Lecture given to Leaders and staff of the Cardinal Santos Memorial Medical Center in preparation for major earthquake in Metro Manila

1. Hospital
Continuity of Operations
Planning
Teodoro J. Herbosa MD FPCS
Professor
Surgery, Emergency Medicine
University of the Philippines, Manila
Undersecretary, Department of Health 2010-2014
Former Board Member World Association for Disaster and Emergency Medicine

2. Typhoon “Yolanda” Storm Surges

3. What happened?

4. Disaster Risk
Reduction
Hazard Analysis
Risk Management or Mitigation
Vulnerability Assessment
Disaster Risk Reduction and Management

5. Disaster Planning
Incident Command System
Operations
Logistics
Finance
Contingency Planning

6. Contingency Planning
No disaster plan
With a disaster plan but situation was not
predicted
There is a disaster plan but those managing the
disaster are not familiar with the disaster plan
entry of external help who are not at all familiar
with the disaster plan

7. * Includes infra and/or equipment costs for affected hospitals, RHUs and BHS
Initial Estimates of Damage of Health Facilities
in Regions IV- B, VI, VII, VIII
Provinces BHS RHUs Hospitals Total No. of
Health
Facilities
Affected
Estimated
Amount*
Region VIII 996 3,928,512,300
Leyte
176 56 17
249 1,205,618,500
Northern
Samar 97 30 11
138 661,555,900
Biliran
46 9 2
57 187,636,900
Eastern
Samar 165 29 12
206 723,485,200
Southern
Leyte 68 23 8
99 385,290,500`
Western
Samar 202 33 11
246 704,925,300
DOH-EV
Office
1 60,000,000
Region VII 60 21,880,000
Cebu 43 15 2 60 21,880,000
Region VI 1,216 49,932,500
Aklan
133 19
9 161 5,244,000
Antique 6 176 10,528,500

8. Timelines
Checklist
Job description
Basis for changes in your disaster plan
Review of the events

10. Job Action Sheets
job description
based on the timelines
triage of what needs to be done
delegation of tasks
lack of manpower

12. Elements of COOP
Continuity Plan - implementation & management of
the Continuity Program.
Outline the ff overarching continuity requirements
Essential Functions – subset of governance &
organizational functions w/c are critical activities used to
identify supporting tasks and resources that must be
included in the organization’s continuity plan
FEMA

13. Elements of COOP
Continuity Plan - implementation & management of the
Continuity Program. Outline the following overarching
continuity requirements
Orders of Succession – essential in a continuity program to ensure
that personnel know who assumes authority/responsibility if
leadership is incapacitated/unavailable during a continuity situation.
“Chain of Command”
Delegations of Authority – provide personnel with the authority to
make key decisions during a continuity situation where the primary
decision maker is not available.
FEMA

14. 14

15. Elements of COOP
Continuity Facilities – alternate facilities from which to
perform essential functions in a threat-free environment
Continuity Communications – ability of an organization
to execute its essential functions at its continuity facilities
depends on the identification, availability/redundancy of
critical communications and information technology (IT)
systems to support connectivity among key leadership
personnel, internal elements, other agencies, critical
customers and the public during crisis and/or disaster
conditions.

16. Elements of COOP
Essential Records Management – identification,
protection and availability of electronic & hard copy
documents, references, records, information systems,
data management software and equipment needed to
support essential functions
Human Resources – guidance to emergency
employees and other categories of employees who
are activated to perform response duties

17. 17

18. Elements of COOP
Tests, Training, and Exercises – identification, training, and
preparedness of personnel capable of relocating to alternate
facilities to support the performance of essential functions
Devolution of Control and Direction – to transfer statutory
authority/responsibility for essential functions from an
agency’s and organization’s primary operating staff and
facilities to other agency and organization employees and
facilities, and to sustain that operational capability

19. Elements of COOP
Reconstitution – process by which surviving
and/or replacement agency and
organizational personnel resume normal
agency operations from the original or
replacement primary operating facility

20. Four Phases of Continuity of
Operations Activation
Phase I – Readiness and Preparedness.
Phase II – Activation: plans, procedures, and schedules to transfer
activities, personnel, records, and equipment to alternate facilities
are activated.
Phase III – Continuity Operations: full execution of essential
operations at alternate operating facilities is commenced.
Phase IV – Reconstitution: operations at alternate facility are
terminated and normal operations resume.

21. Conditions in which the
Continuity Plan will be Activated
The plan could be activated in response to a wide range of
events:
a fire in the building
a natural disaster
the threat or occurrence of a terrorist attack
emerging infectious diseases
Any event that makes it impossible for employees to work
in their regular facility could result in the activation of the
continuity plan

22. Conditions in which Continuity
Plan will be Activated
"Continuity planning is simply the
good practice of ensuring the
execution of essential functions
through all circumstances, and it is a
fundamental responsibility of public
and private entities responsible to
their stakeholders."

23. Lessons from Typhoon
Yolanda
A. Factors for Better Patient Outcome
• Timeliness of intervention
• Competency of Health Personnel
• Adequacy of Service Providers
• Available logistics
• Team Work
B. Existing Partnerships and Agreements
• Facilitates Movement and Entry of
Responding Countries , Teams and Partners

24. Recommendations
 Increase the logistics capacity and lifelines for
health sector response:
◦ Emergency communications system
◦ Air Transport to, and within the affected areas
◦ Emergency logistical needs such as generators, hospital tents,
etc.
 Build resilient health facilities
◦ Hospitals as the last facility standing
◦ Hospitals as hubs for energy, water, logistics,
communications, and shelter
 Develop self-sufficient teams
◦ Properly equipped Mobile surgical, public health teams
◦ Physically and psychologically prepared teams to withstand
the disaster conditions

25. Recommendations
 Improve preparedness, response, and
rehabilitation planning across different
levels
◦ Include worst case scenarios/ mega disasters
◦ Consolidation of top-bottom and bottom-up
planning
 Strengthen systems for service delivery
◦ Improved inter- and intra-operability among all
responding agencies
◦ Improved information management systems
◦ Improved logistics management systems

26. Sometimes it takes a natural
disaster to reveal a social
disaster.
Jim Wallis
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