Department of Health- RO VI

Violence and injury Prevention

Alliance (VIPA)

Violence and injury Prevention Program (VIPP)

 Administrative Order 2014-0007
NATIONAL POLICY ON THE ESTABLISHMENT OF PRE- HOSPITAL
EMERGENCY MEDICAL SERVICES (EMS)

EMERGENCY

DISPATCH
 EMERGENCY DISPATCH
Emergency Dispatch involves the immediate identification and prioritization of
emergency situations, the timely dispatch of the most appropriate resources
and full endorsement to the receiving hospital. Dispatch encompasses all
aspects of communication including request processing, coordination and
support, documentation and monitoring, and endorsement to the receiving
health facility or hospital.

OBJECTIVES
A. General:
To formulate standardized Emergency Dispatch Protocol in order to
institutionalize a comprehensive, accessible and integrated system of pre-
hospital emergency medical services (EMS) from the receipt of information of
an incident, response and care, transport to the appropriate health care
facility, inter-facility referral and until return of EMS team to the Emergency
Operations Center (EOC).

B. Specific:
a. To formulate written policies and procedures on emergency
communication facilities;
b. To formulate written policies and procedures on emergency
dispatch of personnel; and
c. To formulate written policies and procedures on expected response
time during emergency dispatch.

DEFINITION OF TERMS:
The following terms shall be defined as follows:

A. Ambulance – a vehicle designed and equipped for transporting sick or

injured patients to, from, and between places of treatment by land, water
or air, affording safety and comfort to the patients and avoiding
aggravation of illness or injury. This excludes rapid response vehicles such
as, but not limited to, motorcycles, cars and other vehicles designed to
transport patients but are not equipped to respond to medical
emergencies.

B. Basic Life Support (BLS) – constellation of emergency procedures

needed to ensure a person’s immediate survival including cardio-
pulmonary resuscitation, control bleeding, and treatment of shock and
poisoning, stabilization of injuries, and basic first aid. (WHO-Regional
Office for Europe, 2005)

A set of emergency procedures that consist of recognizing respiratory or

cardiac arrest and the proper application of Cardio-Pulmonary
 Resuscitation (CPR) with or w/o Automated External Defibrillation (AED)
or Foreign Body Airway Obstruction Management (FBAOM) and Rescue
Breathing (RB) or to maintain life until a victim recovers or advanced life
support is available. (AHA 2015 Guidelines)

C. Disaster Risk Reduction Management Office (DRRMO) – Shall be the

main unit in-charge during disasters networking other offices; involved
personnel during disasters shall also be the same personnel providing
care on day- to- day emergencies.

D. Dispatch Officer – a properly-trained person responsible for receiving

emergency calls thru the hotline numbers and hand-held radio; will select
appropriate units to respond to a particular call for assistance and in
providing callers with vitals instructions and initial information until the
arrival of EMS; monitors and relays information to the operations section
chief.

E. Emergency Dispatch – involves the immediate identification and

prioritization of emergency situations, the timely dispatch of the most
appropriate resources and full endorsement to the receiving hospital.
Dispatch encompasses all aspects of communication including request
processing, coordination and support, documentation and monitoring, and
endorsement to the receiving health facility or hospital.

F. Emergency Medical Services (EMS) Personnel – Trained and certified

personnel engaged in the provision of emergency medical services during
emergencies. Responders may either be health professionals or non-
health professionals.

G. Emergency Medical Services System (EMSS) – arrangement of

personnel, facilities, and equipment for the effective and coordinated
delivery of EMS required in the prevention and management of incidents
which occur either as a result of a medical emergency or of an accident. It
refers to the broad range of emergency care from pre-hospital care to
transport in an intensive care setting. (WHO-Regional Office for Europe,
2005)

H. Emergency Medical Technician (EMT) – a trained and certified healthcare

provider specializing in basic or advanced pre-hospital emergency medical
services.

I. Emergency Number – a standard telephone and/or cellular phone

number that directly connects to the emergency dispatch central
coordinating office for callers to access needed fire, police, and/or health
emergency services.

J. First Aid – provision of initial care for an illness or injury.

 K. Emergency Medical Responder (EMR) – A person who has the basic
knowledge and skills necessary to provide lifesaving emergency care
while waiting for the arrival of additional EMS help; formerly called First
Responder.

L. Health Facility/Hospital – referral facility where patients rescued or

responded are immediately taken unless request for another facility is
made by the patient or relatives.

M. Injury – a bodily lesion at the organic level, resulting from acute exposure
of energy (mechanical, thermal, electrical, chemical, or radiant) in amounts
that exceed the threshold of physiological tolerance. In some cases,
injuries, such as drowning and strangulation, result from insufficiency of
vital life-sustaining element, such as oxygen. (WHO, 2002)

N. Medical Director - a physician coming from the CHO/MHO/ PHO who

provides medical oversight and is responsible for ensuring that actions
taken on behalf of ill or injured people are medically appropriate.

O. Medical Oversight - the process by which a physician directs the

emergency care provided by EMS personnel to an ill or injured patient.
Also referred to as medical control or medical direction.

P. Offline Medical Direction - the medical supervision of EMS personnel

through the use of policies, protocols, standing orders, education, and
quality management review.

Q. Online Medical Direction - Direct communication with a physician (or his

or her designee) by radio or telephone, or face-to-face communication at
the scene, before a skill is performed or care is given.

R. Operations Officer – the officer who oversees the over-all dispatch

operations.
S. Pre-hospital Emergency Medical Services (EMS) – the range of
services delivered to emergency patients prior to hospital transport. These
services include, and may not be limited to, emergency dispatch;
emergency response and care; emergency transport; and inter-facility
referral and transport.

COMMUNICATION FACILITIES
 Legal Basis:

o Memorandum Circular (MC) 06-07-2016 dated July 21 - states that code

“911” shall be made available for the use of the Philippine government
o Memorandum Order (MO) 07-07-2016 dated July 20 – stipulates the use of
code 911 as emergency hotline number nationwide
o RA 10121, Sec 12 (c) (23) - Disaster Risk Reduction Management Act of
2010 stating the establishment of Provincial/City/Municipal/Barangay Disaster
Risk Reduction Management Operations Center

Emergency Operations Center (EOC)

Memorandum Order (MO) 07-07-2016 dated July 20, 2016, states that
“Due to the variance in the implementation of EMS system in the
country, it is directed that:

Local government units shall use their existing local hotline numbers
that will be contacted during emergencies. This hotline number shall only be
applicable within the jurisdiction of the LGU.”

The roles of the EOC manned by designated and trained dispatch officers at
the provincial, city/ municipality level shall include the following:

o Prioritization of emergency situations through phone triaging guided

by a chart/algorithm and description of symptoms from the caller
o Processing of requests / calls
o Coordination of EMS teams
o Recording / documentation and monitoring of outcomes that may
facilitate improvement of injury registry / database

Standardization of protocols including certification of trainings per level, phone

triaging shall be applied.

When receiving a call, the Dispatch Officer shall gather the following data:

a. Type of incident
i. Trauma
ii. Medical
b. Exact location/ landmarks
c. Number of patients
d. Extent of injuries
e. Nature of illness
f. Name of caller
g. Contact number of the caller
h. Weather condition on-site
 EMS TEAM COMPOSITION

Each EMS team shall have an adequate number of qualified, trained and competent
staff to ensure efficient and effective delivery of quality services.

The ambulance service provider to be dispatched shall consist of:

 A minimum of at least two (2) responders, excluding the driver.

 Additional staff depends on the nature of the emergency as determined by the
management of the service provider

EXPECTED RESPONSE TIME

Set standards for response time shall be attained depending on the:
o availability and accessibility of communication lines
o number of available teams
o back-up teams from neighboring municipalities
o quality of ambulances
o proximity of the station / base to the site of emergency including its
accessibility (geographic considerations)
o traffic situation
o quality and network of roads

Due to the variance in the implementation of EMS system in the country, the
expected response time from notification to the arrival on-scene:
o Urban Areas – 7-10 minutes
o Rural Areas – 25-45 minutes
o Geographically Isolated and Disadvantaged Areas (GIDA) –
more than 45 minutes

NORMAL DAY TO DAY OPERATIONS AT THE EMERGENCY

OPERATIONS CENTER: MEDICAL AND TRAUMA CASES

START

INFORMANT
(Provides Information about the patient, thru telephone, mobile phone, hand-held radio or walk-in)
 DISPATCH OFFICER
(Gathers, analyzes, and validates complete data from the informant)

ACTIVATION AND MOBILIZATION OF THE EMS TEAM TO THE LOCATION OF THE INCIDENT

REFER TO RESPONSE/TREATMENT PROTOCOL FOR SPECIFIC INCIDENT

DISPATCH OFFICER
MONITORS STATUS OF THE EMS TEAM
(Refer to the Reporting Protocol)

END

INCIDENTS INVOLVING MULTISECTORAL AGENCIES:

 SHOOTING INCIDENT, STABBING, MAULING/HACKING, CIVIL DISTURBANCE,
FIRE, DROWNING, ELECTROCUTION, BOMBING, MASS CASUALTY INCIDENT,
COLLAPSED STRUCTURE, HAZMAT START

INFORMANT
(Provides Information about the patient, throught telephone, mobile phone, hand-held radio or walk-in)

DISPATCH OFFICER
Gathers, analyzes, and validates complete data from the informant

DISPATCH OFFICER
VERIFIES/ VALIDATES/ COORDINATES INFORMATION TO SPECIFIC AGENCY INVOLVED

(PNP/K9/EOD/ BFP/ PCG/ Electric Company)

REFER TO RESPONSE PROTOCOL OF SPECIFIC AGENCY

EOC
ACTIVATION AND MOBILIZATION OF THE EMS TEAM TO THE LOCATION OF THE INCIDENT

REFER TO RESPONSE/TREATMENT PROTOCOL FOR SPECIFIC INCIDENT

DISPATCH OFFICER
MONITORS STATUS OF THE EMS TEAM
(Refer to the Reporting Protocol)

END

REPORTING PROTOCOL
 START

EMERGENCY CALL RECEIVED

EMS TEAM Dispatched Dispatched

EMS TEAM Arrives at the Scene

EMS team en route to the health facility

EMS team arrives at the receiving health facility

EMS team departs from the receiving health facility

EMS team back to the emergency operations center

END
 INFORMATION FLOW CHART

START

INFORMANT
(through hotline numbers, mobile phone or hand-held radio)
Relay complete details of incident to the Dispatch Officer

DISPATCH OFFICER
Gathers complete information from the informant/caller
(Type of Incident, Exact Location, Number of Patients, Extent of Injuries, Nature of Illness, Caller’s Telephone Number, and Caller’s Name

Relay Information to the Operations Officer at the EOC

NO Is Operations Officer Available? YES

Operations Officer Operations Officer

(Not Available) (Available)

EMS TEAM LEADER (Designate)

Analyze the situation and will activate team to respond
Operations Officer
Analyze the situation and activate the team to respond
(Upon arrival)
EMS TEAM Assess the area
Inform EOC regarding the situation on scene of Incident
Upon Arrival
Analyze the situation on scene Relay all information of the patient to the Dispatch Officer when transport is requ
Inform EOC about the situation.
the team is advised to call the Online Medical Doctor/Operations Officer for assistance
y all information of the patient to the Dispatcher when transport is requested

EMS DISPATCH OFFICER

Will inform Local Disaster Risk Reduction Management Officer about the incident such as Road Traffic Accident, Shooting incidents, MCI and the like.
Inform the hospital about the Patient Profile and relays the info from the receiving hospital personnel to the EMS team.

END
 START

WALK-IN INFORMANT
(thru hotline numbers, mobile phone or hand held radio)
Relay complete details of incident to the Dispatch Officer

DISPATCH OFFICER
Gather Complete Information from the informant/caller
(Type of Incident, Exact Location, Number of Patients, Extent of Injuries, Nature of Illness, Caller’s Telephone Number, and Caller’s Name

Relay Information to the Operations Officer at the EOC

Is Operations Officer Available?

Operations Officer Operations Officer

(Not Available) (Available)

EMS TEAM LEADER (Designate)

Analyze the situation and will activate team to respond
Operations Officer
Analyze the situation and activate the team to respond
(Upon arrival)
EMS TEAM Assess the area
Inform EOC regarding the situation on scene of Incident
Upon Arrival
Analyze the situation on scene Relay all information of the patient to the Dispatch Officer when transport is requ
Inform EOC about the situation.
the team is advised to call the Online Medical Doctor/Operations Officer for assistance
y all information of the patient to the ispatcher when transport is requested

EMS DISPATCH OFFICER

Will inform Local Disaster Risk Reduction Management Officer about the incident such as Road Traffic Accident, Shooting incidents, MCI and the like.
Inform the hospital about the Patient Profile and relays the info from the receiving hospital personnel to the EMS team.

END

Annex
PHASES OF DISPATCH

ALERT AND MOBILIZATION

 Once an alert was raised the EMS teams on duty, both medical & technical
rescue teams, must be on pre-deployment status and awaits command for
deployment.
 If a situation requires additional assistance, an alert will be sent through any
means of communication to other EMS teams who are not on duty.
 An alert shall be established by the EOC in order to properly notify EMS
teams.

PREPARATION FOR DISPATCH

 All EMS teams must be ready to be deployed as soon as dispatch order is
released by the EOC.
 The team leaders of the EMS teams must organize their members and assign
specific tasks.
 All responders must be in proper uniform, Identification and personal
protective gear (PPG).
 In the event of emergencies/ disasters, volunteers/staff must report
immediately to EOC for proper briefing, mobilization or deployment.

WHILE ENROUTE
• The EMS teams shall ensure that proper information regarding the
emergency call is acquired. (type of emergency, location, landmark and
present status).
• The EMS teams shall advise the EOC through radio of their deployment and
maintain constant communication while en-route to the scene.
• The EOC may recall its deployment command anytime in accordance with
the changes in the situation or when the emergency situation has been
lowered to stand-down.
• All emergency cases must be reported immediately to the EOC for proper
monitoring and assistance as needed by the team leaders.
• Status or condition of the patient/s must be regularly reported to the EOC.

ON-SCENE
 The EMS teams must observe and follow the chain of command and
operational structure at all times.
 The designated team leaders shall have the command and control on-scene
unless other personnel such as the operations officer, EMS technical staff and
officer-in-charge shall take over the responsibility. Proper turn over and
endorsement must be made.
 Status or condition of the patients must be regularly reported to EOC.
 In case of MCI or situations aggravating the incident and may require major
assistance, the team leader must inform the EOC for possible additional
deployment of EMS teams.
 Incident Command System must be established at all times.
 All EMS teams through the Field Command Post established must provide
constant communication and information of the present status on-scene and
movement of all personnel to the EOC.

Stand Down:
 The over-all team leader in the scene shall monitor the situation in the
emergency area, and upon confirmation of stand down, immediate report
must be given to all personnel in the ground and at the EOC
 For stand down, the team must advise the EOC that they will be returning to
base.

EMS OPERATIONAL CHART for SPECIAL EVENTS

 (Mass Casualty Incident, Search and Rescue)

1.) PREPARATION 2.) ACTIVATION and

MOBILIZATION

4.) DEACTIVATION 3.) OPERATIONS

And

3.1 SECURING THE AREA

5.) POST-OPERATIONAL

ACTIVITIES 3.2 INITIAL ASSESSMENT

3.2.1 COMPILE
INFORMATION 3.3 SEARCH and LOCATE

3.2.2 COMMAND POST

3.4 GAIN ACCESS TO
PATIENT

3.2.3 OPERATIONAL
OBJECTIVES
3.5 STABILIZE THE
PATIENT
3.2.4 ASSIGN TASK

3.6 EXTRICATE THE

PATIENT
3.2.5 REASSESS and
ADJUST
PHASE 1. PREMOBILIZATION

1. Brief team members.

2. Ensure availability of personal protective gear (PPG).
3. Ensure availability of tools and equipment. Very important to maintain
them in proper working condition and ready for mobilization to work site
PHASE 2. MOBILIZATION (Upon receipt of request to respond)
1. Request transportation.
2. Pack and load equipment.
3. Notify team members.
4. Obtain information on incident. This includes information such as type,
location and topography, magnitude/area, number of people affected,
number of buildings affected, weather, access routes.

PHASE 3. OPERATIONS

STAGE 1: SECURING THE AREA

STAGE 2: INITIAL ASSESSMENT

The initial assessment consists of the following:

Step 1: Once at the scene, consult local authorities, gather data and conduct
a needs analysis. Confirm and update all information obtained in the
activation phase.

Step 2: Establish Command Post.

Step 3: Establish operational objectives, such as:

 general access to the disaster site
 strategic planning and priorities
 allocating resources and personnel
 managing operations

Step 4: Assign tasks to rescue squads.

Step 5: Reassess the situation and make necessary adjustments.

STAGE 3: SEARCH AND LOCATE

Conduct a search using a specific set of techniques to obtain a response or
indications of the presence of live victims in a void space inside a collapsed
structure.

STAGE 4: GAIN ACCESS TO THE VICTIM

Remove rubble, break and breach materials and create a passageway to

access the void space where a live victim is believed to be located.

STAGE 5: STABILIZE THE VICTIM

Perform basic life support on-site before extricating the victim in order to
improve later chances of survival.
STAGE 6: EXTRICATE THE VICTIM

Remove rubble surrounding the victim, ensure no further injury. Ensure no

additional pressure is applied to any trapped portions of the body. Turn over
the victim to a more advanced medical care after extrication.

PHASE 4: DEMOBILIZATION

1. Confirm no other operations are needed.

2. Account for all tools and equipment. Prepare tools and equipment and
pack them for transportation.
3. Confirm that personnel have all their personal items.
4. Arrange for transportation.

PHASE 5: POST- OPERATIONAL ACTIVITIES

1. Psychological First Aid

2. Medical examination for rescue personnel.
3. Equipment rehabilitation.
4. Operational debriefing with rescue team.
5. After-Action Report for institutional management.

REFERENCES:
o Department of Health, Department Order No. 2014 –007
o Memorandum Circular (MC) 06-07-2016
o Memorandum Order (MO) 07-07-2016
o RA 10121, Sec 12 (c) (23)
o Aehlert, Barbara, Emergency Medical Technician EMT in Action, Page 244-
253, McGraw-Hill, 2009
o Burea of Fire Protection Operational Procedures Manual Emergency Medical
Services/ Special Operations 2015
o National Emergency Response Association (NERA) 3P’s
o PNP
o Iloilo PDRRMO
o Iloilo CDRRMO
o Bago CDRRMO
o Oton MDRRMO
o Capiz PDRRMO
o Western Visayas Medical Center