Insight /Report on Milenyo’s Passing Through Manila Doctors Hospital – circa 2006
Insight /Report on Milenyo’s Passing Through Manila Doctors Hospital
Reynaldo O. Joson, MD
Chair, Disaster Preparedness Committee
October 9, 2006
Last September 28, 2006, Milenyo (international codename “Xangsane”) wrecked havoc in Metro Manila. Manila Doctors Hospital was also affected.
The night before, there was already announcement of suspension of classes and government offices in anticipation of arrival of Milenyo. Early morning of September 28, 2006, I told members of my family to stay home. I cancelled the 8 am Thursday Conference of the Department of Surgery of Ospital ng Maynila Medical Center. Initially, I was thinking of staying home too. However, for one reason or another, probably because of the ongoing internal quality audit, I decided to proceed to Manila Doctors Hospital.
At around 11:00 o’clock in the morning, after auditing Pulmonary Care Services, I saw and felt the strong winds of Milenyo at the entrance of the hospital at United Nations side. There were already advices from the Security Services to move all cars parked under the trees in front of MDH. Mr. Willie Sembran also reported to me on the physical damages outside the NICU and other parts of the hospital.
Realizing that Milenyo had arrived and posing threats to staff, patients, and visitors of the hospital as well as its physical structures, in the absence of Atty. Pilar Almira and Dr. Rex Mendoza who were attending the convention of Personnel Management Association of the Philippines and in the absence of Dr. Dante Morales, who was not in the hospital during this time, I decided to take the role of an “officer-in-charge” of the hospital. I made rounds of the DSMT, NTMT, Main Building, and DEMS. I coordinated with Engr. Mendoza, Mr. Henry Galang, Ms. Rosie de Leon, Dr. Beth Asa, Mr. Benhur Bernardo, Mr. Gerardo Ramos, Mr. Celso Lizano, Mr. Paul Buenconsejo (who was at the hospital at this time) and Dr. Morales (who arrived later in the afternoon).
At the end of the day, damage to physical structures was the main havoc brought by Milenyo. Except for one staff who got a minor injury in the course of controlling the structural damages, there were no other physical injuries reported. There was no flood inside the hospital.
- Not all typhoons are automatically categorized as disasters. A criterion that can be used to say that a particular typhoon should be considered as a disaster is one that causes or has the potential of causing extensive damage to properties and injuries to people. In line with the community parlance and perception, I think typhoons with at least signal no. 2 should be considered a disaster already. Thus, the disaster preparedness plan of the hospital or unit should be activated already.
Milenyo carried a signal no. 3. It created extensive damage to properties outside and inside Manila Doctors Hospital and caused significant injuries to people outside MDH. Thus, it rightfully should be considered as a disaster. I did not formally activate the hospital disaster preparedness plan but somehow informally we activated it through mobilization of staff, particularly, the staff of Facilities Management Department and Housekeeping and Linen Services.
Lesson: From hereon, if there is a typhoon with at least signal number 2 in Metro Manila, a disaster should be declared and a typhoon disaster response plan should be activated. We have to come up with a typhoon disaster preparedness and internal response plan.
- I did not formally declare a disaster and did not formally activate the hospital disaster preparedness plan. I made my rounds in the entire hospital. I had to shift from one place to another to oversee and control activities. I did not create an incident central command. I was just relying on reports of Engr. Mendoza and Mr. Willie Sembran. I did not receive reports from DEMS, Nursing Service, and other areas. I got to know the problems in the areas only when I visited them. At the end of the day, I was physically exhausted. I felt there was no timely arrival of information to me as the “officer-in-charge” as there was no declaration of central command.
Lesson: From hereon, create an incident central command just as with other types of disasters. Have radios for communication. During the Milenyo typhoon, there were no signals for some cellphones. Suggest having 5 more radios to be reserved / used by hospital director, administrative director, nursing director, medical director, and disaster control officer during times of disasters. These radios should be kept in the FMD and distributed to members of the incident command during disasters.
- There should be a brown- / black-out disaster preparedness and response plan. We have one but this has to be reviewed. Generators are the usual answers to brown- / black-out in hospitals. Issues to address: 1) How fast can the generators be activated? This is crucial in critical care areas such as intensive care unit, neonatal care unit, operating room, delivery room, and emergency room. 2) What is the capability of the generators to allow continuous operations of medical equipment? In the Department of Radiology, I was initially told that x-ray procedures could not be done because the power of the generators was not enough. Portable x-rays can be used though. 3) Which areas should be provided with power run by generators? Several doctors were complaining they did not have lights inside their clinics.
Lesson: Review the brown- / black-out disaster preparedness and response plan for the entire hospital and specific areas such as the X-ray Department and Doctors’ Clinics.
- There was clogging of / traffic in the DEMS, mainly because of slow disposition and transfer of patients. For the latter, one cause was the inability of X-ray Department to do x-ray for DEMS patients – five patients with possible fractures waiting. Second, was the ERO’s waiting for the residents to make the necessary admitting orders. When there was problem with the x-ray, I told the ERO to just admit the patients and let them wait in the rooms. The initial response was yes. When I came back 30 minutes after, the patients were still there. I was told that the ERO was still waiting for the ortho / surgery residents to make the admitting orders.
Lesson: Review the system in the DEMS that will promote a fast-turnover of patients to make it vacant most of the time, ready to admit new patients.
- Milenyo’s strength was pre-announced. A lot of staff at about 11 am were asking me whether they can go home, for fear they might not be able to go home later in the afternoon. If they go home, what is the implication on their salary? Upon approval of the Hospital Director, I decided to let the unit heads decide whether they could go home or not. If they go home, the under time will be charged to their vacation leave.
Lesson: We have to come out with a clear-cut policy and procedure on reporting and dismissal of employees during times of disasters, particularly typhoons, together with the salary and wage implication. Some of the issues to be addressed:
In case of pre-announced typhoon with signal number 2, should all employees report for work?
In case of on-going typhoons with signal number 2, should we allow employees to be dismissed to go home?
What to do if employees cannot go home because of the typhoons?
What are the implications on salaries and overtime pay?
Note: Practically all the physical damages had been fixed through the effort of Engr. Rizaldy Mendoza.