1. ROAD SAFETY FORUM 2014 Road Safety: Everybody’s Responsibility PNP Multi-Purpose Center, Main Hall National Headquarters Camp Crame Quezon City, Metro Manila May 16, 2014 8:00 AM – 5:00 PM

2. DOH RESPONSE TO POST-CRASH CARE CLARITO U. CAIRO, JR., MD, DPSVI, DPCOM ACCREDITED SAFETY AND HEALTH PRACTITIONER PROGRAM MANAGER, VIOLENCE AND INJURY PREVENTION ESSENTIAL NON-COMMUNICABLE DISEASE DIVISION DISEASE PREVENTION AND CONTROL BUREAU Email: dokclar@yahoo.com / dokclar@gmail.comdokclar@yahoo.com

3. DEPARTMENT ORDER NO. 2008-0055 “Guidelines on the Disbursement / Utilization of Road Safety Trust Funds for the Operationalization of the National Electronic Injury Surveillance System (NEISS) in Philippine Orthopedic Center, Jose Reyes Memorial Medical Center, East Avenue Medical Center, Quirino Memorial Medical Center, Davao Medical Center, and Vicente Sotto Medical Center”

4. YEARNO. OF REPORTING HOSPITALS NO. OF REPORTED CASES TRANSPORT / VEHICULAR ACCIDENT MAULINGFALL 201011535,06811,6742,5255,111 201110041,33113,5947,9446,771 201212564,25619,26312,94811,733 20136440,14913,9387,0756,721 ONEISS CY 2010-2013 NO. OF HOSPITALS IN THE PHILIPPINES: 1,821 DOH 70 GOVERNMENT 662 PRIVATE 1,089 http://uhmis1.doh.gov.ph/unifiedhmis

5. DEPARTMENT ORDER NO. 2011-0047 “Creation of the Philippine Network for Injury Data Management System (PNIDMS)” MEMBERS DOH, DOTC, DPWH, UNICEF, WHO, PNP- HPG, MMDA, SAFE KIDS PHILIPPINES, LTO, DOLE, DSWD, UP-NCTS, NBI, BFP, CHED, NSO, PHILHEALTH, PCW, PIRA, DEPED http://uhmis2.doh.gov.ph/pnidms

6. ADMINISTRATIVE ORDER NO. 2013-005 “National Policy on the Unified Registry Systems of the Department of Health (Chronic Non- Communicable Diseases, Injury- Related Cases, Persons with Disabilities, and Violence Against Women and Children Registry System)

7. ADMINISTRATIVE ORDER No. 2014 - 0002 “Revised National Policy on Violence and Injury Prevention”

8. REVISED NATIONAL POLICY ON VIOLENCE AND INJURY PREVENTION ROAD TRAFFIC INJURIES

9. ADMINISTRATIVE ORDER No. 2014 - 0007 “National Policy on the Establishment of Prehospital Emergency Medical Service System”

10. RATIONALE As an integral part of the Revised National Policy on Violence and Injury Prevention (AO 2014-0002), there is a need to establish a prehospital EMS system at the national and local level in order to prevent deaths due to injuries and to minimize or mitigate occurrence of disabilities.

11. GENERAL OBJECTIVE Institutionalize a comprehensive, accessible and integrated system of prehospital emergency medical services from the scene of incident to the appropriate health care facility or hospital at the national and local level.

12. SPECIFIC OBJECTIVES Develop, implement, monitor and evaluate evidence- based and customized standards and guidelines for best practices in prehospital emergency medical services; Enhance capacity of Regional Offices (ROs), Local Government Units (LGUs), and other stakeholders as well as strengthen collaboration with them towards establishing an efficient and sustainable prehospital EMS system; and Ensure full operationalization and implementation of the prehospital EMS system from the national level down to the grassroots level.

13. Action Framework for Prehospital Emergency Medical Service System

14. Emergency Dispatch involves the immediate identification and prioritizing 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, and documentation and monitoring

15. INVENTORY OF LOCAL PREHOSPITAL EMS SYSTEM EMS COMPONENT1 ST TIER2 ND TIER3 RD TIER EMERGENCY DISPATCH Communication Facilities Awareness of the people on the available emergency numbers Presence of a Unified Local Hotline Number Presence of a Functional National Hotline Number Personnel Dispatched Barangay Responders and Lay Persons Education among lay persons already strengthened Wide array of responders up to presence of a general physician in the EMS team Complete range of EMS personnel including a specialist (emergency medicine or trauma surgeon) in the EMS team Expected Response Time 20 minutes10-15 minutes< 10 minutes

16. Emergency Response and Care involves arrival of resources at the scene and the timely initiation of appropriate interventions

17. INVENTORY OF LOCAL PREHOSPITAL EMS SYSTEM EMS COMPONENT1 ST TIER2 ND TIER3 RD TIER EMERGENCY RESPONSE AND CARE Services provided on- site First Aid and Basic Life Support Basic Life Support and Advanced Life Support (depending on the training and capability of dispatched personnel Advanced Life Support Special equipment/resources utilized/required Readily available basic first aid kit in the community Complete equipment for BLS. Need to have readily available ALS equipment (desirable but would depend on the training and capability of emergency personnel) Wide-range of available equipment in the provision of BLS and ALS interventions

18. Emergency Transport involves transporting the patient to the most appropriate facility and continued provision of care en route

19. INVENTORY OF LOCAL PREHOSPITAL EMS SYSTEM EMS COMPONENT1 ST TIER2 ND TIER3 RD TIER EMERGENCY TRANSPORT Transportation Options Ambulance Type BWide range of vehicles Complete Range of Vehicles (ideal number of responders vis-a-vis number of ambulance used Services Provided en route to Hospital Patient Transport w/ capacity to provide BLS BLS w/ capacity to provide ALS (depending on the training and capability of responders and ambulance type and equipment Advanced Life Support

20. Inter-Facility Referral and Transport involves the transport of patient with medical escorts, if necessary, from one facility to another, as the patient requires services that are not available in the referring facility

22. INVENTORY OF LOCAL PREHOSPITAL EMS SYSTEM EMS COMPONENT1 ST TIER2 ND TIER3 RD TIER INTER-FACILITY REFERRAL AND TRANSPORT Referral Network Strengthening of existing health facilities Availability and strengthening of trauma-receiving facilities Availability of Trauma-capable Facility

23. Existing Healthcare Delivery Systems involves the various levels of health units, e.g. barangay health stations, rural health units, free standing clinics, etc., and referral units, i.e. inter- local health zones

24. Available Groups of Service Providers and Stakeholders begins with the organizational structure and dynamics of the Program Management Committee which coordinates the strategies and implementation of the National Policy on Violence and Injury Prevention, and shall later include healthcare professionals, accredited EMT / paramedics, barangay health workers, and volunteer organizations

25. INVENTORY OF LOCAL PREHOSPITAL EMS SYSTEM EMS COMPONENT1 ST TIER2 ND TIER3 RD TIER SERVICE PROVIDERS AND OTHER STAKEHOLDERS Shall identify possible stakeholders, including potential roles and responsibilities that could assist in the effective and efficient implementation of the EMS system. Stakeholders with existing roles on pre-hospital EMS will be initially tapped to assist / provide resources in the provision of emergency medical services Identified stakeholders that could be involved in the implementation. Framework of the network including possible roles and responsibilities of the stakeholders are already recognized and beginning coordination and sharing of resources among them are done. Already have a functioning and effective EMS network involving different sectors in its implementation. Each of the stakeholders is functioning well according to their designated roles. Sharing of resources, technical expertise, and capacity building are also being done among stakeholders

26. Support Facilities and Systems refer to accessible communication and transport facilities

27. Legal Framework defines the contractual liabilities of all stakeholders (individuals, agencies, and hospitals) as defined in appropriate policy mechanisms and instruments. It also involves developing and operationalizing procedures and guidelines for policy implementation

28. Governance system management and supervision at the national (or local) level by a council/network/coalition, which may include representation from the government and other stakeholders under the chairmanship of an appropriate authority. It will coordinate the implementation of the EMS system within the country (or province or city) through standardization, regulation, accreditation, policy making, monitoring and evaluation, technical and capability building, resource sharing and management, and steering inter-sectoral coordination. Also, it will manage and supervise at the local level by the local chief executive through a fitting office that will overlook functioning of the EMS system at the grassroots level.

29. INVENTORY OF LOCAL PREHOSPITAL EMS SYSTEM EMS COMPONENT1 ST TIER2 ND TIER3 RD TIER GovernancePublic Initiated w/ beginning negotiations to forge a Public-Private Partnership Public – Private Partnership Lead Agency DRRMO is available but will opt to create a Public Safety Office for the implementation of EMS to address daily emergencies Public Safety Office already created Public Safety Office Scope of Implementation Mapping / clustering of municipalities or barangays already started for province / city wide implementation Province-wide / City- Wide Province-wide / City- Wide (sub-station link to the national EMS system)

30. INVENTORY OF LOCAL PREHOSPITAL EMS SYSTEM EMS COMPONENT1 ST TIER2 ND TIER3 RD TIER Presence of Supporting Policy Already crafted and proposed – for consultation and approval YES Protocols used for system implementation Protocols used are local protocols from LGUs having the same characteristics with already existing EMS system Local Protocol usedNational Protocol used

31. ROLES AND RESPONSIBILITIES Regional Offices (ROs) shall provide technical assistance to the LGUs and oversee the local institutionalization of prehospital EMS system. They shall also establish the standards for an efficient hospital referral system within the locality.

32. ROLES AND RESPONSIBILITIES DOH Hospitals shall ensure provision of quality promotive, preventive, curative, rehabilitative, and palliative care for patients involved in violence and injury.

33. ROLES AND RESPONSIBILITIES Local Government Units (LGUs) shall adopt and implement the prehospital EMS system and provide services and necessities in primary health care facilities and hospitals in their localities.

34. ROLES AND RESPONSIBILITIES Non-government organizations, professional groups, other national government agencies / organizations, private sector, and the academe shall assist in the implementation of this Order.

35. Prehospital Emergency Medical Service Committee (PEMSC) DOJ, DILG, DOTC, DEPED, PCEM, PRC, DOH

36. PREHOSPITAL EMS SYSTEM ORGANIZATIONAL / STRUCTURAL FRAMEWORK PEMSC POLICY -MAKINGSERVICE DELIVERY CAPACITY DEVELOPMENT SECRETARIAT (DOH-ENCDD)

37. DEVELOPMENT OF POLICY OR ORDINANCE FOR THE ESTABLISHMENT OF SAFETY EMERGENCY MEDICAL SERVICE SYSTEM AT THE LOCAL LEVEL DEVELOPMENT OF GUIDELINES FOR THE ESTABLISHMENT AND OPERATIONALIZATION OF LOCAL PREHOSPITAL EMS SYSTEM DEVELOPMENT OF GUIDELINES FOR MEDICOLEGAL CARE OF THE VICTIMS OF VIOLENCE AND INJURIES DEVELOPMENT OF GUIDELINES FOR MENTAL HEALTH CARE AFTER TRAUMA-RELATED EMERGENCIES DEVELOPMENT OF TRIAGE GUIDELINES AND PROTOCOLS FOR INTERFACILITY TRANSFER FORMATION OF FUNCTIONAL MULTISECTORAL PREHOSPITAL EMS TEAM INCLUSION OF PREHOSPITAL TRAUMA CARE IN PHILHEALTH BENEFIT PACKAGES DEVELOPMENT OF TOOL OR METRIC FOR SAFETY RISK ASSESSMENT AND MANAGEMENT IN THE COMMUNITY AVAILABILITY OF MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT FOR VICTIMS OF VIOLENCE AND INJURIES AND THEIR FAMILIES AVAILABILITY OF IEC MATERIALS ON SAFETY PROMOTION AND VIOLENCE AND INJURY PREVENTION AVAILABILITY OF EMERGENCY TRANSPORT SERVICES IN EVERY COMMUNITY STANDARDIZATION OF EMS TRAININGS ACCREDITATION AND REGULATION OF EMS TRAINING AND EMERGENCY TRANSPORT PROVIDERS ACCREDITATION, CERTIFICATION, AND REGISTRATION OF EMS PRACTITIONERS AVAILABILITY OF TRAINED AND CERTIFIED FIRST RESPONDERS IN EVERY BARANGAY / COMMUNITY AVAILABILITY OF TRAINED AND CERTIFIED FIRST RESPONDERS IN SCHOOLS, WORKPLACES, MALLS AND OTHER INSTITUTIONS ORIENTATION AND TRAINING OF ONEISS AND PNIDMS USERS POLICY-MAKING SERVICE DELIVERYCAPACITY DEVELOPMENT LAUNDRY LIST OF PLANS PER SUBCOMMITTEE

38. SAFETY AND EMERGENCY MEDICAL SERVICE SYSTEM AT THE LOCAL LEVEL

39. UPDATES PhilHealth Circular No. 012 – 2014 Z Benefit Rates for Selected Orthopedic Implants June 1, 2014

40. UPDATES RESEARCH TOPICS 2014-2015 “Determination of Incidence of Injuries from Vehicular Crashes in the Philippines (2011- 2013)” “Study on the Socio-Economic Burden of Violence in the Philippines” “Study on the Socio-Economic Burden of Road Traffic Injuries in the Philippines”

41. NEXT STEPS Issuance of the Department Order on the Guidelines for the Establishment and Operationalization of Prehospital EMS System at the Local Level Piloting of Prehospital EMS System: at least one province per region Development of Training Modules on Basic and Advanced Prehospital Trauma Care

42. NEXT STEPS Drafting of the “National Policy on the Prevention and Control of Harmful Alcohol Use” Organizing the National Summit on Safety Promotion and Violence and Injury Prevention Development of Action Framework for Each Subprogram of VIPP