Training Packages for Health

Emergencies
Health Emergency Response
Operations

Healthcare worker in PPE applying mask to patient with

coronavirus infection (Evidently Cochrane, 2020)
Health Emergency Response Operations (HERO)
 MODULE 2

MODULE 2
Management of the
Event/Incident

Figure 1.11. Health Emergency and Disaster Response Management Framework (DOH HEMB, 2015)

Health Emergency Response Operations (HERO)

 Session 4
Code Alert System

Image 2.12. Health Secretary Francisco Duque III (2nd from left), along with other health
officials, confirmed that the DOH has raised "code red sub-level 1" alert on the Covid-19,
Health Emergency Response Operations (HERO) in a press briefing (DOH, 2020)
SESSION OBJECTIVES

At the end of this session, the participants will be able to:

1. Explain the purpose of the different code alerts of the

Department of Health (DOH)
2. Enumerate the human resource requirements of Operations
Centers (OpCens) per alert code of the DOH
3. Explain conditions for activation and lifting of a code alert.

Health Emergency Response Operations (HERO)

LEGAL MANDATE

DOH AO No. 182 series of 2001 DOH AO No. 2008-0024

"Adoption and Implementation of Code Alert "Adoption and Institutionalization of an
System for DOH Hospitals during Integrated Code Alert System within the
Emergencies and Disasters". Health Sector".

● An organizational and code alert system ● The tri-color system has been expanded
was first introduced. from the hospitals to cover DOH Central
Office including the Health Emergency
Management Bureau (HEMB) and DOH
Regional Offices.

Health Emergency Response Operations (HERO)

GENERAL GUIDELINES IN IMPLEMENTING THE
CODE
1. There should only be one Code Alert System for all health offices/agencies
and facilities involved in providing response to any health emergency or
disaster.
2. For national events with potential for mass casualty incidents (e.g., election,
New Year, etc.) and national security concerns, the Code Alert Level shall be
declared by the Secretary of Health upon the recommendation of the HEMB
Director.
3. All Regional Office Directors and Chiefs of Hospitals have the authority to
raise, downgrade or lift the Code Alert Level based on their particular
situation in the area and according to provisions in AO 2008-0024.
Health Emergency Response Operations (HERO)
GENERAL GUIDELINES IN IMPLEMENTING THE CODE

4. Every entity involved in providing response must be given proper orientation

on these codes, and the conditions when these are to be raised or
downgraded.
5. Proper staffing must be put in place as demanded by each level of the Code
Alerts.
6. The HEMB Central Office takes the lead in designing and updating the Code
Alert System and is primarily responsible for its dissemination and adoption
by all concerned agencies and units.

Health Emergency Response Operations (HERO)

PROTOCOL FOR RAISING AND DOWNGRADING OF CODE
ALERT EOD monitors event.

EOD evaluates event severity.

HEMB/RHEMS/HHEMS confirms
assessment.

All disasters except re-emerging Re-emerging diseases,

diseases, CBRNE Type of CBRNE
Emergency/
Disaster?
HEMB/ RHEMS/ HHEMS HEMB/ RHEMS/ HHEMS coordinates with
recommends Code Alert Level to concerned Technical Group recommends Code
Secretary of Health Alert

Secretary of Health/ CHD Director/ Hospital Chief decides Code Alert Level and issues Memorandum

HEMB/RHEMS/HHEMS continues to monitor event and assesses severity

HEMB/RHEMS/HHEMS together with concerned offices recommends Downgrade, Upgrade or Lift the Alert

Downgrade Downgrade, Upgrade, or Lift Upgrade

Alert?
Lift
DOH Secretary/ CHD Director/ Hospital Chiefs
Lifts Code Alert and Issues Memorandum

Health Emergency Response Operations (HERO) Figure 2.9. Overview of the protocol for raising and downgrading of code alert (DOH HEMB, 2015)
PROTOCOL FOR RAISING AND DOWNGRADING OF CODE
ALERT

EOD monitors event.

EOD evaluates event severity.

HEMB/RHEMS/HHEMS confirms assessment.

Figure 2.9. Overview of the protocol in raising and downgrading of alert code, broken down (DOH HEMB, 2015)
PROTOCOL FOR RAISING AND DOWNGRADING OF CODE
ALERT
All disasters except re-emerging Re-emerging diseases,
diseases, CBRNE Type of CBRNE
Emergency/
HEMB/ RHEMS/ Disaster? HEMB/ RHEMS/
HHEMS HHEMS coordinates with
recommends Code concerned Technical
Alert Level to Secretary Group recommends Code
of Health Alert

Secretary of Health/ CHD Director/ Hospital Chief decides Code Alert Level
and issues Memorandum

Figure 2.9. Overview of the protocol in raising and downgrading of alert code, broken down (DOH HEMB, 2015)
PROTOCOL FOR RAISING AND DOWNGRADING OF CODE
ALERT
Secretary of Health/ CHD Director/ Hospital Chief decides Code Alert Level
and issues Memorandum

HEMB/RHEMS/HHEMS continues to monitor event and assesses severity

HEMB/RHEMS/HHEMS together with concerned offices recommends Downgrade,

Upgrade or Lift the Alert

Downgrade Downgrade, Upgrade, or Lift Upgrade

Alert?

Lift
DOH Secretary/ CHD Director/ Hospital Chiefs
Lifts Code Alert and Issues Memorandum
Figure 2.9. Overview of the protocol in raising and downgrading of alert code, broken down (DOH HEMB, 2015)
PROTOCOL FOR RAISING AND DOWNGRADING OF CODE
ALERT
The Code Alert will be lifted if any of the following is present:
● All rescue/relief operations have ended and rehabilitation/development
phase is started. Centers for Health Development (CHDs) no longer
needed in the operation and Local Government Unit (LGU) has
assumed overall command of the situation.
● For situations such as coup d'etat operations, bombings and similar
events, announcement that the situation is under control.

Health Emergency Response Operations (HERO)

OVERVIEW OF THE DOH CODE ALERT SYSTEM

Table 2.2. An overview of the DOH Code Alert System (HEMB, 2015).

It describes the conditions

CODE Prepare for impending threat, activate OpCen, that govern the expected
WHITE deploy standby team. levels of preparation and the
Alert for 50% resource mobilization, augment most suitable responses by
CODE BLUE all concerned particularly
teams and logistics.
during mass casualty situations
Full mobilization of office, activate all and in anticipation of any
CODE RED
resources. untoward incident monitored.
CODE Department-wide response to mega disasters,
ORANGE mobilize outside resources.
Health Emergency Response Operations (HERO)
CRITERIA FOR ACTIVATION OF CODE ALERT
Table 2.10. Code alert criteria in the DOH Code Alert System (DOH HEMB, 2015)

Any one of the following:

• Strong possibility of military operation (e.g., coup attempt, armed
conflict)
• Mass action or demonstration
CODE • Forecast typhoons (signal 2 up)
WHITE • National or local elections
• National event/holidays with potential for MCI
• Emergency w/ potential 10-50 casualties
• Terrorist attack
• Any hazard that may result in emergency

Health Emergency Response Operations (HERO)

CRITERIA FOR ACTIVATION OF CODE ALERT

Table 2.10. Code alert criteria in the DOH Code Alert System (DOH HEMB, 2015)

Any condition in Code White plus 2 below:

• Mobilization of DOH resources
• 30-50% health facilities affected incapability of LGU to respond
CODE
• Geographic coverage and affected population >30%
BLUE
• MCI with 50-100 casualties
• High case fatality rate for epidemics
• Confirmed human-human transmission of Avian u/SARS

Health Emergency Response Operations (HERO)

CRITERIA FOR ACTIVATION OF CODE ALERT

Table 2.10. Code alert criteria in the DOH Code Alert System (DOH HEMB, 2015)

Any natural, manmade, technological or societal disorder, with all

present:
• Declaration of disaster in area
CODE • >100 casualties in 1 area
RED • Regional health personnel incapable of handling entire operation
• Mobilization of health sector needed
• Mobilization of DOH key oces
• Uncontrolled human to human transmission of SARS/ Avian Flu

Health Emergency Response Operations (HERO)

CRITERIA FOR ACTIVATION OF CODE ALERT
Table 2.10. Code alert criteria in the DOH Code Alert System (DOH HEMB, 2015)

Any natural, manmade, technological or • More than 50% of health facilities are
societal disaster, where all or any three of damaged and non-functional or main
the following are present: hospital compromised and unable to
• All lifelines down (communications, render health services
CODE
transportation, power, water, food • No information within 24 hours post
ORANG
supply) disaster
E
• More than 5000 deaths/injured • Breakdown in chain of command
• More than 50% of staff unable to • Isolation of the affected areas
report for work, especially those • Uncontrolled human to human
delivering critical functions transmission of SARS/ Avian Flu

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

Instructions:
1. You will be presented with different emergency scenarios. Take one minute to
carefully read and process each situation.
2. After each scenario, you will have 20 seconds to choose the appropriate code
(White, Blue, Red or Orange) that corresponds to the level of response required.
Raise your corresponding code to indicate your chosen response level.
3. After each scenario, we will briefly discuss the chosen codes as a group.

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

1. Strong Possibility of a Military Operation within the

Area/Region, e.g., Coup Attempt

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

2. Massive Earthquake (Magnitude 7.5) Hits Urban

Area which paralyzes all services, no info from the area
within 24 hours, and urgent response is needed

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

3. National Events, Holidays, or Celebrations in the

Area with Potential for Mass Casualty Incident (MCI)

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

4. Unconfirmed Report of Reemerging Diseases, e.g.,

Bird Flu, SARS

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

5. Hospital is Partially Structurally Damaged,

Requiring Evacuation and/or Transfer of Patients

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

6. Forecast Typhoons (Signal No. 2 up) the Path of

Which Will Affect the Area

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

7. Confirmed/Documented Report of Reemerging

Diseases (SARS, Human to Human Avian Flu) within
the Catchment Area

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

8. National or Local Elections and Other Political

Exercises

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

9. First Case of a Local COVID-19 Transmission Was

Confirmed

Health Emergency Response Operations (HERO)

EXERCISE 5: Raise Your Code

10. An Emergency Wherein the Services of the Hospital

are Paralyzed Since 50% of the Manpower are
Themselves Victims of the Disaster

Health Emergency Response Operations (HERO)

(Recall) RECOMMENDED STAFF COMPLEMENT OF AN
OpCen
Table 2.3. Recommended OpCen Staff Complement By Code Alert Level (Health Emergency Management Bureau, 2015)

CODE STAFF COMPLEMENT

ALERT
CODE At least 2 EOD staff with a supervisor; driver and security
WHITE guard to assist, with 2 EOD relievers on standby
CODE BLUE 3 teams with supervisors with each team composed of 4
emergency officers-on-duty (EODs) for 24 hours rotated every
3 days, with a driver/security guard to assist. Incoming team on
standby.

Health Emergency Response Operations (HERO)

(Recall) RECOMMENDED STAFF COMPLEMENT OF AN
Table 2.3. Recommended OpCen Staff Complement By Code Alert Level (continued) (Health Emergency Management Bureau, 2015)
OpCen
CODE RED A team comprising the following and is on duty for 24 hours,
rotated every other 3-4 days and is relieved by the next team with
the same composition.
● Team leader/assistant team leader
● Data encoder/collector (Surveillance in Post-Extreme
Emergencies and Disasters or SPEED)
● Logistics EOD
● Communications EOD (in charge of line list)
● Team Mobilization EOD
● Driver/security guard to assist
● Administrative officer

Health Emergency Response Operations (HERO)

(Recall) RECOMMENDED STAFF COMPLEMENT OF AN
OpCenTable 2.3. Recommended OpCen Staff Complement By Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE A team comprising the following and is on duty for 24 hours, rotated
ORANGE every other 3-4 days and is relieved by the next team with the same
composition.
● Team leader/assistant team leader
● Data encoder/collector (SPEED)
● Logistics EOD
● Communications EOD (in charge of line list)
● Team Mobilization EOD
● Driver/security guard to assist
● Administrative officer

Health Emergency Response Operations (HERO)

TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL
Table 2.11. Tasks of OpCen Personnel by Code Alert Level (Health Emergency Management Bureau, 2015)

CODE ALERT WHITE CODE ALERT BLUE CODE ALERT RED OR

ORANGE
Supervisor EOD 1 Note:
● Supervise EOD tasks ● Supervise and oversee the ● Under CODE ORANGE, staff
completion. operation. functions remain the same as
● Review and correct EOD ● Coordinate with regional in CODE RED, but with
outputs. office and partners. increased personnel.
● Assist in OpCen decision- ● Analyze and synthesize ● Team composition includes:
making. communications. ○ Team Leader
● Report urgent issues to ● Prepare final Health ○ Assistant Team Leader
division chief/head of office. Emergency Alert Reporting ○ 2-3 Data
● Perform additional tasks as System (HEARS) report. Collectors/Encoders
needed. ● Escalate issues and provide ○ 2-3 Logistics Members
recommendations. ○ 2-3 Communications Staff
● Report to division chief and
head of office.
TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL
Table 2.11. Tasks of OpCen Personnel by Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE ALERT WHITE CODE ALERT BLUE CODE ALERT RED OR

ORANGE
EOD 1 EOD 2 Team Leader
● Lead endorsements between EOD ● Evaluate info for HEARS ● Lead OpCen, activate
shifts.
● Monitor and document reportable
with EOD1. backups if needed.
events. ● Monitor SPEED site, ● Manage disaster concerns,
● Daily reports to Division Chief analyze. advise Head.
and Head of Office. ● Coordinate with affected ● Coordinate expert and
● Prepare Flash Reports, HEARS, regions, verify reports. emergency teams.
Alert Memo with EOD2. ● Collaborate with SPEED ● Supervise DOH logistics in
● Coordinate with DOH Central
Office, regional offices, hospitals, team for HEARS. affected areas.
NDRRMC partners. ● Liaise with ROs, hospitals,
● Dispatch MCI and rapid health sector.
assessment teams. ● Update division chiefs,
● Handle admin tasks after hours, Head.
weekends, and holidays.
● Prepare endorsement for
incoming leader.
TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL
Table 2.11.Tasks of OpCen Personnel by Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE ALERT WHITE CODE ALERT BLUE CODE ALERT RED OR

ORANGE
EOD 2 EOD 3 Assistant Team Leader
● Monitor media reports. ● Manage Logistics operations. ● Assume Info Management
● Handle radio ● Include all logistical support and Report Supervisor role.
communications. in reports. ● Oversee received reports.
● Report incidents to EOD1. ● Cover DOH mobilization, ● Analyze, validate, and ensure
● Prepare reports for EOD1 RO support, and donations. accuracy of data.
review. ● Monitor teams and human ● Create Health Situation
● File and update resources for LGU support. Report approved by Team
documents/data. Leader for dissemination.
● Assist in agency/facility ● Prepare PowerPoint for
contacts. Division Chief/Office Head.
● Handle admin tasks (fax, ● Fulfill additional duties as
email, etc.). directed by Team Leader.
● Perform assigned office
errands.
TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL
Table 2.11.Tasks of OpCen Personnel by Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE ALERT CODE ALERT BLUE CODE ALERT RED OR ORANGE

WHITE
EOD 4 Data Collector/ Encoder
● Convey and validate reported ● Gather, consolidate, and encode
mortalities/morbidities. data for reporting and recording.
● Discuss and get team approval ● Perform initial analysis, refer to
before reporting to NDRRMC. Info Management Supervisor.
● Monitor events and handle ● Verify reports and cross-check
administrative tasks. with relevant data.
● Update whiteboard, log text ● Prepare reports as instructed by
messages, etc. Supervisor.
● Carry out assignments from
EOD1.
Health Emergency Response Operations (HERO)
TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL
Table 2.11. Tasks of OpCen Personnel by Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE ALERT CODE ALERT CODE ALERT RED OR ORANGE

WHITE BLUE
Logistics Staff
● Conduct regular inventory updates.
● Coordinate with Material Management Division (MMD) at
the DOH Central Office and National Disaster Risk
Reduction and Management Council (NDRRMC) supply
mobilization.
● Prepare logistics reports.
● Monitor logistics transfers to affected regions.
● Manage international and local donations.
● Coordinate with Bureau of International Health
Cooperation (BIHC) and MMD for donation acceptance
and processing.

Health Emergency Response Operations (HERO)

01
TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL

Table 2.11.Tasks of OpCen Personnel by Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE ALERT CODE ALERT CODE ALERT RED OR ORANGE

WHITE BLUE
Communications Staff
● Monitor radio and phone operations; log messages.
● Address communication issues.
● Verify reports from Ultra High Frequency/ Very High
Frequency (UHF/ VHF) radio.
● Manage casualty list from Centers for Health
Development (CHDs) and submit completed tally to
NDRRMC.

Health Emergency Response Operations (HERO)

11
01
TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL

Table 2.11. Tasks of OpCen Personnel by Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE ALERT CODE ALERT CODE ALERT RED OR ORANGE

WHITE BLUE
Administrative Staff
● Support personnel in various areas.
● Gather extra data for event monitoring.
● Manage administrative tasks, including food
allowance.

Health Emergency Response Operations (HERO)

01
TASKS OF OpCen PERSONNEL BY CODE ALERT LEVEL

Table 2.11. Tasks of OpCen Personnel by Code Alert Level (continued) (Health Emergency Management Bureau, 2015)

CODE ALERT CODE ALERT CODE ALERT RED OR ORANGE

WHITE BLUE
Drivers
● Provide administrative support.
● Schedule and prioritize trips.
● Maintain and ensure vehicle readiness.
● Transport resources, supplies, and personnel.
● Prepare incident reports when required.

Health Emergency Response Operations (HERO)

EXERCISE 6: Raising the Code Alert

Instructions:
1. You will be presented with four different emergency scenarios. Choose one
situation.
2. Based on the code level indicated per scenario, prepare a memo with
justifications for the recommended Code Alert Level. Use the provided memo
templates or paper.
3. Each group will present their memo and justification to the group.
4. After all memos have been presented, engage in a group discussion to analyze
the choices and justifications. Discuss any differing opinions and insights.

Health Emergency Response Operations (HERO)

EXERCISE 6: Raising the Code Alert

Scenarios:
1. One day before the annual Black Nazarene Procession in Manila. (White)
2. Fifty percent (50%) of health facilities in affected areas damaged. (Blue)
3. More than 50 casualties brought to a hospital. (Hospital – Red)
4. Magnitude 8 earthquake with more than 5000 casualties/injured. (Orange)

Note: You are free to invent the specific details of the scenario as long as they
adhere to the criteria set within the DOH Code Alert System.

Health Emergency Response Operations (HERO)

KEY LEARNING POINTS

I. Legal Mandate
● DOH AO No. 182 (2001) introduced the Code Alert System for DOH Hospitals during
emergencies.
● DOH AO No. 2008-0024 expanded the system to cover DOH Central Office and Regional
Offices.

II. General Guidelines in Implementing the Code

● There is one unified Code Alert System for all health offices/agencies involved in emergency
response.
● Code Alert Levels for national events with mass casualty potential are declared by the Secretary
of Health.

Health Emergency Response Operations (HERO)

KEY LEARNING POINTS

III. Protocol for Raising and Downgrading of Code Alert

● Event monitoring, assessment, validation, recommendation, decision, and continued monitoring
are key steps.
● Upgrading, downgrading, and lifting Code Alerts are based on ongoing assessments.

IV. Purpose of Different Alert Codes

● The DOH Code Alert System provides a structured approach to preparedness and response during
mass casualty incidents.
● Four levels of DOH Code Alerts (White, Blue, Red, Orange) cater to various scenarios and
resource needs.

Health Emergency Response Operations (HERO)

KEY LEARNING POINTS

V. Human Resource Requirements of OpCen per Code Alert Level

● Each Code Alert Level requires a specific staffing complement at the
Operations Center (OpCen).
● Tasks of OpCen personnel vary by Code Alert Level, ensuring
efficient response and coordination.

Health Emergency Response Operations (HERO)

KEY LEARNING POINTS
White Alert: activated when there is a potential health threat that requires close monitoring, but no
immediate action is needed. Resources mobilized include surveillance and monitoring systems.
Blue Alert: activated when there is a potential health threat that requires immediate action, but the
situation is still manageable at the local level. Resources mobilized include local health resources and
personnel.
Red Alert: activated when there is a health threat that requires immediate action and the situation is
beyond the capacity of local health resources. Resources mobilized include national and international
health resources and personnel.
Orange Alert: activated when there is a health threat that requires immediate action and the situation is
beyond the capacity of national and international health resources. Resources mobilized include all
available resources and personnel.

Health Emergency Response Operations (HERO)

REFERENCES
Department of Health [DOH]. (2001). Administrative Order No. 182 series of 2001: Adoption and Implementation of Code Alert System for
DOH Hospitals During Emergencies and Disasters. Retrieved from: https://dmas.doh.gov.ph:8083/Rest/GetFile?id=336357
Department of Health [DOH]. (2008). Administrative Order No. 2008-0024: Adoption and Institutionalization of an Integrated Code Alert
System Within the Health Sector. Retrieved from: https://elibrary.judiciary.gov.ph/thebookshelf/showdocs/10/57484#:~:text=their
%20respective%20jurisdictions.-,Administrative%20Order%20No.,Health%20during%20emergencies%20and%20disasters.
Department of Health [DOH]. (2020, March 07) Health Secretary Francisco Duque III (2nd from left), along with other health officials,
confirmed that the DOH has raised "code red sub-level 1" alert on the Covid-19, in a press briefing [Image]. In Rocamora, J.A.L. (2020,
March 07). DOH raises 'code red' alert on Covid-19; confirms 6th case. Philippine News Agency.
https://www.pna.gov.ph/articles/1095869
Department of Health Health Emergency Management Bureau [DOH HEMB]. (2015). Manual of Operations on Health Emergency and
Disaster Response Management [PDF]. Retrieved August 1, 2023, from
https://hospitalsafetypromotionanddisasterpreparedness.wordpress.com/2015/11/04/manual-of-operations-of-health-emergency-and-
disaster-response-management-doh-hemb-2015/
Evidently Cochrane. (2020). Healthcare worker in PPE applying mask to patient with coronavirus infection [Image]. Retrieved August 1,
2023, from https://www.evidentlycochrane.net/wp-content/uploads/2020/04/healthcare-worker-in-PPE-applying-mask-to-patient-with-
coronavirus-infection-e1588063977244.jpg.webp

Health Emergency Response Operations (HERO)

01