERVE BASIS”
 DISASTER CONTROL?
DISASTER PREPAREDNESS
DISASTER MANAGEMENT!

The Key is Preparedness