Institutionalization of an Integrated Code Alert System for

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Code Alert System April 01, 2008

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INSTITUTIONALIZATION OF AN INTEGRATED CODE ALERT SYSTEM FOR THE DEPARTMENT OF HEALTH (A.O. 0024)

CODE ALERTLEVEL

HEMS CENTRAL OFFICE HOSPITAL CENTER FOR HEALTH DEVELOPMENT DOH CENTRAL OFFICES

CODE WHITE1. Conditions for Adopting Code White: ̈ Strong possibility of a military

operation e.g. coup attempt/ armedconflict which have a nationalimplication ̈ Any planned mass action ordemonstration which have a nationalimplication ̈ Forecast Typhoons (signal 2 up) ̈ National or local elections and otherpolitical exercises ̈ National events, holidays orcelebrations with potential for MCI ̈ Any emergency with potentially 10-50 casualties (deaths, injuries)

¨ Notification of reliable information of terrorist/ attack activities ̈ Any other hazard that may result toemergency ̈ Unconfirmed report of reemergingdiseases eg. bird flu, SARS

1. Conditions for Adopting Code White: ̈ Strong possibility of a military operationwithin the area/ region e.g. coup attempt ̈ Any planned mass action ordemonstration within the catchment area ̈ Forecast Typhoons, (signal 2 up) thepath of which will affect the area ̈ National or local elections and otherpolitical exercises ̈ National events, holidays, or celebrationsin the area with potential for MCI ̈ Any emergency with potentially 10-50casualties (deaths, injuries) ̈ Any other hazard that may result toemergency

¨ Unconfirmed report of reemergingdiseases eg. bird flu, SARS

1. Conditions for Adopting Code White: ̈ Strong possibility of a militaryoperation e.g. coup attempt within theregion ̈ Presence of hazards that pose a publicthreat such as epidemics, chemical,biological and radiological threat, etc. ̈ Notification of on-going epidemic byLGU, with adequate measures by localhealth personnel. ̈ Any planned mass action ordemonstration in the area ̈ Forecast Typhoons (signal 2 up) thepath of which will affect the region ̈ National or local elections and other

political exercises ̈ National events, holidays orcelebrations with potential for MCI ̈ Any emergency with potential 10-50casualties (deaths, injuries)

¨ Any other hazard that may result toemergency ̈ Unconfirmed report of reemergingdiseases eg. bird flu, SARS

1. Conditions for Adopting Code ̈ Strong possibility of a operation e.g. coup attempconflict which have a implication ̈ Any planned mass demonstration which have aimplication ̈ Forecast typhoons (Signal 2 u ̈ National or local elections apolitical exercises ̈ National events, holidcelebrations with potential for ̈ Notification of reliable informterrorist/ attack activities

¨ Any other hazard that mayemergency ̈ Unconfirmed report of rediseases eg. bird flu, SARS

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CODE ALERTLEVEL


CODE WHITE2. Human Resource requirements for

responding to the Code: ̈ Emergency Officer on Duty (EOD) 1and 2

¨ Driver and Security Guard to assistat the Operation Center ̈ Reliever 1 and 2 (next day EOD s) onstand by ̈ Response Division Chief or alternateon continuous monitoring and willserve as Medical Controller for MassCasualty Incident.

2. Human Resource requirements forresponding to the Code:

Manpower

̈ First response team ready for dispatch to

include the following:ü 2 doctors preferably Surgeon,

Internist, anesthesiologist, etc.ü 2 nursesü First Aider/ EMTü Driver ̈ Second response team should be on call ̈ The following should be available forimmediate treatment of incomingpatientsü General Surgeonsü Orthopedic Surgeonsü Anesthesiologists

ü Internistsü O.R. Nursesü Ophthalmologistsü Otorhinolaryngologistsü Infectious Specialists ̈ Emergency service personnel, nursingpersonnel and administrative personnel

residing at the hospital dormitory shall beplaced on call status for immediatemobilization

2. Human Resource requirements forresponding to the Code: ̈ 2 Emergency Officers on Duty ̈ Driver

¨ Regional HEMS Coordinator on call andon proactive monitoring ̈ One Rapid Assessment Team ready fordispatch to include the following:ü DOH Representativeü Nurseü Driver

2. Human Resource requiremresponding to the Code:

¨ Concerned Division Ch

alternates of the followinshould be on stand by:ü Material Management Divü Finance Serviceü Administrative Serviceü Procurement and Logistiü National Epidemiology Ceü National Center for Healtü Media Relations Unitü National Center for

Prevention and Controlü National Center for

Facilities and Developmeü Bureau of Quaran

International Health Surv

ü Bureau of Food and Drug








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CODE ALERTLEVEL


CODE WHITE3. Other requirements: ̈ EOD 1 to check all medicines,

supplies available ̈ EOD 1 & 2 to do proactivemonitoring ̈EOD to alert the region, hospitalsand other facilities that might beaffected or needed to respond orreceive patients. ̈ Response Division Chief or HEMSDirector to alert key officials asneeded ̈ EOD to i nform National EpidemiologyCenter regarding outbreaks forconfirmatory report.

3. Other requirements: ̈ The Hospital s Operation Centershould be activated. It shouldcontinuously report and coordinate withthe Regional and DOH Central Operation

Centerv Medicines and Supplies ̈ Ensure that emergency medicines(especially for trauma needs) be madeavailable at the emergency room ̈ Medicines and supplies in the operatingrooms should likewise be reviewed andincreased to meet sudden requirements ̈ Other needs such as x-ray plates,laboratory requirements, etc. should bemade available and not required to bepurchased by victims ̈ Personnel department to prepare formobilization of additional staff ̈ Finance department to ensure availability

of funds in cases of emergencypurchases and the like ̈ Logistics department to coordinate withpossible suppliers for additionalrequirements ̈ Dietary department to open and meetthe need of the victims as well as thehealth personnel on duty ̈ Security force to institute measures andstricter rules in the hospital ̈ Activate Bird Flu Plan/ SARS Plan etc. ̈ Enforce and monitor use of personalprotective equipment (PPE) for all healthpersonnel. ̈ Triage system should be activated.

3. Other requirements: ̈ The Regional Operation Center shouldbe activated on 24 hours andContinuously report and coordinate withHEMS Operation Center ̈Do proactive monitoring for anydevelopment ̈ Report to HEMS-OPCEN daily and asnecessary ̈ Require update from field as necessary ̈ Finance Division to ensure availability of funds in cases of emergency purchasesand the like ̈ Supply section to coordinate withpossible suppliers for additional

requirements ̈ Transport section to ensure availability of vehicles ̈ Monitor and assess continuously forrequirements of other teams (medical,

surveillance, environmental, healthpromotion, psychosocial etc.). Theseteams are on standby/ on call forimmediate mobilization.

¨ Intensify IEC campaign through healthadvisories

¨ Coordinate regularly with affected LGUs ¨ Coordinate with Regional hospitals for

back-up teams ̈ Monitor stock level of needed drugs/supplies, preposition as needed. ̈ Activate Bird Flu Plan. ̈ Mobilization of RESU team to conductinvestigation for outbreaks.









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CODE ALERTLEVEL


CODE BLUE 1. Conditions for Adopting Code Blue v Any condition mentioned in

Code White plus any of the twobelow: ̈ Mobilization of DOH resources is

needed (manpower, materials, etc.) ̈ 30-50% health facilities in the areas

affected or damaged ̈ No capability of the LGU and/ or lack of resources of the Region torespond to the affected area ̈ Magnitude of the disaster based ongeographic coverage and number of affected population (more than30%) ̈ Any Mass Casualty Incident (MCI)

with 50-100 casualties irrespective of color code

¨ High case fatality rate for epidemics

¨ Confirmed human to human for

avian flu or SARS.

1. Conditions for Adopting Code Blue:v Any of the following conditions: ̈ When 20-50 casualties (red tags) are

suddenly brought to the hospital ̈ Any internal emergency/ disaster in the

hospital which brings down theiroperating capacity (i.e vital areas) to

50% or which would require evacuationof patients and setting up of a FieldHospital ̈ For conditions other than MCI, the influxof patients is beyond the capacity of thehospital to handle. ̈ Confirmed/ documented report of reemerging diseases (SARS, human tohuman avian flu) within the catchmentarea.

1. Conditions for Adopting Code Blue:v Any of the following conditions: ̈ 50-100 casualties irrespective of tags

for MCI. ̈ Declaration of epidemic ̈Declaration of calamity in any provincein the region ̈ Presence of evacuation centersestimated to last for more than a week which has public health implications ̈ Magnitude of the disaster based ongeographic coverage and number of affected population (more than 30%) ̈ Any conditions that would requiremobilization of resources of the entire

region

1. Conditions for Adopting Codev Any condition mentioned in

White plus any of the two be ̈ Mobilization of DOH resoneeded (manpower, materials ̈30-50% health facilities in affected or damaged ̈ No capability of the LGU and/resources of the Region to rethe affected area ̈ Magnitude of the disaster geographic coverage and naffected population (more tha ̈ Any Mass Casualty Incident (50-100 casualties (mortalitinjuries) irrespective of color c ̈ High case fatality rate for epconfirmed/ documented rreemerging diseases (SARS, human Avian flu)









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CODE ALERTLEVEL


CODE BLUE 2. Human Resource requirements forresponding to the Code:

̈ Response Division Chief or HEMS

Director should be physically presentat OPCEN ̈ EOD 1 and 2 ̈ Driver and Security Guard to assistat the Operation Center ̈ Incoming EOD s on call forimmediate mobilization ̈ Logistics Officer or alternate to goon duty ̈ At least one DOH representative togo on duty to NDCC if requiredand/or requested


̈ HEMS Coordinator to be physically

present at the hospital ̈ On-Scene Response Team ̈ Medical Officer in charge of theEmergency Room ̈ All residents of the Department of Orthopedics ̈ Medical Officer in charge of theOperating Room ̈ Surgical Team on duty for the day ̈ Surgical team on duty the previous day ̈ Mental health professionals ̈ All anesthesiology residents ̈ Toxicologist, chemical experts forpoisoning and/ or chemical cases (if available)

¨ All third and fourth year residents ̈ Administrative Officer or designate ̈ Nursing supervisor on duty ̈ All OR nurses ̈ Social workers ̈ Dietary personnel ̈ Officer in charge of supplies at the CSR ̈ The entire security force and ̈ Institutional workers on duty


¨ RHEMS Coordinator to be physicallypresent at OPCEN ̈Rapid Assessment Teams and otherappropriate teams (RAT) ̈Three (3) teams on standby(environmental/ surveillance/ medical) ̈EOD 1 and 2 ̈Logistics Officer ̈Finance Officer as necessary ̈Health Promotions Officer as necessary ̈Driver ̈ All other regional staff on standby for

immediate mobilization ̈ All DOH REPS in the affected area shouldbe available at the LGU

2. Human Resource requirementresponding to the Code:

¨ Director or designate to be p

the respective officesü Material Management Divisioü Finance Serviceü Administrative Serviceü Procurement and Logistics Seü National Epidemiology Centerü National Center for Health Prü Media Relations Unitü National Center for Disease P

and Controlü National Center for Health

and Developmentü Bureau of Quarantine & Inte

Health Surveillanceü Bureau of Food and Drug








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CODE ALERTLEVEL


CODE BLUE Other requirements: ̈ Coordinate with the following:ü Implementing agencies

(hospitals, region, central office)for possible dispatching of

teams or expertsü NDCC and other sectors for

other concerns e.g.transportation, etc.

ü MMD regarding suppliesavailable at DOH

ü Different DOH Central Officesfor personnel augmentation tothe Operation Center and forother technical support ̈ Prepare possible drugs and

medicines needed for movement toaffected area ̈ If needed drugs/medicines notavailable, prepare emergencypurchase ̈ Check all possible means of transportation ex. With NDCC, aircargo, etc. ̈ Anticipate need of medical teamsand other experts ̈ Prepare all needed reports and

presentation required especially foremergency NDCC meetings ̈ Orient staff to be deployed to NDCCand those additional staff toaugment the OPCEN ̈ In cases of long term emergencies,plan for support to the affectedregion.

Other requirements: All those mentioned in Code White plus ̈ Activate Hospital Emergency Incident

Command System (HEICS) ̈ Other needs of victims apart from

medicines and supplies depending on thedisaster should as much as possible be

made available ̈ The Chief of Hospital/ Medical Center or hisdesignate should make proper coordinationwith other hospitals for networking and/ orpossible transfer of patients. ̈ Incident Commander should assign aSafety Officer, Liaison officer, to coordinatewith other agencies and Public InformationOfficer to serve as the spokesperson of thehospital. ̈ Social Service section should prepareassistance to victims in coordination with

mental health professionals of the Hospital

if available and the Department of SocialWelfare; in addition they should lead inproviding information to relatives of victims ̈ Mortuary section should anticipate deadvictims brought to the hospital for propercare and identification ̈ The security team in anticipation of possible influx or patients, relatives,responders, police, press etc. should ensuresmooth flow of traffic inside the compoundespecially for the ambulances. ̈ Should report regularly to HEMS OPCENand as much as possible have a regularpress release or briefing.

Other requirements: All those mentioned in Code White plus: ̈ Activate the Regional Emergency

Incident Command System (REICS) ̈ Operation Center on 24/7 with adequate

personnel and logistical support toreceive, evaluate, analyze all reports. ̈ Mobilize teams to affected areas forRapid Assessment in coordination withthe DOH Rep ̈ Regional Director or his designate tomake proper coordination with RDCC andother agencies like DSWD, DEPED etc.for networking and other requirements ̈ Incident Commander should assignneeded staff in Operations, Logistics,

Planning and Administrative to assistaffected LGU s ̈ Public Information Officer to prepare andhave regular media conference or pressrelease. ̈ Continuous IEC campaign through healthadvisories especially in evacuationcenters. ̈ May need to activate also a Field EOC as

needed to coordinate health activities ̈ Oversees operation of Management of Mass Dead together with the Health unitof the LGU concerned ̈ Leads in coordinative meetings of thedifferent cluster under the DOH: Health,Nutrition and WASH. ̈ Provides technical support to LGU s.

Other requirements: Activate the following offices:

§ Material Management Divisiü Ensure availability of staff to

all medicines and supplies neeü

Ensure that the medicines anbe transferred to the affevia NDCC arrangement or oth

ü Ensure the presence of the iteam (DOH and BFAD Teams)

§ Finance Serviceü All unit heads must be av

facilitate release of fundsü Petty cash must be in place ü Facilitate in the travel arran

and other requirements inlocal or international teams to

§ Administrative Serviceü Should ensure availability o

with drivers, gasoline/diesel eü Should ensure the prov

electricity/ generator in allresponding to the emergencyat the Central Office

ü Should ensure availability communication lines specially

ü Security Force to institute stricter rules at the DOH Com

ü Assist MMD in the prepmedicines and supplies and tthis to airports etc,

ü Facilitate arrangement with tfor the travel of medical team

§ National Epidemiology Centü Ready surveillance and

investigation team and expe

deployed as needed.









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CODE ALERTLEVEL


CODE BLUE ̈ Activate Code Blue for HEMS andprepare necessary documentation

¨ Initiate the conduct of coordinativemeeting of the national clusters:Health, Nutrition and WASH

̈ Mobilize other requirements as neededsuch as psychosocial team etc.

¨ Regularly coordinate with DOH-HEMS

OPCEN for reports and other needs.

§ Procurement Divisionü Should ensure the availability

qualified & responsible pharmcompanies and other supemergency procurement of dmedicines.ü Should facilitate procure

emergency drugs/ supplies as

§ National Center for HealthPromotion (NCHP) and Medü Should ensure their availa

assist and provide technical ato HEMS and Regional Officconceptualization and develobehavioral messages and IEC

ü Should assist Regional Officconduct of Health Education a

ü Assist in documentation of eve§ Media Relations Unit (MRU)ü Anticipate any untoward med

and recommend necessary resü Prepare press releases and

statement ü Recommend and organiz

conference and other mediaradio and television appearan

ü Coordinate with HEMS for inputs

§ National Center for DiseasePrevention and Control (NCDü All Program Managers with co

disaster should be available technical support such communicable disease, envirnutrition, sanitation, psychoso

ü Provide treatment proto

necessary.ü Standby experts to be mo

affected area.









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CODE ALERTLEVEL


CODE BLUE ¨ ¨ § National Center for Health FDevelopmentü Technical support for hospita

be readily available espe

infrastructure concerns.ü There should be protocol

movement of blood requirememergencies especially foCasualty Incidents. Blood intelective can be realigned foof victims

ü Provide technical support sphospital management.

§ Bureau of Food and Drugü Ensure the presence of the ins

team to issue certificate of cl efor drugs and medicines

ü Facilitate requirements andcertification for donated medi

§ Bureau of Quarantine & International Health Surveiü Will only be activated in the p

of cases of reemerging diseasas SARS and Avian Flu which international surveillance in aentry and other emergencies incoming and outgoing transp

* Have regular coordination with

HEMS








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CODE ALERTLEVEL


CODE RED 1. Conditions for Adopting Code Red

Any natural, manmade,technological or societal disaster,

where all of the following arepresent: ̈ Declaration of disaster to theaffected area ̈ 100 or more casualties in one area ̈ Health personnel in the region notcapable to handle entire operation ̈ Mobilization of the health sectorneeded ̈ Mobilization of key offices in DOH ̈ Uncontrolled human to humantransmission of SARS/ Avian Flu

1. Conditions for Adopting Code Red

Any of the following is present: ̈When more than 50 (red tag) casualties are

suddenly brought to the hospital ̈ An emergency wherein the services of thehospital is paralyzed due to 50% of themanpower are themselves victims of thedisaster ̈Hospital is structurally damaged requiringevacuation and/or transfer of pa tients ̈Conditions requiring mandatory quarantineof hospital and its personnel (e.g. sars,avian flu); Uncontrolled human to humantransmission of SARS/ Avian Flu within thecatchment area.

1. Conditions for adopting Code Red

Any of the following is present: ̈ Conditions resulting to mass dead and

missing ̈ Disaster declared in 2 or moreprovinces in the region or 30% of thecities in Metro Manila. ̈ Major Facility or Hospital such as theProvincial/ City/ Hospital in area arenot able to provide optimal servicesdue to damages or 50% of staff areaffected ̈ Mobilization of entire regionalresources not enough and thus requireexternal support

¨ Uncontrolled epidemic/ outbreak ¨ Uncontrolled human to human

transmission of SARS/ Avian Flu

1. Conditions for adopting Code

Any natural, manmade, techor societal disaster where a

following are present: ̈Declaration of disaster to the

area ̈100 or more casualty in one are ̈Health personnel in the recapable to handle entire operati ̈Mobilization of health sector nee ̈Mobilization of key offices of Deof Health

¨ Uncontrolled human to transmission of SARS/ Avian Fregion








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CODE ALERTLEVEL


CODE RED 2. Human Resource requirements forresponding to the Code:

The HEMS Office personnel and staff augmentation from other offices shall bedivided into 3 teams to go on a 24 hour dutyrotation every 3 days. The team iscomposed of the following: ̈ Team Leader ̈ 2 Data Collector/ Encoder ̈ Logistics ̈ Communication ̈ Administrative Officer ̈ Support Staff/ Clerk ̈ Driver ̈ At least 1 staff to be assigned at

OCD OPCEN on 24 hours duty


¨ All personnel enumerated under Code Blue ̈ All medical interns and clinical cl erks ̈ All nurses ̈ All nursing attendants ̈ All institutional workers ̈ All administrative staff


¨ Mobilize all regional staff as needed onrotation basis ̈Establish surveillance system in allevacuation centers ̈ All other teams deployed in affected area

2. Human Resource requirementresponding to the Code:

¨ All services should eavailability of staff for 24 address all requests for technicas other logistical support.

ü






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CODE ALERTLEVEL


CODE RED v Other requirements

̈HEMS to represent the Department of

Health to NDCC and other agencies. ̈Leads in the coordination withinternational partners in the Health,Nutrition and WASH Clusters. ̈Leads in the coordination with allmembers of the health sectors ̈Leads in the coordination with donoragencies both international and local. ̈Prepares updated reports for use of Secretary, and other partners ̈ Assists in the preparation of therehabilitation and recovery plan;

represent the DOH in the nationalDANA team ̈HEMS-OPCEN to serve as DOH

Command Post. ̈Recommends the activation of theCrisis Committee who serves as thetechnical, operations arm and preparesrecommendation to the ExecutiveCommittee of DOH to be chaired bythe Undersecretary for Policy

Development Team for ServiceDelivery and to be assisted by theDirectors of HEMS, NEC, NCDPC,NCHFD, Finance, Administrative andMMD

v Other requirements

All those mentioned in Code Blue plus:

¨ The Chief of Hospital/ Medical Center Chiefscan cancel all types of leaves and can orderall personnel to report to the hospital ̈The Chiefs of Hospital/ Medical Center Chiefs

can temporarily stop all elective admissionsand surgeries and network with otherhospitals ̈The Chief of Hospital/ Medical Center Chiefsshould anticipate requests of additional manpower and specialists notavailable in his hospital. He is furtherauthorized to accept medical volunteers andother professionals to augment it s manpowerresources rather than transferring patients

based on some agreements.

¨ Networking with other hospitals foraugmentation of resources and transfer of patients in special cases ̈ Answers all queries of the media pertaining topatients in the hospital ̈ Anticipate evacuation and/ or use of fieldhospital; closure and/ or quarantine of thehospital ̈The Chief of Hospital/ Medical Center Chief to

specifically be concerned with safety andsecurity, not only the patients but thepersonnel as well.


All those mentioned in Code Blue plus:

¨ The CHD Director can cancel all types of leaves and can order all personnel to reportto the CHD. ̈The CHD Director can stop all operations

not related to the disaster. ̈The CHD Director should anticipate requestof additional manpower and specialists notavailable in his CHD. He is furtherauthorized to accept volunteers and otherprofessionals to augment it s manpowerbased on some agreements. ̈Continue networking with RDCC and itsClusters (Health, Nutrition, WASH). ̈ Public Information campaign. ̈Handles queries from media.

¨ For reemerging diseases, to provideleadership together with the LGU indecisions like quarantine of the area andother decisions in preventing spread of theepidemic. ̈Provide updated report to HEMS CentralOPCEN.


̈Each Office to deploy one pers

augment HEMS Central Operatioand NDCC Operation Center ̈DOH Crisis Committee to convprovide overall support, direction a

directions to affected regions. they can call on any other otechnical and management suppor ̈ All Directors or Designates (above) to report 24/7 to OperaCode Red is activated. ̈Other Offices/ units shall be orequired to report to OPCEN as ideneeded by the Crisis Committee.






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CODE ALERTLEVEL


CODE RED v Guidelines in implementing theCode Alert ̈ The HEMS Code Alert shall be

declared by the HEMS Director or bythe Division Chief (Response orPreparedness).

̈ Announced through telephonebrigade. ̈ Administrative Officer to prepareOffice Order/ Department PersonnelOrder. ̈ HEMS Director or the Division Chief (Response or Preparedness) lifts theCode Alert and make necessaryannouncement.

v Guidelines in implementing the Code Alert ̈The Hospital Code Alert shall be declared

by the Secretary of Health or by theDirector of HEMS for external emergencies;by the Medical Center Chiefs; Chiefs of Hospital; HHEMS Coordinator; Head of theDisaster Committee of the Hospitalemergencies within their catchment area. ̈Chiefs of Hospital/ Medical center Chiefs toautomatically declare Code White duringnational events and activities especiallywith the potential of an MCI ̈Each hospital shall prepare it s ownprocedures in declaring and lifting theCode.

v The alert level is raised, lowered orsuspended by the Secretary of Health,Director of HEMS for external emergenciesand national events; the respective Medical

Center Chiefs/ Chiefs of Hospital or theirdesignates for emergencies within theircatchment area.

v Conditions to raise or suspend the alertlevel depends on the threat whether it isincreased or is no longer present.

v Arrival of patients in the hospitals warrantthe raising of the alert level; likewise alertcan be suspended when no significantincident is monitored and the hazard orcondition (typhoon, election, bombing etc.)is finished and/ or contained

v Guidelines in implementing the Code Alert ̈The Regional Code Alert shall be declared

by the Secretary of Health or Director of HEMS for emergencies with nationalimplications; Regional Director andRHEMS Coordinator for internal(regional) emergencies ̈Regional Directors to automaticallydeclare Code White during nationalevents and activities especially with thepotential of an MCI ̈The alert is raised, lowered or suspendedby the Secretary of Health, HEMSDirector for emergencies with nationalimplications; by the respective RegionalDirector or RHEMS Coordinator for

internal (regional) emergencies ̈Each Region shall prepared it s ownprocedures in declaring and lifting theCode

v Conditions to raise or suspend the alertlevel depends on the threat whether it isincreased or is no longer present.

v Guidelines in implementing th Alert

̈The Central Code Alert shall beby the Secretary of Health recommendation and evaluatioDirector of HEMS for natmanmade emergencies with implications; for epidemireemerging diseases by Directoand NCDPC ̈This will be disseminated thDepartment Memorandum; HEMmay call through a telephone bOffices concerned; this will followed in lifting the Code






Documents

Institutionalization of an Integrated Code Alert System for