Republic of the Philippines

Department of Health
HEALTH EMERGENCY MANAGEMENT BUREAU

COMPENDIUM OF RISK
COMMUNICATION MESSAGES
FOR PUBLIC HEALTH EMERGENCY
IN THE PHILIPPINES

2024 Edition
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COMPENDIUM OF RISK COMMUNICATION MATERIALS
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FOREWORD

Throughout the COVID-19 Pandemic, there was a heightened concern on the need for information
while misinformation and disinformation have emerged. New communication designs and
applications identified as vital in responding to a public health emergency have potential risks and
benefits that have to be weighed against those already in use.

Since people have increasing expectations on the government during public health emergencies as
exemplified during the heights of the pandemic, the two distinct purposes of risk messages—
informing and influencing—that coexist in risk communication, must be achieved. This can reduce
or allay fear and panic in the communities and can aid in building disaster health resiliency in a
society.

Based on the observed benefits of risk communication and the availability of materials from various
sources, this compendium was conceived in order to help bring about better-informed decision
makers, both individuals and public or private officials and a more engaged population. The Key
Health Messages for Emergencies and Disasters 2013, 2nd Edition by the Health Emergency
Management Bureau served as a major reference in the development of this document along with
trends and new information related to Disaster Risk Reduction and Management in Health (DRRM-
H) from both local and international publications. The Philippine Health Advisories were also
integrated in appropriate sections.

This introduces the readers to risk communication, its importance and objectives, as well as its
contribution to public health emergency management. The risk communication messages for
common events in the country focusing on the pre, during, and post disaster phases alongside the
first aid interventions are incorporated into the existing communication plans and Information,
Education, and Communication (IEC) materials without taking out the cross-cutting actions as lack
of emphasis on these can have implications on the health and safety of the population. Furthermore,
the translation of the messages to make it more appropriate to the feelings, beliefs, and cultural
orientation of the target audience is encouraged.

Finally, this aims to attain a two-pronged objective – improving risk communication regarding
personal action and enhancing risk communication for a more informed public decision. The
available messages are not target-specific but can be disseminated in strategic centers for
communication and are intended for a broad spectrum of recipients such as policy makers, program
managers, field implementers, and practically every Juan and Juana since public health emergencies
can affect anyone, anywhere, and anytime.

Health Emergency Management Bureau

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ACKNOWLEDGEMENTS
This supplemental edition to the “The Key Health Messages for Emergencies and Disasters 2013,
2nd Edition” is compiled through the efforts of the group who envisioned to contribute to the
improvement of the quality and standards of communicating measures in preventing and mitigating,
preparing for, and responding to public health risks.

The Health Emergency Management Bureau acknowledges the fortitude of Ms. Marie Grace Anne
M. Reynoso, Instructor 1 of Marinduque State University who initiated this project during her stint
as Health Program Officer (HPO) 1 of this Bureau and to Ms. Bianca May B. Mamauag, Technical
Specialist II of Metro Manila Center for Health Development for her contribution when similar to
the former was an HPO 1 of the Bureau.

Equal appreciation is given to the Health Promotions Bureau (HPB) represented by the group of
Messrs. Roderick Domingo, a former HPB personnel and Ricardo Noel R. Gervasio, Supervising
Health Program Officer and their team.

EDITORIAL BOARD

Chairpersons

Dr. Bernadett P. Velasco

Director IV, Health Emergency Management Bureau

Dr. Ronald P. Law

Chief, Preparedness Division

Members

Ms. Florinda V. Panlilio

Supervising Health Program Officer

Ms. Virjean Marie R. Tagocon

Health Program Officer I
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DISCLAIMER AND PERMISSION TO REPRODUCE

The risk communication materials compiled are excerpts from both international and local
publications and references of which the “The Key Health Messages for Emergencies and Disasters
2013, 2nd Edition” by the Health Emergency Management Bureau served as its primary reference.
The messages were chosen considering the type of hazards that the country and the population are
exposed to and those which are context-applicable.

Evolving public health emergencies best exemplified by the COVID-19 pandemic made us realize
that current knowledge and procedures may change as a result of the global and local updating of
health policies and protocols hence, the messages in this compendium will need to be updated to
ensure benefits, relevance, and usefulness based on the situation.

It is therefore imperative that the users of this compendium shall exercise their best judgment, as
health safety, protection, and promotion advocates or health workers and responders practicing the
suggested health behaviors to communicate or adopt the most suitable messages to specific
situations, the target audience and beneficiaries, and the available supportive resources.

As compiled, risk communication messages in this compendium may be reproduced without

permission from Department of Health – Health Emergency Management Bureau (DOH-HEMB),
provided that no changes or alterations in their contents are made, and the source is properly
acknowledged. Additional readings and samples of Information Education Communication (IEC)
materials can be sourced from the publications and links mentioned in the reference lists.

Finally, every effort was made for this compendium to be as exhaustive as possible in terms of
coverage of hazards at the time of its development. Hence, it requires continuous updating based on
the emerging and future hazards that may affect the country.
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ABOUT THE COMPENDIUM

Background

People need to know what health risks are and the correct actions in order to protect their health and
lives before, during, and after any public health emergency. Accurate information provided early,
often, and in languages and channels that people understand, trust and use, enables them to make
informed choices, to influence behavior, and ultimately take actions to protect themselves, their
families, and communities.

This compendium is informed by the World Health Organization’s Classification of Hazards from
the guidance document, the Strategic Toolkit for Assessing Risks issued in 2021. The selection of
hazards to be included was based on what are commonly experienced in the country. Please see the
table below:

A. Natural B. Human-induced

A.1. Hydro - A.2. Geophysical A.3. Biological B.1. Technological B.2. Societal
Meteorological

Drought Earthquake Airborne Fire Conflict

Flood Tsunami - Measles Transportation Mass
- Tuberculosis Accidents like air, Gathering
Landslide Volcanic Eruption - Other diseases land, and water
like Chicken
Typhoon Chemical Spill
Pox, Influenza,
Storm Surge Pertussis
- Oil Spill
Water Borne Radiation and
- Polio Nuclear
- Typhoid Fever Emergencies
- Cholera
Vector Borne

- Dengue
- Leptospirosis
- Malaria

This compendium is designed to serve as a quick reference in packaging risk communication

messages and IEC materials for Disaster Risk Reduction and Management in Health (DRRM-H).
The Key Messages for Health Emergencies and Disasters 2013, 2nd edition is one of the main
references used along with updates on trends and new information on promotion and communication.
Relevant information as selected from local and international publications and references were also
incorporated.
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In collaboration with the Health Promotion Bureau, this collection of health messages was pre-tested
through the consultation with Regional DRRM-H Managers and Health Education and Promotion
Officers (HEPOs).

The compendium is composed of three major parts: a) Understanding Risk Communication; b)

Elements of Risk Communication; and c) Hazard-Specific Key Health Messages.

How and when to use the messages

After reading the compendium, there is no assurance that one can overcome all communication
challenges when faced with a public health emergency. The ease of access can certainly improve
awareness and understanding and more likely reduce the communication challenges.

Moreover, the pre-prepared messages should be incorporated into the existing communication plans
in order that they are automatically integrated in the day-to-day operations and these are readily made
available for use. The compendium can complement and assist in the development and/or updating
of existing plans and IEC materials by highlighting the key communication considerations for
specific hazards.

The instructions below can be used for guidance and reference:

1. The pre-prepared messages can be considered for immediate release to the public before,
during, and after a public health emergency.
2. The pre-prepared messages are designed to be given directly to media outlets, including
television and local radio networks, or dissemination through other channels such as online
communications and social media.
3. These generic messages are used as prototypes but should be replaced by clear scientific
advice, once available.
4. The messages are packaged exclusively for public health emergencies.
5. The messages are designed to be generic. They only focus on health and safety tips and
reminders. Specific advices concerning non-health aspect can be obtained from authorities
such as Office of the Civil Defense (OCD), Philippine Atmospheric, Geophysical and
Astronomical Services Administration (PAGASA), Philippine Institute of Volcanology and
Seismology (PHIVOLCS), Department of the Interior and Local Government (DILG),
Department of Social Welfare and Development (DSWD), etc.
6. The use of language and techniques that are appropriate to the feelings, beliefs, and cultural
orientation of the target audience must be observed when communicating these messages.

In localizing the key messages, it is important to consider each action and ask whether it needs to be
adapted to the local context. There could be some key messages that may conflict with cultural norms
or may be applicable in urban areas but not in rural areas or the other way around. Hence, it is
important to reflect, analyze, and situate carefully on how to adapt the messages to local context,
rather than rejecting the message completely.
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In terms of adaption and localization, it is also important to consider a participatory approach with
experts involved, in order to come up with sets of messages that are acceptable and appropriate.

The following are the suggested steps on how to adapt and localize key messages:

1. Identify the geographic location or area for which the key messages will be adapted. The
messages adapted first for national application can serve as reference in sub-national
adaptations particularly if it has urban and rural versions. In some situations, it may be
effective to start with provincial or municipal versions to get the process started. Select the
target dialect for your messages, if necessary. If possible, also produce a generic version that
is culturally acceptable in the locality or area.
2. Draft a translation. Work in close consultation with a bilingual expert who is familiar with
the subject matter and facilitate a review process with a couple of trusted bilingual speakers
who are familiar with local and international disaster risk-related terminology.
3. Use participatory processes to develop a localized set of key messages. Select the most
relevant key messages and consider how relevant and applicable each key message is, as
well as the context-specific details. Make sure to understand the reasoning behind each
message or identify any questions that might require further research.
4. Assign a small and trusted team to finalize the messages.
5. Co-publish the agreed messages to communicate consensus, if necessary. Each partner
should add their logo to the document to show their support. Encourage partners to try
communicating them in a variety of ways, and to test the messages for uptake and impact;
and report back with the results, so that the messages can be further improved in the future.
6. Plan to review and revise the messages every two or three years, as deemed necessary.

Target users of the compendium

The compendium was developed for use and reference of health educators, policy and decision-
makers; and program managers and implementers responsible for risk communication before, during,
and after public health emergencies to support their roles in contextualizing risk communication in
varied community settings.

Other groups who may use the compendium are: frontline responders; local, national and
international development partners; civil society groups; and all other organizations, private and
public, involved in the thematic areas of disaster risk reduction and management.
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CONTENTS
I. Introduction

II. Understanding Risk Communication

- Objectives
- Principles
- Role of Risk Communication in Public Health Emergency

III. Elements of Risk Communication

- WHO: The Spokesperson
- WHAT: The Message
- TO WHOM: The Audience
- WHY: The Purpose
- HOW: The Communication Channel
- Steps in Communicating Risk
- Monitoring and evaluation of the effectiveness of risk communication messages and
approaches

IV. Hazard-Specific Key Messages

A. Caused by Natural Hazards

A.1 Hydrometeorological

- Drought
- Flood
- Landslide
- Typhoon
- Storm Surge

A.2 Geophysical

- Earthquake
- Tsunami
- Volcanic Eruption

A.3 Biological

A.3.a Airborne

- Measles
- Tuberculosis
- Other diseases like Chicken Pox, Influenza, Pertussis
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A.3.b Water Borne

- Polio
- Typhoid Fever
- Cholera

A.3.c. Vector Borne

- Dengue
- Leptospirosis
- Malaria

B. Human-induced

B.1 Technological

- Fire
- Transpotation Accidents like air, land, and water
- Chemical Spill i.e. Oil Spill
- Radiation and Nuclear Emergencies

B.2 Societal

- Conflict
- Mass Gathering
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I. INTRODUCTION
INTRODUCTION
Every word counts in a public health emergency. The public needs to know what the responders
know and how this knowledge translates into action during a public health emergency. Everyone,
including the community and the responders, must not only understand what the risk is, but also how
(and if) this can affect them, and how this can be prevented or mitigated.

In epidemics and pandemics, in humanitarian crises and natural disasters, effective risk
communication allows people at risk to understand and adopt protective behaviors. Hence, risk is
personal and often subjective. Each risk has its own unique characteristics that defines how it is
perceived by an individual and how he/she acts and reacts to it because what one person considers
to be a risk, may not be a risk to another depending on their respective levels of vulnerabilities.

Recent calamities and major disasters revealed challenges and gaps in how health risk is
communicated to the public. The health sector has to amplify its approach for building trust and
engaging the communities particularly the affected populations. Risk communication has to be both
strategic and integrated into the existing national and local Disaster Risk Reduction and Management
in Health (DRRM-H) plans and structures. Likewise, risk communication should form part of the
planning, messaging, channels and methods of communication; and engagement up to monitoring
and evaluation.

Based on the goals of risk communication which are to share information vital for saving life,
protecting health, and minimizing harm to self and others; to change beliefs and/or to change
behavior, authorities and experts have to apply risk communication by listening and addressing
people’s concerns and needs so that the advice they provide becomes relevant, trusted, and
acceptable. Moreover, proactive risk-based communication must become an essential component of
disaster risk reduction and management (DRRM) measures.

Although risk communication is an intervention used in a wide array of DRRM, this compendium
only focuses on public health emergeny to provide the most up-to-date and evidence-based
recommendations for communicating health risk. The compendium aims to provide specific
interventions and reminders that need to be practiced and performed before, during, and after an
emergency or disaster. Being able to demonstrate the contents of this compendium will enable
everyone at risk to take informed decisions to protect themselves, their families, and communities
against threats to increase the level of their survival, and to promote health and well-being.

To guide the users, the compendium includes an introduction about risk communication and how it
applies topublic health emergencies. Basic steps in communicating risks per specific hazard and
emergency are also provided in detail. Substantively, this compendium contains risk communication
messages that can be applied before, during, and after public health emergencies
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Adopting the six principles of effective risk communication based on the Crisis and Emergency Risk
Communication 2014 Edition of the United States Department of Health and Human Services-
Centers for Disease Control and Prevention, this compendium emphasizes the following:

1. Be First: Crises are time-sensitive. Communicating information quickly is almost always

important. For members of the public, the first source of information often becomes the
preferred source.
2. Be Right: Accuracy establishes credibility. Information can include what is known, what is
yet to be known, and what is being done to fill in the gaps.
3. Be Credible: Honesty and truthfulness should not be compromised during crises.
4. Express Empathy: Crises create harm, and the suffering should be acknowledged in words
through addressing what people are feeling, and the challenges they face, while building trust
and rapport.
5. Promote Action: Giving people meaningful things to do calms anxiety, helps restore order,
and promotes a restored sense of control.
6. Show Respect: Respectful communication is particularly important when people feel
vulnerable. Respectful communication promotes cooperation and rapport.
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II. Understanding Risk Communication

- Objectives
- Principles
- Role of Risk Communication in Public Health
Emergency
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UNDERSTANDING RISK COMMUNICATION

According to the World Health Organization (WHO), risk
communication refers to the real-time, interactive process of sharing The right message at the
of information, advice and opinions between experts or officials and right time from the right
people who face a threat (hazard) to their survival, health, economic source through the right
or social well-being. The risk which is defined as a hazard times the channel can save lives.
probability of its occurrence becomes the core of communication.

Nowadays, risk communication is recognized as the two-way and multi-directional communication

and engagement with affected populations so that they can take risk-based decisions to protect
themselves and their loved ones. It can and should utilize the most appropriate and trusted channels
of communication and engagement. It needs to bring together a diverse range of expertise in the field
of communication, social sciences (mass media, emergency and crisis communication, social media,
health education, health promotion, communication for behavior change, etc.) and systems
strengthening techniques in order to achieve public health goals in emergency management.

Effective and clear communication with the public is essential before, during, and after an emergency
or disaster. Actions, words, and other interactions that incorporate and respect the perceptions of the
recipients must become the foundation of risk communication messages.

Therefore, the risk communicator should understand what the target

In all cases, messages audience perceives and believes in order to tailor the messages and
must be clear, concise, information based on their level of awareness, knowledge, and
consistent and convey call
practices. Considerably, there is no ‘one size fits all’ method for
to action.
communicating risk. Instead, it requires a mixture of effective best
practices outlined in this compendium and a firm understanding of
the audience and its needs. There is a need to facilitate formal and informal dialogue through
applicable platforms with the community to monitor what they need and what they want.

Risk communication also suggests that it is not enough to relay to people that something is a risk.
Instead, they need help in understanding what they can do about it and to feel empowered to take
actions.

Objectives of Risk Communication

The ultimate purpose of risk communication is to enable everyone at risk to make informed decisions
to mitigate the effects of the threat (hazard) such as death, injury, or disease outbreak; and take
proactive and preventive actions.

Specifically, it aims to:

1. Provide accurate and timely information to inform the public of potential health risks and
steps to be undertaken by responsible agencies;
2. Stimulate behavioral change through information and education of communities, health
personnel, and decision-makers;
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3. Facilitate the translation of information into tangible action for critical interventions and
guideline development or updating;
4. Serve as a control point in preventing the misallocation and wastage of resources; and
5. Contribute generally to decreased illness, injuries, and deaths.

Principles of Risk Communication

1. Accept and involve the public as a legitimate partner.

2. Listen to and appreciate the public’s concerns.
3. Be sensitive to the public’s emotions and potential outrage.
4. Plan carefully and evaluate risk communication efforts.
5. Meet the timing and needs of the media to ensure that they provide accurate and useful
information.

Roles of Risk Communication in Public Health Emergency

1. Help at risk populations to make informed decisions.

2. Encourage protective behaviors.
3. Complement existing surveillance systems.
4. Coordinate health with non-health partners.
5. Minimize social and economic disruption.
6. Build the trust required to prepare for, respond to, and recover from serious public health
threats.
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III. Elements of Risk Communication

- WHO: The Spokesperson
- WHAT: The Message
- TO WHOM: The Audience
- WHY: The Purpose
- HOW: The Communication Channel
- Steps in Communicating Risk
- Monitoring and Evaluation of the Effectiveness of
Risk Communication Messages and Approaches
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ELEMENTS OF RISK COMMUNICATION

The elements describe the basic components of risk communication. These include discussion on the
identification of spokesperson, goal setting, message development, audience segmentation,
communication channels, monitoring and evaluation, and steps in communicating risk. Having all
these essential elements available may contribute to advancing risk awareness and promoting health-
protective behaviors among individuals and communities.

WHO: The Spokesperson

The spokesperson is the assigned person who makes official, public statements for the
agency/organization. He/she delivers messages to the public and media to promote, build, and
maintain the profile and reputation of the
agency/organization.
What makes a “good” spokesperson?
He/she should portray the following characteristics:  Always available (24 hours/day, 7
days/week)
 Able to speak clearly and convincingly  Confident at all times
 Calm, confident, and responsible  Competent (has sufficient knowledge
 Holding a key position and information)
 With media experience  Fluent in the common languages
*An equally good alternate exhibiting the above  Media-savvy
qualities should also be identified.  Respected by the public
 Versatile (e.g. can project qualities of a
What do spokespersons need to effectively statesman or a brawler, as needed)
communicate risk?

 Up-to-date information and facts cleared for release

 Resources and contacts

Identify and train spokespersons and other senior health and/or other sector officials

 Speak with one voice, even if there are several people

 Ensure that the spokespersons are trained in risk communication
 Prepare talking points

WHAT: The Message

 What ‘we’ know about the situation?
 What ‘we’ (e.g. health authorities) are doing about the situation?
 What ‘you’ (the community) can do about the situation?

What do the people want to know?

 What happened? (Type of Incident, Location, Number of Casualties, and Scope)

 Why did it happen? (Cause)
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 Who or what should be held responsible? (Accountability)

 What is being done about it? (Action/Emergency Services)
 What will prevent it from recurring? (Result)

What are the steps in message development?

 Follow the 3 Cs in developing a message: Clear, Concise, and Consistent

 Bring it down to the basics: Simplify
 Provide recommended actions
 Be positive: provide more “dos” than “don’ts”
 Do not lie
 Be sympathetic

TO WHOM: The Audience

Like any other communication process, success in risk communication largely depends on
understanding the audience, what are their concerns, how they perceive risk, and whom they trust
and find credible.

The target audiences must be defined, which often involves the key government officials, sectoral
partners, business leaders, healthcare workers and providers, media, and special or vulnerable groups.

Below is the enumerated list on how to understand and identify the target audience.

 Analysis - Who is the audience (primary, secondary, and tertiary)?

 Understanding - What is the audience's knowledge of the risk?
 Demographics - What is their age, sex, gender, educational background, etc.?
 Interest - Why are they reading your document / listening to you?
 Environment - Where will the risk communication document be accessed / risk communication
message be sent / viewed?
 Needs - What are the audience's needs associated with your risk communication message?
 Customization - What specific needs / interests should you address relating to the specific
audience?
 Expectations - What does the audience expect to learn from your risk communication message?
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WHY: The Purpose

The purpose of any communication strategy should be clear and appropriate. Specifically, risk
communication aims to achieve the following:

 Provide accurate and timely information to both the public and stakeholders for reliable
decision-making and appropriate actions.
 Address the strong desire of the public for authoritative information.
 Clarify all the inaccurate information circulating about the effects of the public health
emergency which can trigger public anxiety.
 Help assure the public and respond to the strong demand for a variety of services immediately.

The goals of risk communication are to share information vital for saving life, protecting health, and
minimizing harm to self and others; to change beliefs; and/or to change behavior.

It is becoming increasingly accepted that there are two complex issues that determine the success
and failure of risk communication: different perceptions of the same risk by experts and the public;
and issues of the trustworthiness of the information and advice that is communicated.

HOW: The Communication Channels

The communication channels are the means through which the sender and receiver of information
communicate and interact with each other. Each of these communication channels has different
strengths and weaknesses. In most cases, more than one channel is used at the same time.

It is important for risk communicators to decide what channels will be used to ensure that appropriate
messages are relayed to its target audience at the right time. The following are examples of
communication channels:

 Electronic media – fax, mobile phone, short messaging service (SMS), telephone
 Folk media – dance, drama, puppet show, song, storytelling, street entertainment
 Interpersonal/face to face – community leaders’ assembly, conferences, door to door knocking,
exhibitions, group meetings, marches, seminars, workshops
 Mail – direct mailing, postal
 Mass media – cinema, internet (Online Campaign, Virtual Teleconference), newspaper,
television, radio
 Print media – banners, billboards, brochures, leaflets, pamphlets, posters
 Social media – Facebook, Instagram, Twitter
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STEPS IN COMMUNICATING RISKS

Risk communication is better applied before, during, and after an event. To optimize its effectiveness,
the following generic steps can be applied when faced with any public health emergency.

Pre-Event

1. Conduct needs assessment for emergency risk communication.

2. Develop a risk communication plan.
3. Evaluate channels to use for public communication.
4. Determine the functions and resources needed to carry out the plan.
5. Prepare the team to carry out the plan.
6. Prepare fact sheets, press releases, and talking points ahead of time that can be quickly
improved.

During the Event

 Verify the situation.

- Get the facts and obtain information from additional sources to put the event in perspective
- Review and critically judge all information, determine credibility
* Acknowledge what you do not know
* Acknowledge that information will/may change
- Clarify information through subject matter experts
- Begin to identify staffing and resource needs to meet the expected media and public interest
- Determine who should be notified of the potential public health emergency
 Conduct notifications.
 Assess level of crisis.
- Ensure direct and frequent contact with the Emergency Operations Center (EOC)
- Determine what your organization is doing in response to the event
- Determine what other agencies/organizations are doing
- Determine who is potentially affected by the public health emergency:
* What are their perceptions?
* What do they want and need to know?
- Determine what the public must be doing
- Determine what is being said about the event (Is the information accurate?)
 Organize assignments.
- Identify the spokesperson for this event.
- Determine if subject matter experts are needed as additional spokesperson.
- Determine if the organization should continue to be a source of information to the media
about the public health emergency or would some issues be more appropriately addressed
by other government agencies.
 Prepare information and obtain approval/clearance.
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 Release information to the public and partners through arranged channels.

- Provide only information that has been approved by the appropriate managers, do not
speculate.
- Repeat the facts about the event.
- Describe the data collection and investigation process.
- Describe what your organization is doing about the emergency.
- Describe what other organizations are doing.
- Explain what the public should be doing.
- Describe how to obtain more information about the situation.
 Monitor events, obtain feedback, and conduct risk communication evaluation.

Based on the country’s experience on pandemic, the following five circumstances were identified
as providing especially compelling reasons to report early and openly as a means communicating
risk:
a. when avoidable behaviors in the general population are contributing to spread: warn the
public;
b. when a defined risk group, such as health-care workers or rural farmers, is known to be
especially vulnerable: alert them to the risk and explain ways to reduce it;
c. when neighboring countries may be at risk: warn them to watch out for imported cases;
d. when the affected country can benefit from collective international knowledge and
experience: start the information flow; and
e. when local authorities know they need international assistance: reporting early brings a
public expectation that interventions will follow; assurance that these interventions will
be made available is a powerful motivation to report.

Post-Event

1. Provide for the well-being and recovery of the communication personnel or team.
2. Conduct public education.
3. Monitor messages and events through media, public, partner, and stakeholders.
4. Debrief response team early.
5. Review data on messages, on delivery, and on effects.
6. Compile and analyze comprehensive set of data.
7. Develop results/lessons and report measures of success.
8. Establish a new state of readiness and implement risk communication plan changes.

Monitoring and Evaluation of the Effectiveness of Risk Communication Messages and

Approaches

The identified goals in applying risk communication can be and should be measured. Without
assessing, monitoring and evaluating outcomes on changes to knowledge, behavior, and practice, the
activities related to risk communications become mechanical and meaningless. In this case, risk
communication does not necessarily help manage and control the risks secondary to a public health
emergency; rather it only consumes and waste valuable resources, thereby creating a false sense of
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achievement in those who are responsible for the event. The success and failure of risk
communication has to be determined by understanding different perceptions of the same risk by
experts and the public.

Monitoring the effectiveness of the approaches and strategies used must be applied all throughout
the event - pre, during, and post. Challenges in resolving communication problems like rapid and
far-reaching spread of information that may be accurate or inaccurate, or the so-called “infodemic”
should be immediately addressed. Below are some tips that can be used during monitoring and
evaluation:

 Monitoring done throughout: Pre  during  post

 Be flexible and be able to adjust along the way
 Scale up what works, as appropriate
 Identify lessons and best practices
 Refine communications plans for the future

The success of risk communication in public health emergencies relies heavily on public’s
confidence in government agencies. Hence, maintaining and nurturing trust in the government is a
concern in communicating emergency risk to the public. Guidelines for risk and crisis
communication advocate; they should be truthful, honest, frank, and open to ensure more effective
outcomes. Trust plays a central role in decision making processes and compliance rates among
message recipients, as individuals are more likely to follow instructions given by someone they trust.
When the public has low knowledge about the risk at hand, trust plays an important part in public
perceptions about severity of that risk.
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IV. Hazard Specific Key Messages

Safety and resilience require dramatic behavior changes. These only become possible when the
public can see that “everyone is doing it.” For behavioral change messages to catch hold, people need
to understand the reasons for carrying out specific measures and feel not only convinced of their
effectiveness but capable of implementing them for better outcome.

In order to organize and simplify a limited but fairly comprehensive set of messages, a rough
typology of hazards is used to identify those that occur together and that call for common sets of
interventions. The priorities selected are based on the World Health Classification of Hazards
(Strategic Toolkit for Assessing Risks, 2021) as listed in the background of this material.
Cutting across all these efforts is the need to consider all members of households and communities,
from the youngest to the oldest and including women and men, girls and boys, recognizing their
individual access and functional needs, and those of the animals in their care.

All-hazard Household and Family Disaster Prevention Measures “in a Nutshell”

 Find out what could happen. Stay informed.
 Make a household’s public health emergency plan, considering everyone in the household.
 Reduce structural, non-structural, and environmental risks in and around the home.
 Learn response skills including basic life-saving techniques and practice the skills and the plan.
 Prepare an evacuation plan and an Emergency Go-Bag with essential items to survive for about
a week.
 Work together with your workplace, schools, neighbors, and local community to assess your
risks; plan to reduce them; and prepare to respond.

A. Caused by Natural Hazards

A.1 HYDROMETEOROLOGICAL
Hydrometeorological hazards are of atmospheric, hydrological or oceanographic origin. Examples
are tropical cyclones (also known as typhoons and hurricanes); floods, including flash floods;
drought; heatwaves and cold spells; and coastal storm surges.

The Philippines as located along the typhoon belt in the Pacific experiences an average of 20
typhoons every year. It is highly susceptible to hazards brought by typhoons including floods, strong
winds, storm surges, and landslides.
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DROUGHT
A drought, as defined by the PAGASA, is an abnormally dry weather in an area over an extended
period of time. It commonly results in reduced ground surface water and/or dam levels. The shortages
of water for drinking and sanitation can result to negative impacts on human lives such as spread of
disease, malnutrition, and starvation.

1. Understand the signs related to the emergency.

Before a. Signs can include any of the following:
ii. When the conditions of water supply are running short.
iii. When there are a lot of hot sunny days.
iv. When only a little amount of rainfall has occurred during the
month.
v. When plants trees and grass are starting to turn brown.
vi. When water levels in lakes are low and start to become an
emergency.
b. Listen to weather reports to learn about Early Warning Systems
(EWS) for drought; understand and follow the Emergency Medical
Services (EM) in the community.

2. Prepare your home and practice indoor and outdoor water conservation.
a. Repair old pipes, dripping faucets, and leaky plumbing.
b. Collect, store, and manage water safely in large containers like
covered tanks and drums for storage over long periods.
c. Install rain barrels properly to catch and store rainwater.
d. Choose energy- and water-efficient models when you buy new
appliances.
e. Learn about how to keep drinking water and food safe and clean.
f. Contact your local water provider for information and assistance.

3. Participate in meetings and other activities including community drills and

other information sharing activities about water conservation in the
community.

4. Get involved with tree-planting and cleanup drive initiatives especially in

places near bodies of water.
During 1. Follow instructions and orders from authorities.
a. Stay informed. Monitor drought conditions in your area. Listen to the
radio or television for situation developments and instruction for
water conservation or restrictions for your area.
b. Always observe state and local restrictions on water use. Contact your
local government for current information and suggestions.
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2. Help conserve water by limiting how much water each person uses.

Indoors (Bathrooms and Laundry)

a. Do not let the water running while brushing your teeth, washing your
face, or shaving
b. Take short showers. Turn off the water while you soap up, and then
turn it back on to rinse.
c. If possible, use “tabo” (dipper) to control water consumption when
taking a bath.
d. Avoid flushing the toilet if not necessarily. Dispose of tissues and
other similar waste in the trash can rather than the toilet.
e. Only run full loads of laundry when using a washing machine.

Indoors (Kitchen)
a. Clean vegetables in a pan-filled with water rather than running water.
b. Avoid using running water to thaw meat or other frozen foods. Defrost
food overnight in the refrigerator or use the defrost setting on your
microwave oven.

Outdoors
a. Do not wash your car with a handheld hose.
b. If you use a commercial car wash, consider using a car wash that
recycles water.
c. Reuse water whenever possible — collect water from dish washing or
bathing. Recycled water can be used to water the yard and plants,
wash your car, or flush the toilets.

3. Protect your health against the risks brought about by the drought season.
a. Cover your mouth and nose from the dust to prevent respiratory
infections.
b. Drink at least 8 cups of water or 1.5-2 liters per day to prevent
dehydration. Infants, children, pregnant and lactating women must
drink adequate water.
c. Wear light-color, breathable, and loose clothing when indoors.
d. Refrain outdoor activities to reduce Ultra Violet (UV) exposure from
the sun.
e. Look out for symptoms of:
 malnutrition such as big belly, skin rashes, skin infections, stunted
growth.
 diarrhea such as 3 or more loose stool in a day.
f. Avoid too much salty foods and sweet beverages so as not to feel
thirsty.
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g. Hot climate makes food spoiling easier. Place the food and leftovers
on a cool dry storage.
h. Avoid drinking contaminated water; purify water by boiling or using
chlorine tablets.
After Once the situation is over, it is still important to continue to conserve water to
prevent or mitigate health impacts of future droughts.
a. Continue to be aware of how much water is used on a daily basis.
b. Continue water conservation at home.
c. Understand how drought has affected your health, home, livestock,
and finances.
d. Create a plan for the next potential period of drought.
First Aid Heat-related syndromes include:

1. Heat cramps
Are painful, involuntary muscle spasms that usually occur during heavy exercise
in hot environments. The spasms may be more intense and more prolonged than
are typical nighttime leg cramps. Fluid and electrolyte loss often contribute to
heat cramps. Heat cramps can escalate to a more serious heat illness.

Treatment:
a. Rest
b. Hydration
c. Stretching may help resolve
d. Seek medical care or call 911 if at-home treatment does not resolve the
issue

2. Heat exhaustion and heatstroke treatment

Are conditions characterized by heavy sweating and a rapid pulse, a result of
body’s overheating.

Treatment:
a. Get out of the heat quickly and into a cool place, or at least shade.
b. Lie down and elevate your legs to get blood flowing to your heart.
c. Take off any tight or extra clothing.
d. Apply cool towels to your skin or take a cool bath.
e. Drink fluids, such as water or a sports drink.

3. Heat Stroke
Is the most severe form of heat illness when the body overheats and cannot cool
down. The body cannot take off the excessive heat by sweating because of
dehydration and/or humid environment.
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Causes / Risk Factors:

a. Hot and humid weather
b. Vigorous exercise in hot weather
c. Dehydration
d. Too much direct exposure to the sun
e. Infants, the elderly, athletes, and individuals who work outside

Signs may start with the following signs of heat exhaustion:

a. Warm, flushed skin
b. Faintness
c. Dizziness
d. Weakness
e. Headache
f. Very high fever of 41°C
g. Rapid heartbeat
h. Convulsion
i. Unconsciousness

Prevention: During very hot and humid weather,

a. Limit the amount of time you spend outdoors. Schedule heavy-duty
activities for the beginning or end of the day, when it’s cooler.
b. Drink plenty of water.
c. Avoid tea, coffee, soda, and alcohol.
d. Wear a wide-brimmed hat and long- sleeved clothing when outdoors.
e. Schedule heavy-duty activities for the beginning or end of the day, when
it’s cooler

Treatment (emergency measures):

a. Move the person to a shady spot or indoors.
b. Have him/her lie down with legs elevated.
c. If able to drink liquids, have him/her sip cool water.
d. Remove clothing, apply cool water to the skin, and fan the person.
e. Apply ice packs to the armpits, wrists, ankles, and groin.

Heat stroke is a MEDICAL EMERGENCY!

Bring the patient immediately to the hospital after instituting emergency
measures.
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FLOOD
Massive flooding occurs when it has been raining for several days, when rainfall is intense even for
just a short time, when debris or sediments jam rivers and waterways causing them to overflow, or
when garbage clogs sewers and gutters preventing the water from draining into the waterways.

Before 1. Know the types of flood risk in your area.

a. Be aware of streams, drainage channels, canyons, and other areas known to
flood suddenly. Flash floods can occur in these areas with or without typical
warnings such as rain clouds or heavy rain.
b. Follow weather updates from PAGASA via the radio, television, or internet.
c. Learn, understand and follow the EMS in the community.
d. Regularly monitor river water levels, if applicable.

2. Prepare your home for flooding.

a. Secure your home, bring in outdoor furniture, and move essential items to
an upper floor.
b. Elevate utilities, such as electrical panels, switches, and appliances.
c. Reinforce and tightly close the windows and doors; and turn off the electrical
main switch.
d. Do not store your important documents in the basement. Keep them at a
higher level, protected from flood damage.
e. If feasible, construct barriers to stop flood water from entering your home
and seal walls in basements with waterproofing compounds.

3. Be ready for a possibility of evacuation.

a. Identify the safest and quickest way to a higher safe ground.
b. Know the locations of multi-storey buildings in your area.
c. Make pre-arrangements with family or friends living in higher grounds with
whom you can temporarily stay when flooding is imminent.
d. Be ready for the possibility of evacuating to a more elevated area or
evacuation center even before the flooding happens.
e. Create a personal flotation device just in case the situation requires the use
of one.

4. Participate in community drills.

a. Participate in the conduct of community drills and other information-sharing
activities.
b. Participate in formulating emergency, rehabilitation, and relief distribution
plans in your community.
c. Practice community evacuation plans and map out your routes from home
and work.
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d. Plan and designate a meeting place in case you and your family get
separated.

5. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you have an

Emergency Go Bag/E-balde in places you frequently visit or you might have to stay
for 24 hours.
a. This includes ready to eat food, tools, clothes, first aid kit, sleeping bags,
flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean water for the
whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes, packaged
biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without power).
d. Make sure that everyone knows the location of the Emergency Go Bag/E-
balde.

During 1. Evacuate your home or location in the following situations:

a. If your local government’s mandated theory evacuation.
b. If there is any possibility of a flash flood.
c. If you live in a temporary shelter or house made of light materials.
d. If you live near,
 A body of water or a place that easily gets flooded;
 Mountainous areas prone to landslides; or
 Coastal, lakeside, and riverside areas prone to storm surges.

2. If you cannot evacuate, here are what you need to do:

a. Gather family members and stay calm.
b. Stay indoors in the highest portion of your house, away from windows. If
your home is vulnerable to flooding, make sure to stay on the second floor
or on the roof.
c. Secure your home and turn off your electrical appliances.
d. Monitor the flood progress and listen for warnings or instructions from local
officials. You can also get updates by listening to the news on the radio or
TV, or social media.
e. Save the batteries on your phone for emergency calls.
f. Don not go outside unless you need to evacuate or an emergency situation
has happened.
g. Do not wade through floodwaters to avoid being electrocuted and
contracting diseases such as leptospirosis.
h. Continue breastfeeding infant during flood.
i. Eat well-cooked foods and drink clean water.
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j. Watch out for animals like poisonous snakes that may have come into
buildings with the flood waters.
k. If advised to evacuate, evacuate immediately and follow the recommended
routes. Turn off the main power switch and close all windows and doors
before leaving.
l. Use available personal flotation devices as required by the situation.
m. Be aware of risks such as drowning and hypothermia from cold.

After 1. Only return home once you are told it is safe to do so.
a. Listen for further alerts and instructions about evacuation zones and shelters.
b. Watch out for flooded outlets, frayed wires, and flammable leaks.
c. Notify the authorities about hazards and management of uprooted trees and
electrical posts.
d. Refrain from using a generator (if you have one) inside the house as
electricity and floods can be a dangerous mix.

2. Inspect your home for damage.

a. Use caution when re-entering buildings or homes.
b. Carefully check your home’s walls, floors, doors, windows, and staircases
for damage.
c. Inspect foundations for cracks or other damage that can render a building
uninhabitable. If you see structural damage, like cracks in the foundation or
missing support beams, you may need to relocate to a shelter or another safe
location. Floodwaters can undermine foundations causing buildings to sink,
crack, or collapse.
d. Check gas, electrical, and water lines for damage. Watch out for fire hazards
such as broken or leaking gas lines, flooded electrical circuits, or submerged
furnaces or electrical appliances.
e. Open the windows and doors to help dry the building.
f. Shovel mud while it is still moist to give walls and floors an opportunity to
dry.

3. If the power is out, use flashlights instead of candles.

a. Do not use matches, lighters, appliances, or light switches until you are sure
there are no gas leaks. Sparks from electrical switches could ignite gas,
causing an explosion.
b. If you must use candles, keep them away from anything that can catch fire.
Always stay near lit candles.

4. Avoid areas impacted by the emergency.

a. Delay return home as you might hamper rescue and other emergency
operations and be at further risk from the residual effects of the flooding.
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b. Avoid flooded areas, weakened bridges, overhanging structures, damaged

buildings, power lines and trees.

5. Check food supplies.

a. Throw out any food that has come in contact and contaminated with flood
waters.
b. Do not eat drowned animals, their meat could be contaminated by the flood
waters.
c. Make sure that the food you eat is prepared with clean water.

6. Check for unwanted animals that may cause harm and diseases
a. Beware of animals, such as rodents, snakes, and insects that may have
entered your home. Tap loudly and often on the floor with a stick to give
notice that you are there.
b. Remove stagnant water that can become breeding grounds for mosquitos.
c. Apply insect repellant or wear long sleeves, pants and socks to prevent
diseases caused by insects, mosquitos and other animals.

7. Stay connected and be informed.

a. Listen to receive emergency information and instructions from your battery-
operated TV or radio, social media, or cell phone text alerts.
b. Save phone calls for emergencies – text messages may be more reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how to seek help.

8. Once you are safe, follow the emergency plan that you have prepared to
communicate and reconnect with family members. Take your disaster supplies kit
with you.

First 1. Take care of any wounds or injuries to prevent infection. Please refer to First
Aid Aid for Wounds.
a. Get first aid quickly to help heal small wounds and prevent infection.
b. If you can, help others in need. Make sure you are not hurt, then help others.

2. Help injured or trapped persons.

a. Give first aid where appropriate.
b. Call for help.
c. Do not move seriously injured persons unless they are in immediate danger
of further injury.
d. Follow the minimum public health protocols when helping others, or when
staying in evacuation areas.
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3. People moving back to their flood-hit homes should watch out for poisonous
snakes as snakebites have been identified as one of the major killers in the post-
flood scenario.

Poisonous Snakes include Cobra, Copperhead, Coral Snake, Cotton Mouth (water
moccasin), Rattle Snake, and various snakes found in zoos. Depending on the type of
snake, signs and symptoms may include bleeding from wound, blurred vision, burning
of the skin, convulsions, diarrhea, dizziness, excessive sweating, fainting, fang marks
in the skin, fever, increased thirst, collapse (hypotension, shock), nausea, vomiting,
diarrhea, severe headache, “heaviness” of the eyelids, and drowsiness.

First aid treatment should be carried out immediately or very soon after the bite before
the patient reaches a dispensary or hospital. These are what can be immediately done:
 Clean the area of the bite with soap and water.
 Apply pressure immobilization bandage with splint on the bitten limb.
 Make the victim lie down quietly and comfortably.
 Keep victim calm; do not allow unnecessary movements.
 Bring victim to hospital / animal bite center immediately.
 For other parts of the body affected, wash wounds, do wound care and minimize
movement.

Do not perform the following:

 Do not suck the wound to remove the venom.
 Do not apply cold compress.
 Do not incise the bitten area.
 Do not use tourniquet.

4. Please see First Aid for Drowning.

LANDSLIDE
Landslide is the rapid downward sliding of a mass of earth and rock, usually over a confined area. A
landslide may be triggered by: the over-steepening of slopes by natural erosion or excavation; the
overloading of the slope by an inflow of water; or the motion caused by an earthquake. Even
mountains of garbage in dumpsites can cause a landslide.

Before 1. Find out whether or not landslides have occurred previously in your area by
contacting local authorities.

2. Be aware of your surroundings when you observe the following:

a. When you see slowly developing, widening cracks appear on the ground.
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b. When bulging ground appears at the base of a slope.

c. When fences, retaining walls, utility poles, or trees tilt or move.
d. When you hear a faint rumbling sound that increases in volume.
e. When you hear unusual sounds, such as trees cracking or boulders knocking
together.
f. When the ground slopes downward in one direction and may begin shifting in
that direction.
g. When there are holes or bare spots on hillsides. Tilted trees or fences/riprap
may also indicate unstable slope.

3. Prepare your home

a. If possible, do not build your home near steep slopes, close to mountain edges,
near drainage ways, or natural erosion valleys.
b. Watch the patterns of storm-water drainage near your home, and note the
places where runoff water converges, increasing flow in channels. These are
areas to avoid during a storm.
c. On slopes, plant ground cover and build retaining walls to protect your
property.
d. Build deflection walls or channels to direct mudflow around buildings.

4. Participate in community preparedness activities

a. Learn, understand and follow the Early Warning Systems (EMS) in the
community.
b. Participate in the conduct of community drills and other information sharing
activities.
c. Participate in formulating emergency, rehabilitation and relief distribution
plans in your community.
d. Practice community evacuation plans and map out your routes from home and
work.
e. Plan and designate a meeting place in case you and your family get separated.

5. Prepare an Emergency Go Bag/E-balde ahead of time.

a. This includes ready to eat food, tools, clothes, first aid kit, sleeping bags,
flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean water for the
whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes, packaged
biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without power).
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6. Make sure that everyone knows the location of the Emergency Go Bag/E-balde.
If you Suspect Imminent Landslide Danger
a. Contact your local authorities.
b. Inform affected neighbors. Your neighbors may not be aware of potential
hazards. Advising them of a potential threat may help save lives.
c. Evacuate. Getting out of the path of a landslide or debris flow is your best
protection.

During Stay alert and awake. Be watchful when there is intense rainfall. Intense, short bursts
of rain are particularly dangerous, especially after long periods of heavy rains and
damp weather.
Prepare for secondary risks such as flooding, downed power lines, and damaged
buildings.

1. If indoors:
a. Find cover in the part of the building that is the furthest from the
approaching landslide.
b. Take shelter under a strong table or a bench.

2. Hold on firmly and stay put until all movement has stopped.
If outdoors:
a. Move quickly away from its likely path, keeping clear of embankments,
trees, power lines and poles.
b. Stay away from the landslide area. The slope may experience additional
failures for hours to days afterwards.

3. If you are in your car:

a. Watch for collapsed pavement, mud, fallen rocks and other indications of
possible debris flow.

After 1. Only return home once you are told it is safe to do so.
a. Stay away from the slide area. There may be danger of additional slides.
b. Listen for further alerts and instructions about evacuation zones and shelters.
c. Watch for flooding, which may occur after a landslide or debris flow. Floods
sometimes follow landslides and debris flows because they may both be
started by the same event.

2. Inspect your home for damage.

a. Use caution when re-entering buildings or homes.
b. Carefully check your home’s walls, floors, doors, windows, and staircases for
damage.
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c. Inspect foundations for cracks or other damage that can render a building
uninhabitable. If you see structural damage, like cracks in the foundation or
missing support beams, you may need to relocate to a shelter or another safe
location. Floodwaters can undermine foundations causing buildings to sink,
crack, or collapse.
d. Check gas, electrical, and water lines for damage. Watch out for fire hazards
such as broken or leaking gas lines, flooded electrical circuits, or submerged
furnaces or electrical appliances.
e. Open the windows and doors to help dry the building.
f. Shovel mud while it is still moist to give walls and floors an opportunity to
dry.

3. If the power is out, use flashlights instead of candles.

a. Do not use matches, lighters, appliances, or light switches until you are sure
there are no gas leaks. Sparks from electrical switches could ignite gas, causing
an explosion.
b. If you must use candles, keep them away from anything that can catch fire.
Always stay near lit candles.

4. Avoid areas impacted by the emergency.

a. Delay return home as you might hamper rescue and other emergency
operations and be at further risk from the residual effects of the landslide.
b. Avoid weakened bridges, overhanging structures, damaged buildings, power
lines and trees.

5. Take care of any wounds or injuries to prevent infection.

a. Get first aid quickly to help heal small wounds and prevent infection.
b. If you can, help injured or trapped persons and others in need. Make sure you
are not hurt, then help others.
 Give first aid where appropriate.
 Call for help.
 Do not move seriously injured persons unless they are in immediate danger
of further injury.
 Follow the minimum public health protocols when helping others, or when
staying in evacuation areas.

6. Check for unwanted animals that may cause harm and diseases
a. Beware of animals, such as rodents, snakes, and insects that may have entered
your home. Tap loudly and often on the floor with a stick to give notice that
you are there.
b. Remove stagnant water that can become breeding grounds for mosquitos.
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c. Apply insect repellant or wear long sleeves, pants and socks to prevent
diseases caused by insects, mosquitos and other animals.
7. Stay connected and be informed.
a. Listen to receive emergency information and instructions from your battery-
operated TV or radio, social media, or cell phone text alerts.
b. Save phone calls for emergencies – text messages may be more reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how to seek help.

8. Once you are safe, follow the emergency plan that you have prepared to
communicate and reconnect with family members. Take your disaster supplies kit
with you.

First Aid Please refer to the first aid management for wounds and on the management of snake
bite below:

Snake bite is an important medical emergency and cause of hospital admission. It may
result in the death or chronic disability of many active younger people, especially
those involved in farming and plantation work, if not given immediate treatment.
However, not all snake bites are fatal. A majority of snakes are not poisonous.
Poisonous Snakes include Cobra, Copperhead, Coral snake, Cottonmouth (water
moccasin), Rattlesnake, and various snakes found in zoos.

Depending on the type of snake, signs and symptoms may include bleeding from
wound, blurred vision, burning of the skin, convulsions, diarrhea, dizziness, excessive
sweating, fainting, fang marks in the skin, fever, increased thirst, collapse
(hypotension, shock), nausea, vomiting, diarrhea, severe headache, “heaviness” of the
eyelids, and drowsiness.

First aid treatment should be carried out immediately or very soon after the bite before
the patient reaches a dispensary or hospital.
 Clean the area of the bite with soap and water.
 Reassure the victim who may be very anxious.
 Immobilize the whole of the patient’s body by laying him/her down in a
comfortable and safe position. Make sure to immobilize the bitten limb with
a splint or sling. Apply pressure if necessary.
 Avoid any interference with the bite wound (incisions, rubbing, vigorous
cleaning, massage, application of herbs or chemicals) as this may introduce
infection, increase absorption of the venom, and increase local bleeding.
 Bring the patient to the hospital.
 Antivenom is the only effective antidote for snake venom.
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Do not perform the following:

 Do not make the patient tired.
 Do not use tourniquet.
 Do not use ice pack or apply cold compress on the bite marks.
 Do not incise, puncture, pinch, or scrape bitten area.
 Do not suck in venom from the patient’s open wound.
 Do not give medication not prescribed by the doctor.
 Do not elevate the wound at the same level or higher than the chest/heart area.

TYPHOON

According to PAG-ASA, typhoons are tropical cyclones with winds that exceed 118 kilometers per
hour (kph). Tropical cyclone is defined as a non-frontal, synoptic-scale cyclone developing over
tropical and sub-tropical waters at any level and having a definitely organized circulation. The name
is applied to a severe tropical cyclone in the Western Pacific.

Tropical cyclones are warm-core low pressure systems associated with a spiral inflow of mass at the
bottom level and spiral outflow at the top level. They always form over oceans where sea surface
temperature, also air temperatures are greater than 26°C. The air accumulates large amounts of
sensible and latent heat as it spirals towards the center. It receives this heat from the sea and the
exchange can occur rapidly, because of the large amount of spray thrown into the air by the wind.
The energy of the tropical cyclone is thus derived from the massive liberation of the latent heat of
condensation.

Tropical cyclones can only form over oceans of the world except in the South Atlantic Ocean and
the South Eastern Pacific where a tropical cyclone could never be formed due to the cooler sea
surface temperature and higher vertical wind shears. They develop at latitudes usually greater than
5° from the equator. They reach their greatest intensity while located over warm tropical water. As
soon as they move inland, they begin to weaken, but often not before they have caused great
destruction.

The Philippines is prone to tropical cyclones due to its geographical location which generally produce
heavy rains and flooding of large areas and also strong winds which result in heavy casualties to
human life and destructions to crops and properties. Thus, it is of utmost importance to have
sufficient knowledge on such maritime phenomena for beneficial purposes.

Before 1. Understand the signs related to the emergency.

a. Watch/listen/pay close attention to weather updates of the possible
scope, track, intensity, and typhoon-warning signal from PAGASA
via the radio, television, internet, or other reliable media
information outlet.
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b. Learn, understand, and follow the Early Warning Systems (EMS) in

the community.
c. Determine the characteristic features of the tropical cyclone:
i. eye, a central region of clear skies
ii. warm temperatures and low atmospheric pressure
iii. eyewall, the most dangerous and destructive part where winds
are strongest and rainfall is heaviest
iv. rainbands, secondary cells that spiral into the center of the
storm

2. Take steps to prepare your home

a. Inspect your house for necessary repairs such as a leaky roof, loose
and clogged rain gutters, and downspouts, cracked walls, or broken
doors and windows.
b. Bring in all outdoor furniture, decorations, garbage cans and
anything else that is not tied down.
c. Fully charge all your electronic gadgets and emergency batteries.
d. Prepare your home for flooding.
 Elevate home furniture and appliances such as refrigerators,
televisions, and electric fans.
 Reinforce and tightly close the windows, doors and turn off the
electrical main switch.
 Do not store your important documents in the basement. Keep
them at a higher level, protected from flood damage.

3. Be ready for a possibility of evacuation.

a. Know the important emergency contact numbers.
b. Get everyone in your family a whistle.
c. Identify the safest and quickest way to a higher safe ground.
d. Know the locations of multi-storey buildings in your area in case of
flooding.
e. Make pre-arrangements with family of friends living in higher
grounds with whom you can temporarily stay during the typhoon.
f. Be ready for the possibility of evacuating to a more elevated area or
evacuation center even before the storm surge happens.
g. Create a Personal Floatation Device/ life preservers (salbabida) just
in case the situation requires the use of one.
h. Plan and designate a meeting place in case you and your family get
separated.
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4. Participate in community drills.

a. Participate in the conduct of community drills and other information
sharing activities.
b. Participate in formulating emergency, rehabilitation and relief
distribution plans in your community.
c. Practice community evacuation plans and map out your routes from
home and work.

5. Prepare an Emergency Go Bag/E-balde ahead of time.

a. Include ready to eat food, tools, clothes, first aid kit, sleeping bags,
flashlight, batteries, toiletries, COVID-19 Protection Kit
(facemasks, face-shield, alcohol spray, gloves, etc., as necessary).
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean
water for the whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes,
packaged biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without
power).
d. Make sure that everyone knows the location of the Emergency Go
Bag/E-balde.
During 1. What to do during Public Storm Signal No. 1:
a. Listen to your radio for more information about the typhoon.
b. Check the ability of the house to withstand strong winds and
strengthen it if necessary.
c. Monitor the latest severe weather Bulletin issued by PAGASA
every six hours. In the meantime, business may be carried out as
usual except when a flood occurs.

2. What to do during Public Storm Signal No. 2:

a. Special attention should be given to the latest position, the
direction and speed movement as the cyclone may intensity and
move towards the locality.
b. The public, especially people travelling by sea and air are
cautioned to avoid unnecessary risks.
c. Protect properties before signals are upgraded.
d. Board up windows or put storm shutters in place and securely
fasten it. Stay at home.

3. What to do during Public Storm Signal No. 3:

a. Keep your radio on and listen to the latest news about the typhoon.
b. Everybody is advised to stay in safe and strong houses.
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c. Evacuate from low-lying areas to higher grounds.

d. Stay away from coasts and riverbanks.
e. Watch out for the passage of the "EYE" of the typhoon.

4. What to do during Public Storm Signal No. 4:

a. Stay in safe houses or evacuation centers.
b. All travels and outdoor activities should be cancelled.
c. Keep listening to your radio to the latest news about the typhoon.

5. What to do during Public Storm Signal No. 5:

a. Stay in safe houses or evacuation centers.
b. All travels and outdoor activities should be cancelled.

6. Evacuate your home or location in the following situations:

a. Comply with your local government’s mandatory evacuations.
b. If your home structure is weak and is susceptible to being blown
away by the winds.
c. If you live near:
 A body of water or a place that easily gets flooded;
 Mountainous areas prone to landslides;
 Coastal, lakeside, and riverside areas prone to storm surges;
 Mobile homes, temporary shelter or houses made of light
materials; and
 Top floors in high-rise buildings – hurricane winds are stronger
at higher elevations.

7. Evacuate to a higher ground while observing the following precautions:

a. Secure children on a higher ground or on a flotation device.
b. Wear a protective head gear or helmet while evacuating.
c. Use a rope to secure yourself.
d. Carry the elderly or sick on your back.
e. Watch out for open manholes or side ditches. Use a stick to check
the safety around your feet when walking on flooded areas.

8. If you cannot evacuate, here are what you need to do:

a. Gather family members and stay calm.
b. Wash your hands frequently.
c. Drink bottled water, use purification tablets or boil for 1 minute.
d. Monitor the storm's progress and get updates by listening to the
news on the radio, TV, or social media for warnings or instructions
from local officials.
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e. Keep your eyes and ears open. Anything could happen in an

instant.
f. Secure your home and turn off your electrical appliances.
g. Save the batteries on your phone for emergency calls.
h. Never go out or never stay near a window and watch out for broken
glass until the storm subsides.
i. Do not go outside unless you need to evacuate or an emergency
situation has happened.
j. If you are unable to evacuate your home and you are in a place that
is vulnerable to flooding, make sure to stay indoors on the second
floor or in the highest portion of your house, away from windows.
Avoid floodwaters.
k. Stay away from downed power lines. When exposed to water,
electric facilities such as power. switchboards and power lines
could cause not only a power outage but also the hazard of electric
shock.
l. Wear enclosed footwear. Use available personal flotation devices
as required by the situation.
m. Be aware of risks such as drowning and hypothermia from cold.

After 1. Only return home once you are told it is safe to do so.
a. Listen for further alerts and instructions about evacuation zones
and shelters.
b. Watch out for flooded outlets, frayed wires, and flammable leaks.
c. Notify the authorities about hazards and management of uprooted
trees and electrical posts.
d. Refrain from using a generator (if you have one) inside the house
as electricity and floods can be a dangerous mix.

2. Inspect your home for damage.

a. Carefully check your home’s walls, floors, doors, windows, and
staircases for damage.
b. If you see structural damage, like cracks in the foundation or
missing support beams, you may need to relocate to a shelter or
another safe location.
c. Check gas, electrical, and water lines for damage.
d. Do not use matches, lighters, appliances, or light switches until you
are sure there are no gas leaks. Sparks from electrical switches
could ignite gas, causing an explosion.
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FOR PUBLIC HEALTH EMERGENCY IN THE PHILIPPINES

3. Use caution when re-entering buildings or homes.

a. Floodwaters can undermine foundations causing buildings to sink,
crack, or collapse.
b. Inspect foundations for cracks or other damage that can render a
building uninhabitable.
c. Look for fire hazards such as broken or leaking gas lines, flooded
electrical circuits, or submerged furnaces or electrical appliances.
d. Open the windows and doors to help dry the building.
e. Shovel mud while it is still moist to give walls and floors an
opportunity to dry.

4. If the power is out, use flashlights instead of candles.

a. If you must use candles, keep them away from anything that can
catch fire.
b. Always stay near lit candles.

5. Avoid areas impacted by the emergency.

a. Delay return home as you might hamper rescue and other
emergency operations and be at further risk from the residual
effects of the typhoon.
b. Avoid flooded areas, weakened bridges, overhanging structures,
damaged buildings, power lines and trees.

6. Take care of any wounds or injuries to prevent infection.

a. Get first aid quickly to help heal small wounds and prevent
infection.
b. If you can, help others in need. Make sure you are not hurt, then
help others.

7. Help injured or trapped persons.

a. Give first aid where appropriate.
b. Call for help.
c. Do not move seriously injured persons unless they are in
immediate danger of further injury.
d. Follow the minimum public health protocols when helping
others, or when staying in evacuation areas.

8. Check food supplies,

a. Beware! If the power is out, your food may have spoiled.
b. Throw out any food that has come in contact and contaminated
with flood waters
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FOR PUBLIC HEALTH EMERGENCY IN THE PHILIPPINES

c. Do not eat drowned animals, their meat could be contaminated

by the flood waters
d. Make sure that the food you eat is prepared with clean water.

9. Check for unwanted animals that may cause harm and diseases.
a. Beware of animals, such as rodents, snakes, and insects that may
have entered your home. Tap loudly and often on the floor with
a stick to give notice that you are there.
b. Remove stagnant water that can become breeding grounds for
mosquitos and other animals.
c. Apply insect repellant or wear long sleeves, pants and socks to
prevent diseases caused by insects, mosquitos and other animals.

10. Stay connected and be informed.

a. Listen to receive emergency information and instructions from
your battery-operated TV or radio, social media, or cell phone
text alerts.
b. Save phone calls for emergencies – text messages may be more
reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how
to seek help.

11. Once you are safe, follow the emergency plan that you have prepared
to communicate and reconnect with family members. Take your
Emergency Go Bag/E-balde with you. Keep dry and warm.
First Aid Please see First Aid for Wounds, Drowning or other conditions that may
result from typhoons.

STORM SURGE
Also known as “Daluyong ng Bagyo”, is the abnormal rise in sea level that occurs during tropical
cyclones or “bagyo”. It is caused by strong winds and low atmospheric pressures produced by
tropical cyclones. As the tropical cyclone approaches the coast, strong winds push the ocean water
over the low-lying coastal areas, which can lead to flooding. This makes storm surges very
dangerous.

Storm surge becomes more dangerous when it arrives on top of a high tide. When this happens, it
may flood areas that otherwise might have been dry or safe. On top of the storm surge, big and strong
waves generated by powerful winds also come with it. (PAGASA)
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Before 1. Understand the signs related to the emergency.

a. Watch/listen to weather updates of the possible scope, track,
intensity, and typhoon-warning signal from PAGASA via the
radio, television, internet, or other reliable media information
outlet.
b. Learn, understand, and follow the Early Warning Systems (EMS)
in the community.
c. Determine the character of the storms:
i. When storms produce strong winds, this pushes the water into
the shore.
ii. When a storm hits land, storm surge often floods the
surrounding coastal area.

2. Prepare your home.

a. Elevate utilities, such as electrical panels, switches, and
appliances.
b. Reinforce and tightly close the windows, doors and turn off the
electrical main switch.
c. Store your important documents including medical records at a
higher level, protected from flood damage.

3. Be ready for the possibility of evacuating to a more elevated area or

evacuation center even before the storm surge happens.
a. Identify the safest and quickest way to a higher ground.
b. Know the locations of multi-storey buildings in your area.
c. Make pre-arrangements with family of friends living in higher
grounds with whom you can temporarily stay during the storm
surge.
d. Make a Personal Floatation Device or know where to access
similar devices in case the situation requires the use of one.
e. Plan and designate a meeting place in case you and your family
get separated.

4. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you

have an Emergency Go Bag/E-balde in places you frequently visit or
you might have to stay for 24 hours.
a. This includes ready to eat food, tools, clothes, first aid kit, sleeping
bags, flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean water
for the whole family that would last for at least 3 days.
 44
COMPENDIUM OF RISK COMMUNICATION MATERIALS
FOR PUBLIC HEALTH EMERGENCY IN THE PHILIPPINES

 Include easy-open canned goods, dried fruits or trail mixes,

packaged biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without
power).
d. Make sure that everyone knows the location of the Emergency Go
Bag/E-balde.
5. Participate in community drills.
a. Participate in the conduct of community drills and other information
sharing activities.
b. Participate in formulating emergency, rehabilitation, and relief
distribution plans in your community.
c. Practice community evacuation plans and map out your routes from
home and work.

6. Follow the advice of the authority.

a. Follow the pre-emptive evacuation procedures.
b. Obey seaboard’s recommendations and travel restrictions for
small/large water vessels.
During 1. Comply with your local government’s mandatory/forced evacuations in
the following situations:
a. If your home is mobile, temporary, or structure is weak or made of
light materials, and is susceptible to being blown away by the winds
and strong waves.
b. If you live near:
i. A body of water or a place that easily gets flooded;
ii. Mountainous areas prone to landslides; and
iii. Coastal, lakeside and riverside areas prone to storm surges.

2. If unable to evacuate your house, here is a list of what you need to do:
a. Gather family members and stay calm.
b. Stay indoors in the highest portion of your house away from
floodwaters and away from windows.
c. Monitor the storm's progress and get updates by listening to the
news on the radio, TV, or social media for warnings or instructions
from local officials.
d. Keep your eyes and ears open for storm surges could happen in an
instant.
e. Secure your home and turn off your electrical appliances.
f. Save the batteries on your phone for emergency calls.
g. Never go out unless you need to evacuate or an emergency situation
has happened and until the storm subsides.
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FOR PUBLIC HEALTH EMERGENCY IN THE PHILIPPINES

3. If you are unable to evacuate your home and you are in a place that is
vulnerable to flooding, make sure to stay off the floodwater.
a. Stay away from downed power lines. When exposed to water,
electric facilities such as power switchboards and power lines could
cause not only a power outage but also the hazard of electric shock.
b. Use available personal flotation devices as required by the situation.
c. Be aware of the risks such as drowning and hypothermia.

4. If you are outside of the hazard zone and receive a warning,

a. Stay where you are unless officials tell you otherwise.
b. Leave immediately if you are told to do so.
After 1. Only return home once you are told it is safe to do so.
a. Listen for further alerts and instructions about evacuation zones and
shelters.
b. Watch out for flooded outlets, frayed wires, and flammable leaks.
c. Notify the authorities about hazards and management of uprooted
trees and electrical posts.
d. Refrain from using a generator (if you have one) inside the house as
electricity and floods can be a dangerous mix.

2. Inspect your home for damage.

a. Carefully check your home’s walls, floors, doors, windows, and
staircases for damage.
b. If you see structural damage, like cracks in the foundation or
missing support beams, you may need to relocate to a shelter or
another safe location.
c. Check gas, electrical, and water lines for damage.
d. Do not use matches, lighters, appliances, or light switches until you
are sure there are no gas leaks. Sparks from electrical switches could
ignite gas, causing an explosion.

3. Use caution when re-entering buildings or homes

a. Floodwaters can undermine foundations causing buildings to sink,
crack, or collapse. Inspect foundations for cracks or other damages
that can render a building or the home uninhabitable.
b. Look for fire hazards such as broken or leaking gas lines, flooded
electrical circuits, or submerged furnaces or electrical appliances.
c. Shovel mud while it is still moist to give walls and floors an
opportunity to dry.
d. Open the windows and doors to help dry the building or the home.
 46
COMPENDIUM OF RISK COMMUNICATION MATERIALS
FOR PUBLIC HEALTH EMERGENCY IN THE PHILIPPINES

4. If the power is out, use flashlights instead of candles.

a. If you must use candles, keep them away from anything that can
catch fire and be on watch.

5. Avoid areas impacted by the emergency.

a. Avoid flooded areas, weakened bridges, overhanging structures,
damaged buildings, power lines, and trees.
b. Avoid further risk from the residual effects of the storm surge while
allowing rescue and other emergency operations to take place prior
returning home.

6. Take care of any wounds or injuries to prevent infection.

a. Get first aid quickly to help heal small wounds and prevent
infection.
b. If you are not hurt or have given first aid to oneself, help others in
need.

7. Help injured or trapped persons.

a. Give first aid where appropriate.
b. Call for help.
c. Do not move seriously injured persons unless they are in immediate
danger of further injury.
d. Follow the minimum public health protocols when helping others
and when staying in evacuation areas.

8. Check food supplies.

a. Throw out any food that has come in contact and contaminated with
floodwaters.
b. Do not eat drowned animals; the floodwaters could contaminate
their meat.
c. Make sure that the food you eat is prepared with clean water.

9. Check for unwanted animals that may cause harm and diseases.
a. Beware of animals, such as rodents, snakes, and insects that may
have entered your home. Tap loudly and often on the floor with a
stick to give notice that you are there.
b. Drain stagnant water from containers that can become breeding
grounds for mosquitos and other animals.
c. Apply insect repellant or wear long sleeves, pants and socks to
prevent diseases caused by insects, mosquitos and other animals.
 47
COMPENDIUM OF RISK COMMUNICATION MATERIALS
FOR PUBLIC HEALTH EMERGENCY IN THE PHILIPPINES

10. Stay connected and be informed.

a. Listen to receive emergency information and instructions from your
battery-operated TV or radio, social media, or cell phone text alerts.
b. Save phone calls for emergencies; text messages may be more
reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how to
seek help.

11. Once you are safe, follow the emergency plan that you have prepared
to communicate and reconnect with family members. Take your
disaster supplies kit with you.
First Aid Drowning as common is flooding and storm surge is a respiratory
impairment due to submersion/ immersion in water.
Special Considerations:
 Make sure that the scene is safe.
 Do NOT swim out to a victim unless you have the proper
training, skills, and equipment.
 If the appropriate safety equipment is not available and there is
a chance that you cannot safely help a person in trouble, call for
help immediately.
 If you must assist someone who is having trouble in the water,
you must have the appropriate equipment both for your own
safety and the victim’s.
 Send someone else to call the local emergency number while
you start the rescue.

Perform the following for submerged victims:

 If the victim is in shallow water that is less than chest deep,
carefully wade into the water with some kind of flotation
equipment.
 Reach down and grasp the victim.
 Pull the victim to the surface.
 Turn the victim face-up and bring him or her to safety.
 Remove the victim from the water.
 Provide emergency care.

If trained on Cardiopulmonary Resuscitation (CPR), perform the following

to revive an unresponsive victim:
 If the victim vomits while you are resuscitating him, turn the
person toward you, and clear out the mouth before turning
him/her on to the back and resuming rescue breathing.
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 If the victim vomits while in recovery position, clear out the

mouth and keep a close eye on breathing to ensure that it has not
stopped.
 If the victim is conscious and becomes sick, encourage him/her
to lean forward and give support while he/she is vomiting.
 Do not make any effort to remove water from the lungs by
applying chest compressions or abdominal thrusts.
 Ensure an open airway and that the person is breathing.
 Tilt the head, check the mouth, and lift the chin.
 Check for breathing for up to 10 seconds.
o If the victim is breathing, place him/her into the recovery
position.
o If the victim is not breathing, provide rescue breathing
before moving on to an assessment of circulation and full
CPR (cardiopulmonary resuscitation) as necessary.
 Keep warm; remove cold wet clothes.
 Bring victim to the nearest health care facility.

A.2 GEOPHYSICAL
Geological or geophysical hazards originate from internal earth processes. Examples are
earthquakes, volcanic activity and emissions, and related geophysical processes such as mass
movements, landslides, rockslides, surface collapses and debris or mud flows.

EARTHQUAKE
An earthquake is a weak to violent shaking of the ground produced by the sudden movement of rock
materials below the earth’s surface.

The earthquakes originate in the tectonic plate boundary. The focus is the point inside the earth where
the earthquake started, sometimes called the hypocenter, and the point on the surface of the earth
directly above the focus is called the epicenter.

There are two ways by which we can measure the strength of an earthquake: magnitude and intensity.
Magnitude is proportional to the energy released by an earthquake at the focus. It is calculated from
earthquakes recorded by an instrument called seismograph. It is represented by Arabic Numbers (e.g.
4.8, 9.0). Intensity on the other hand, is the strength of an earthquake as perceived and felt by people
in a certain locality. It is a numerical rating based on the relative effects to people, objects,
environment, and structures in the surrounding. The intensity is generally higher near the epicenter.
It is represented by Roman Numerals (e.g. II, IV, IX). In the Philippines, the intensity of an
earthquake is determined using the Philippine Institute of Volcanology and Seismology
(PHIVOLCS) Earthquake Intensity Scale (PEIS).
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Before 1. Understand the signs related to the emergency.

a. Signs can include any of the following:
i. Avoid building houses in places known to be landslide-prone
like hillsides or mountainsides.
ii. Avoid construction within 5 meters on each side of a fault trace,
or a total width of 10 meters or the ideal "10-meter wide no-
build zone" in the vicinity of a fault.
iii. Notice possible foreshocks (smaller earthquakes that lead up to
the "main" earthquake).
iv. Notice ground tilting that is caused by the buildup of stress in
the rocks.

2. Prepare your home.

a. Check for hazards inside your home and repair any deep cracks in
the ceilings, walls, or floors.
b. Do not hang heavy items such as pictures and mirrors in areas where
people sit or sleep.
c. Repair potential fire risks such as defective electrical wiring and
leaky gas connections.
d. Identify safe places indoors such as under sturdy furniture, heavy
desks or tables away from windows, mirrors, pictures where glass
could shatter around or where heavy bookcases or other heavy
furniture could fall over.
e. Educate yourself and your family members and practice Duck,
Cover, and Hold.

3. Be ready for a possibility of evacuation.

a. Identify the safest and quickest way to a higher safe ground.
b. Identify safe places outdoors in an open area, away from buildings,
trees, telephone and electrical lines, and elevated roadways.
c. Plan and designate a meeting place in case you and your family get
separated.
d. Take note of hotlines and emergency numbers to call for help.

4. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you

have an Emergency Go Bag/E-balde in places you frequently visit or
you might have to stay for 24 hours.
a. This includes ready to eat food, tools, clothes, first aid kit, sleeping
bags, flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
● Ensure that you have an adequate supply of food and clean
water for the whole family that would last for at least 3 days.
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COMPENDIUM OF RISK COMMUNICATION MATERIALS
FOR PUBLIC HEALTH EMERGENCY IN THE PHILIPPINES

● Include easy-open canned goods, dried fruits or trail mixes,

packaged biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without
power)
d. Make sure that everyone knows the location of the Emergency Go
Bag/E-balde.

5. Participate in community drills

a. Participate in the conduct of community drills and other
information sharing activities.
b. Participate in formulating emergency, evacuation, rehabilitation
and relief distribution plans in your community.
During Wherever you are, it is very important to be calm and try not to panic.
Always remember the earthquake drill procedures and maintain your
composure.

1. If indoors:
a. Perform the “Duck, Cover, and Hold” Technique — drop to the
ground, find cover under a table or other sturdy piece of furniture,
and hold on until the shaking stops.
b. Move away from glass windows, doorways, heavy cabinets and
hanging objects like chandeliers that may fall during or right after
the shaking.
c. Stay inside until the shaking has stopped and you are sure that
going out is safe. Once outside, move away from buildings to an
open space.
d. If the building is structurally sturdy, stay inside and brace yourself
in a doorway or stay beside or underneath sturdy furniture to
protect yourself from falling objects.

2. If outdoors:
a. Stay out in the open and do not go inside any building.
b. Move to an open area away from nearby buildings, bridges, posts,
power lines, electric posts, tall structures, tree branches, and other
structures that may fall or collapse.
c. If driving, pull over to the side of the road. Stay as low as possible
inside the vehicle.
d. DO NOT use elevators as the electricity may shut down.
e. Go to the nearest exit and leave the building as soon as possible.
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3. If you are inside a crowded place:

a. Duck, Cover, and Hold on. If you can, grab something to cover or
shield your head from any falling debris and objects.
b. Do not rush to the doorways to prevent crowding and eventual
stampede.

4. If you are in a moving vehicle:

a. Stop as quickly and safely as possible.
b. Stay inside the car and set the parking brake.
c. The car may jiggle violently on its springs, but it is a good place to
stay until the shaking stops.
d. When it is safe to begin driving again, watch for hazards created by
the earthquake, such as breaks in the pavement, downed utility poles
and wires, rising water levels, fallen overpasses, or collapsed
bridges.
e. Avoid crossing partially or heavily damaged bridges, flyovers
and/or
f. tunnels as these may collapse.

5. If you cannot drop to the ground:

a. Try to sit or remain seated to maintain your balance and prevent
yourself from being knocked down. Doing the tripod position can
prevent you from being knocked down. It is done by kneeling on
one foot and holding your ground until the shaking stops.
b. If you are in a wheelchair, lock your wheels. Remove any items that
are not securely attached to the wheelchair.
c. If you are unable to move from a bed or chair, protect yourself from
falling objects by covering up with blankets and pillows.
d. Protect your head and neck with a large book, a pillow, or your
arms.

6. If you are outside of the hazard zone and receive a warning:

a. Stay where you are unless authorities tell you otherwise.
b. Leave immediately, if you are told to do so.

7. Expect aftershocks to follow after the main shock of an earthquake. Be

always ready to Duck, Cover, and Hold if you feel an aftershock.
After 1. When inside a building or structure:
a. Remain calm and look around to assess the situation before
moving.
b. Check yourself and others for any sustained injury.
c. Grab your 3-day Emergency Go Bag/E-balde.
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d. Exit the building using the recommended emergency evacuation

route.
e. Walk cautiously faster than normal.
f. Refrain from running and pushing other evacuees.
g. In case of Pandemic, maintain at least 1-meter social distancing,
wear facemasks, and remove it only if necessary.
h. Once you are outside, stay vigilant for any danger.

2. If you got trapped on a confined space:

a. Draw attention by making loud sounds by whistling, knocking on
pipes or walls and shouting out for help.
b. Using your mobile phone, send SOS messages to proper authorities
or loved ones containing your exact location and current condition.
You may also use your phone’s flashlight to get others’ attention.
c. Protect your mouth, nose, and eyes from dust by covering your face
with your shirt or with a facemask if available.

3. If you are in a Tsunami-prone area:

a. Evacuate immediately if you hear an official tsunami warning or
notice signs of a tsunami like sudden pulling back of seawater or
loud crashing wave sounds.
b. Get into a higher ground as far inland as possible.

4. On returning to your workplace in a building:

a. Wait until the authorities, like the safety officers, gave their
clearance if it is safe to re-enter the structure.
b. Watch out for destroyed outlets, frayed wires, and flammable
leaks.
c. Notify the authorities about the hazards.

5. Inspect your home for damages and other risks:

a. Carefully check your home’s walls, floors, doors, windows, and
staircases for damages.
b. If you see structural damage, like cracks in the foundation or
missing support beams, you may need to relocate to a shelter or
another safe location.
c. Check for fire, toxic chemical spills, and other hazards in your
surroundings.
d. Reduce risk associated with fires after earthquakes.
 Check gas and electrical lines for any damage or leak.
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 Do not use matches, lighters, appliances, or light switches until

you are sure there are no gas leaks. Sparks from electrical
switches could ignite gas, causing an explosion.
 If the power is out, use flashlights instead of candles.
 If you must use candles, keep them away from anything that
can catch fire. Remember: Do not leave open candles
unattended.
e. Beware of animals, such as rodents, snakes, and insects that may
have entered your home. Tap loudly and often on the floor with a
stick to give notice that you are there.

6. Expect aftershocks.
a. Strong earthquakes usually produce aftershocks. If you feel
another ground shaking, do again the Duck, Cover, and Hold-on
Technique.
b. Do not re-enter any partially or heavily damaged building or
structure.
c. Use stairs in emergency exits and not the elevator/lifters when
exiting a building.

7. Stay connected and be informed.

a. Listen to receive emergency information and instructions from
your battery-operated TV or radio, social media, or cell phone text
alerts.
b. Save phone calls for emergencies – text messages may be more
reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how to
seek help.
First Aid 1. Provide self-care to any wounds.
a. Quickly treat life-threatening wounds with first aid management.
b. If you can, help others in need. Make sure you are not hurt and then
help others.
c. Be sure to move to a safe location before doing the first aid.

2. Help the injured or trapped persons.

a. Follow the minimum public health standards when helping others
b. As much as possible, provide emergency assistance to injured
persons only if there is an available set of PPE - gloves and
facemasks.
c. Give first aid where appropriate.
d. Call for additional help if necessary.
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e. Do not move seriously injured persons unless they are in

immediate danger of further injury.

3. First Aid for specific conditions

3.1. Wounds
Wounds are common injuries of the skin and underlying tissues that
result from exposure to external forces. Wounds are generally
classified as either closed or open.

Follow these steps to treat minor cuts and wounds:

 Wash your hands before treating the wound.
 Check that there is nothing in the wound. If the wound is dirty, clean
it under running water.
 Pat dry with clean, non-fluffy material.
 Clean the wound from the center out with gauze swabs or antiseptic
wipes, using a fresh piece for each wipe.
 Cover the wound with an adhesive dressing to apply pressure and
protect it from infection.
 Elevate the wound, if necessary, to help control bleeding.

The proper first aid to prevent the undesirable effects of wounds depends
on the type of wound present.

3.1.a. Closed Wounds

The skin surface is intact and the damage is on the underlying
tissues.

Examples are bruise and contusion. Signs include redness, swelling,

and hematoma. Severe bruising may indicate possible internal
bleeding.

First Aid for Closed Wounds:

 Apply cold compress for 15 minutes (range to 20 minutes) every
20 minutes until referred.
 Apply cold compress within 15 minutes (range of 10 to 20
minutes) every 2 hours on the first 24 hours, for home remedies.
 Hot compress for 15 minutes 3 X a day after 24 hours.
 Keep affected part elevated, when possible.

3.1.b. Open Wounds

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The skin surface is broken. Examples are abrasion (galos/gasgas),

laceration (punit), incision, puncture (tusok), amputation (putol),
and avulsion (tuklap). While the most common type of closed
wound are bruise and contusion.

First Aid for Open Wounds:

A. Abrasion (Galos/Gasgas) – scraping or wearing away of the top

layer of the skin.
 Wash the wound immediately with soap and water.
 Apply mild antiseptic solution.
 Keep surface exposed.

B. Laceration (Punit) – tear on the surface of the skin.

 Wash with large amounts of clean water.
 Control bleeding by applying direct pressure using clean
dressing.
 For persistent bleeding: apply second dressing over first; use
elastic bandage.
 Bring victim to health care facility.

C. Incision – cut or wound of body tissue caused by sharp edged object

or material.
 First aid intervention for incision will be the same as for
laceration.

D. Puncture (Tusok) – entry of sharp, pointed object.

 Wash with large amounts of clean water.
 Apply mild antiseptic.
 Cover the wound.
 Bring victim to health care facility.

E. Amputation (Putol) – total separation of body part or limb.

 Control bleeding by using pressure dressings.
 Cover detached part with moist dressing, place in clean plastic
bag, and place in bag with ice.
 Apply tourniquet to minimize or control massive bleeding.
 Bring victim and detached part to health care facility.
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F. Avulsion (Tuklap) – skin and tissues under it torn off from surface.
 Wash with large amounts of clean water.
 Apply pressure dressing.
 Bring victim immediately to the health care facility.

TSUNAMI
Tsunami is a series of sea waves commonly generated by under-the-sea earthquakes and whose
heights could be greater than 5 meters. It is erroneously called tidal waves and sometimes mistakenly
associated with storm surges. Tsunamis can occur when the earthquake is shallow-seated and strong
enough to displace parts of the seabed and disturb the mass of water over it. (PHIVOLCS)

Before 1. Understand the signs related to the emergency.

a. Earthquakes often precede a tsunami. The occurrence of a very large
earthquake that lasts for more than 20 seconds can produce a
potential tsunami.
b. Learn the signs of a potential tsunami, such as an earthquake, a loud
roar from the ocean, or unusual ocean behavior, such as a sudden
rise or wall of water or sudden draining of water showing the ocean
floor and these are considered “nature’s tsunami warning”.
c. Learn, understand, and follow the Early Warning Systems (EMS)
in the community.

2. Prepare your home

a. Elevate utilities, such as electrical panels, switches, and appliances.
b. Reinforce and tightly close the windows, doors and turn off the
electrical main switch.
c. Do not store your important documents in the basement. Keep
them at a higher level, protected from flood damage.

3. Be ready for a possibility of evacuation

a. Identify the safest and quickest way to a higher safe ground.
b. Know your local community’s suggested evacuation routes to safe
areas, where shelter can be provided while you await the “all clear.”.
c. Make pre-arrangements with family of friends living in higher
grounds with whom you can temporarily live.
d. Be ready for the possibility of evacuating to a more elevated area or
evacuation center even before the storm surge happens.
e. Make a Personal Floatation Device or know where to access similar
devices in case the situation requires the use of one.
f. Plan and designate a meeting place in case you and your family get
separated.
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1. Participate in preparedness activities

a. Participate in the conduct of community drills and other information
sharing activities.
b. Participate in formulating emergency, rehabilitation and relief
distribution plans in your community.
c. Practice community evacuation plans and map out your routes from
home and work.
d. Consider taking a first aid course and learn survival skills.

2. Prepare an Emergency Go Bag/E-balde ahead of time.

a. Include ready to eat food, tools, clothes, first aid kit, sleeping bags,
flashlight, batteries, toiletries, COVID-19 Protection Kit
(facemasks, face-shield, alcohol spray, gloves, as necessary). etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean water
for the whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes,
packaged biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without
power).
d. Make sure that everyone knows the location of the Emergency Go
Bag/E-balde.

3. When a “Tsunami Watch” is issued,

a. Locate family members and review evacuation plans.
b. Be ready to evacuate. Being prepared will help you to move more
quickly.
c. If time permits, secure unanchored objects to reduce potential loss
or damage.
During 1. If you are in a tsunami area and there is an earthquake:
a. First protect yourself from the earthquake. Drop, Cover, and Hold.
b. When the shaking stops, move immediately to a safe place as high
and as far inland as possible.
c. Listen for official warnings, but also listen and watch for natural
signs. A tsunami is a series of waves, danger is not over after the
first wave.

2. If you cannot evacuate to higher ground, evacuate vertically to a higher

floor, onto a roof, up a tree, or grab a floating object.

3. If you are outside of the hazard zone and receive a warning:

a. Stay where you are unless officials tell you otherwise.
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b. Leave immediately if you are told to do so. Move inland to higher

ground immediately and stay there.

4. If you are in the water:

a. If you are caught in the tsunami's grip, do not fight the current.
b. Try to grab onto debris or something solid in the ground, like a pole.
c. Grab onto something that floats, such as a raft, tree trunk, or door
until the water subsides.

5. If you are in a boat:

a. Face the direction of the waves and head out to sea.
b. If you are in a harbor, go inland.

6. Take your Emergency Go Bag/E-balde.

a. Having food and supplies will make you more comfortable during
the evacuation.
After 1. Only return home once you are told it is safe to do so.
a. Listen for further alerts and instructions about evacuation zones and
shelters. Tune in to a radio or TV station that serves your area and
listen for instructions from emergency officials. Follow these
instructions and wait for the “all clear” before returning to the coast.
b. Watch out for flooded outlets, frayed wires, and flammable leaks.
c. Notify the authorities about hazards and management of uprooted
trees and electrical posts.
d. Refrain from using a generator (if you have one) inside the house
as electricity and floods can be a dangerous mix.

2. Inspect your home for damage.

a. Carefully check your home’s walls, floors, doors, windows, and
staircases for damage.
b. If you see structural damage, like cracks in the foundation or
missing support beams, you may need to relocate to a shelter or
another safe location.
c. Check gas, electrical, and water lines for damage.
d. Do not use matches, lighters, appliances, or light switches until you
are sure there are no gas leaks. Sparks from electrical switches could
ignite gas, causing an explosion.

3. Use caution when re-entering buildings or homes.

a. Tsunami waters can undermine foundations causing buildings to
sink, crack, or collapse.
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b. Inspect foundations for cracks or other damage that can render a

building uninhabitable.
c. Look for fire hazards such as broken or leaking gas lines, flooded
electrical circuits, or submerged furnaces or electrical appliances.
d. Open the windows and doors to help dry the building.
e. Shovel mud while it is still moist to give walls and floors an
opportunity to dry.

4. Avoid areas impacted by the emergency.

a. Avoid flooded areas, weakened bridges, overhanging structures,
damaged buildings, power lines, and trees.
b. Avoid further risk from the residual effects of the storm surge while
allowing rescue and other emergency operations to take place prior
returning home.
c. Stay out of the building if water remains around it; tsunami waters,
like flood waters, can cause buildings to sink and collapse.

5. Take care of any wounds or injuries to prevent infection.

a. Get first aid quickly to help heal small wounds and prevent
infection.
b. If you can, help injured or trapped people. Make sure you are not
hurt, then help others.

6. Help injured or trapped persons.

a. Give first aid where appropriate.
b. Call for help.
c. Do not move seriously injured persons unless they are in immediate
danger of further injury.
d. Help others, like elderly people, small children, or persons with
disabilities, who may require special assistance.
a. Follow the minimum public health protocols when helping others,
or when staying in evacuation areas.

7. Check food supplies.

a. Throw out any food that has come in contact and contaminated with
floodwaters.
b. Do not eat drowned animals; the floodwaters could contaminate
their meat.
c. Make sure that the food you eat is prepared with clean water.
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8. Check for unwanted animals that may cause harm and diseases.
a. Beware of animals, such as rodents, snakes, and insects that may
have entered your home. Tap loudly and often on the floor with a
stick to give notice that you are there.
b. Remove stagnant water that can become breeding grounds for
mosquitos and other animals.
c. Apply insect repellant or wear long sleeves, pants and socks to
prevent diseases caused by insects, mosquitos and other animals.

9. Stay connected and be informed.

a. Listen to receive emergency information and instructions from your
battery-operated TV or radio, social media, or cell phone text alerts.
b. Save phone calls for emergencies – text messages may be more
reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how to
seek help.

10. Check for possible breeding places for mosquitoes.

a. Drain water collected on containers.
b. Apply insect repellant or wear long sleeves, pants and socks to
prevent diseases caused by insects, mosquitos and other animals.

11. Once you are safe, follow the emergency plan that you have prepared
to communicate and reconnect with family members. Take your
disaster supplies kit with you.
First Aid Please see First Aid for Wounds, Drowning or other conditions that may
result from tsunami.

VOLCANIC ERUPTION
A volcanic eruption may involve lava and other debris that can flow up to 100 mph, destroying
everything in their path. Volcanic ash can travel 100s of miles and cause severe health problems. A
volcanic eruption can:

- Contaminate water supplies.

- Damage machinery.
- Reduce visibility through smog and harmful gases that may threaten low-lying areas.
- Make it hard to breathe and irritate the skin, eyes, nose, and throat.
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Before 1. Understand the signs related to the emergency.

a. Signs can include any of the following:
i. When there are magmatic eruptions involving the rise of magma
toward the surface, which normally generates detectable
earthquakes.
ii. When there are deformations on the ground surface and cause
anomalous heat flow or changes in the temperature and chemistry
of the groundwater and spring waters.
iii. When there are steam-blast eruptions, however, it can occur with
little or no warning as superheated water flashes to steam.
b. Learn, understand and follow the Early Warning Systems (EMS)
in the community.

2. Participate in community drills.

a. Participate in the conduct of community drills and other information
sharing activities.
b. Participate in formulating emergency, rehabilitation, and relief
distribution plans in your community.
c. Practice community evacuation plans and map out your routes from
home and work.
d. Plan and designate a meeting place in case you and your family get
separated.

3. Be ready to evacuate if your area is under a volcano warning.

a. If advised, evacuate early. Bring only essential items such as your
Emergency Go Bag/E-balde, important documents, and prescription
medicines.
b. Listen for emergency information and alerts issued by PHIVOLCS
and other reliable national or local authorities, and take the
necessary precautions.
c. Keep handy a pair of goggles and a dust mask for each member of
your household in case of ash fall.

4. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you

have an Emergency Go Bag/E-balde in places you frequently visit or you
might have to stay for 24 hours.
a. This includes ready to eat food, tools, clothes, first aid kit, sleeping
bags, flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean water
for the whole family that would last for at least 3 days.
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 Include easy-open canned goods, dried fruits or trail mixes,

packaged biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without
power).
d. Make sure that everyone knows the location of the Emergency Go
Bag/E-balde.
During 1. Follow instructions and evacuation orders from authorities.
a. Evacuate early especially if your house is located within the danger
zone.
b. Leave the area immediately if a lahar, pyroclastic flow, or lava flow
is headed toward you.
c. Move away immediately if you become irritated from volcanic
gases and fumes.
d. Avoid areas downstream and downwind of the eruption. Rubble and
ash will be carried by wind and gravity.
e. Take only essential items with you. Your Emergency Go Bag/E-
balde, important documents, and your prescription medicines.
f. Stay away from ash fall areas, if possible. Avoid contact with ash
as much as you can. Keep your skin covered to avoid irritation
from contact with ash.

2. Protect yourself from falling ash. Stay indoors until authorities say it is
safe to go outside.
a. Stay inside, with windows and doors closed, if possible.
b. Wear long-sleeved shirts and long pants.
c. Wear goggles to protect your eyes from ash.
d. Limit your time outdoors and use a dust mask or cloth mask as a last
resort.
e. Cover ventilation openings and seal doors and windows with moist
blanket or cloth.
f. If you have any breathing problems, avoid contact with ash.

3. Public health reminders:

a. Remain indoors and minimize outdoor activities.
b. Wear n95 mask if venturing outside cannot be avoided.
c. Wear protective clothing including goggles.
d. Turn off the air conditioning and fans.
e. Close windows and doors to keep ash and gases from getting inside
the house.
f. Remain alert and prepared to evacuate if advised.
g. Keep pets in a safe place.
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After 1. Only return home once you are told it is safe to do so. Stay indoors until
authorities say it is safe to go outside.
a. Listen for further alerts and instructions about evacuation zones and
shelters.
b. Do not travel unless you have to. Driving in ash is hazardous to your
health and your car. Driving will stir up more ash that can clog
engines and stall vehicles.
c. Clear roofs of ash to avoid roof collapse. However, be very cautious
when working on the roof. Ash can be slippery and make it easy to
fall.
2. Inspect your home for damage.
a. Carefully check your home’s walls, floors, doors, windows, and
staircases for damage.
b. If you see structural damage, like cracks in the foundation or missing
support beams, you may need to relocate to a shelter or another safe
location.
c. Check gas, electrical, and water lines for damage.
d. Do not use matches, lighters, appliances, or light switches until you
are sure there are no gas leaks. Sparks from electrical switches could
ignite gas, causing an explosion.

3. Use caution when re-entering buildings or homes.

a. Check the outside of your home before you enter.
b. Damage on the outside can indicate a serious problem inside.
c. If the door is jammed, do not force it open – it may be providing
support to the rest of your home.
d. Beware of animals, such as rodents, snakes, and insects that may
have entered your home. Tap loudly and often on the floor with a
stick to give notice that you are there.
e. Damaged objects, such as furniture or stairs, may be unstable. Be
very cautious when moving near them. Avoid holding, pushing or
leaning against damaged building parts.

4. If the power is out, use flashlights instead of candles.

a. If you must use candles, keep them away from anything that can
catch fire.
b. Always stay near lit candles.

5. Avoid areas impacted by the emergency.

a. Delay return home as you might hamper rescue and other emergency
operations and be at further risk from the residual effects of the
volcanic eruption.
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b. Avoid weakened bridges, overhanging structures, damaged

buildings, and power lines.

6. Take care of one’s health and provide first aid.

a. If you have any breathing problems, avoid contact with ash.
b. Get first aid quickly to help heal small wounds or injuries and
prevent infection.
c. If you can, help injured or trapped persons and others in need.
Make sure you are not hurt, and then help others.

 Give first aid, where appropriate.

 Call for help.
 Do not move seriously injured persons unless they are in
immediate danger of further injury.
 Follow the minimum public health protocols when helping
others, or when staying in evacuation areas.

7. Check food and water supplies.

a. Throw out any food that has come in contact and contaminated with
volcanic ash.
b. Do not eat dead animals; the volcanic ash could contaminate their
meat.
c. Make sure that the food you eat is prepared with clean water.
d. Do not drink water that is contaminated with ash, use another source
of drinking water or wait until your water can be tested and safe to
drink.

8. Check for unwanted animals that may cause harm and diseases.
a. Beware of animals, such as rodents, snakes, and insects that may
have entered your home. Tap loudly and often on the floor with a
stick to give notice that you are there.
b. Remove stagnant water that can become breeding grounds for
mosquitos and other animals.
c. Apply insect repellant or wear long sleeves, pants and socks to
prevent diseases caused by insects, mosquitos and other animals.

9. Stay connected and be informed.

a. Listen to receive emergency information and instructions from
your battery-operated TV or radio, social media, or cell phone text
alerts.
b. Save phone calls for emergencies – text messages may be more
reliable.
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c. Connect with family, friends, and others in your community.

d. Take care of yourself and each other and know when and how to
seek help.

10. Once you are safe, follow the emergency plan that you have prepared to
communicate and reconnect with family members. Take your disaster
supplies kit with you.
First Aid Major health threats from a volcanic eruption need to be immediately
managed.
Volcanoes spew hot, dangerous gases, ash, lava, and rock that are powerfully
destructive. People die from volcanic blasts. Volcanic eruptions can result in
additional threats to health, such as:
 Floods
 Mudslides
 Power outages
 Drinking contaminated water
 Wildfires

The health concerns after a volcanic eruption include:

 Infectious disease
 Respiratory illness
 Burns
 Injuries from falls
 Vehicle accidents related to the slippery, hazy conditions caused by
ash.

The first aid that must be administered depends on the effects of the
following on health:

Volcanic Ash
Ash is gritty, abrasive, sometimes corrosive, and always unpleasant.
1. Exposure to ash can be harmful. Infants, elderly people, and people
with respiratory conditions such as asthma, emphysema, and other
chronic lung diseases may have problems if they breathe in volcanic
ash.
2. Small ash particles can abrade (scratch) the front of the eye.
3. Ash particles may contain crystalline silica, a material that causes a
respiratory disease called silicosis.

Gases
Most gases from a volcano quickly blow away. However, heavy gases such
as carbon dioxide and hydrogen sulfide can collect in low-lying areas. The
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most common volcanic gas is water vapor, followed by carbon dioxide and
sulfur dioxide. Other volcanic gases include hydrogen chloride, carbon
monoxide, and hydrogen fluoride. Amounts of these gases vary widely from
one volcanic eruption to the next.

Although gases usually blow away rapidly, it is possible that people who are
close to the volcano or who are in the low-lying areas downwind may be
exposed to levels that may affect health.
1. Sulfur dioxide can cause breathing problems in both healthy people
and people with asthma and other respiratory problems.
2. At low levels, gases can irritate the eyes, nose, and throat. At higher
levels, gases can cause rapid breathing, headache, dizziness, swelling
and spasm of the throat, and suffocation.
3. If you experience any symptoms secondary to the exposure, seek
immediate medical attention at the nearest health facility.

When warnings are heeded, the chances of adverse health effects from a
volcanic eruption are very low.

A.3 BIOLOGICAL
Biological emergencies can be caused by disease outbreaks brought by biological vectors or
poisonous substances produced by living organisms. It may also be a biological attack due to the
deliberate release of germs or other biological substances like bacteria, viruses and toxins that can
make people sick. Biological agents can spread by spraying them into the air, person-to-person
contact, infecting animals that carry the disease to humans and by contaminating food and water.
Examples include COVID-19, Measles, Dengue, Polio, etc.

In most cases, local health care workers will report a pattern of unusual illness or there will be a wave
of sick people seeking emergency medical attention. In the event of a biological attack, public health
officials may not immediately be able to provide information on what you should do. It will take
time to figure out exactly what the illness is, how it should be treated, and who is in danger. After a
biological agent has been identified, officials will take steps to characterize how long the agent will
persist and implement protocols to control the contagious disease including isolation, quarantine,
barrier devices (gloves, filter masks, eye protection), and hand washing.

Before 1. Be aware of your surroundings.

a. Biological agents are hard to detect and may take time to grow and
cause disease. It is almost impossible to know if there is a biological
emergency.
b. Practice personal hygiene; cleanliness and good sanitation at home,
in the workplace, and in the community.

2. Learn, observe, and practice health and safety protocols.

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a. Inform and educate your family members about individual and

household infection prevention and control (IPC).
b. Make sure that everyone in your family has up-to-date
immunizations.

3. Participate in community drills.

a. Learn, understand and follow the Early Warning Systems (EMS) in
the community.
b. Participate in the conduct of community drills and other information
sharing activities.
c. Participate in formulating emergency, rehabilitation and relief
distribution plans in your community.
d. Practice the Prevent, Detect, Isolate, Treat, Re-integrate (PDITR)
Protocols in the community.

3. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you

have an Emergency Go Bag/E-balde in places you frequently visit or
you might have to stay during the quarantine or isolation.
a. This includes ready to eat food, tools, clothes, first aid kit, sleeping
bags, flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean
water for the whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes,
packaged biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without
power).
d. Make sure that everyone knows the location of the Emergency Go
Bag/E-balde.
During 1. Follow instructions and orders from authorities.
a. If there is a biological emergency, authorities will tell you to
evacuate the area immediately, or to seek shelter.
b. Listen for emergency information and alerts issued by reliable
national or local authorities. Take the necessary precautions,
monitor and understand the following information:
 Areas in danger.
 Signs and symptoms of the disease.
 Where to seek medical attention if you become ill.
 Availability or distribution access of medications or
vaccinations.
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2. If you become aware of a suspicious substance,

a. Quickly try to figure out the affected area or the location of the
biological emergency.
b. Cover your mouth and nose with layers of fabric that can filter the
air but still allow breathing.
c. Get away from the area quickly.

3. If you came from outside and think you may have been exposed to a
biological agent or infection:
a. Immediately take a bath and put on clean clothes.
b. Stay away from others or observe self-quarantine.

4. If you are sick,

a. Immediately seek emergency medical attention if you are in the
group considered at risk and symptoms match those that are
associated to specific infectious disease.
b. Follow the instructions of doctors and other public health officials
to avoid exposure and/or transmission.
c. Avoid crowds and avoid close contacts with people, if necessary.
d. Always cover your mouth when coughing and sneezing.
e. Do not share food or utensils.

5. If you are caring for a sick family member,

a. Always protect yourself with minimum personal protective
equipment i.e. gloves and masks when in contact with the sick.
b. Wash your hands with soap and water frequently.
c. Do not share food or utensils.
After 1. Only return home once you are told it is safe to do so.
a. Listen for further alerts and instructions about evacuation zones
and shelters.
b. Pay close attention to all official warnings and instructions on how
to proceed.
c. Wait for the advice of the authorities as to when you can safely
get back to your home.
d. Disinfect or sanitize to kill the agent. Decisions regarding how
much clean-up is necessary will depend on:
 The amount of agents released.
 How far the agent has spread.
 How the space will be used following clean-up.

2. Check food supplies.

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a. Throw out any food that has come in contact and contaminated
with biological agents.
b. Do not eat dead animals; the biological agents could contaminate
their meat.
c. Make sure that the food you eat is prepared with clean water.

3. Stay connected and be informed.

a. Listen to receive emergency information and instructions from
your battery-operated TV or radio, social media, or cell phone text
alerts.
b. Save phone calls for emergencies – text messages may be more
reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how to
seek help.
First Aid Precautions and Management of Biological Emergencies:

 Identify the signs and symptoms of biological agents (e.g. cough,

eye irritation, difficulty breathing).
 If you become aware of a suspicious substance, quickly get away.
 Cover your mouth and nose with a facemask to reduce inhaling or
spreading germs.
 If you have been exposed to a biological agent, remove and disinfect
your clothes and personal items. Follow instructions on how to
decontaminate, disinfect, or sanitize.
 Wash yourself with soap and running water and put on clean
clothes.
 Inform local authorities if condition gets worse and seek medical
assistance. You may be advised to stay away from others or even to
quarantine.
 If you manifest symptoms and you are in the group considered at
risk, immediately seek emergency medical attention.
 Follow the orders of your doctor and other public health officials.
 Avoid crowded areas.
 Frequently wash your hands with soap and water.
 Avoid sharing food or utensils.
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A.3.a AIRBORNE DISORDER

An airborne disorder is any disease that is caused by a microorganism that is transmitted through the
air as stated by the National Center for Biotechnology Information. Many clinically important
airborne diseases are caused by a variety of pathogens, including bacteria, viruses, and fungi. These
organisms may be transmitted through sneezing, coughing, spraying of liquids, the spread of dust,
talking, or any activity that results in the generation of aerosolized particles. It is important to be
aware that airborne diseases, in general, do not include disorders caused by air pollution, poisons,
smog, and dust.

According to the WHO, “airborne transmission of infectious agents refers to the transmission of
disease caused by the dissemination of droplet nuclei that remain infectious when suspended in air
over long distance and time.” Airborne transmission can be characterized as obligate or preferential
depending on whether it is only transmitted via droplet nuclei or if it has multiple other routes of
transmission.

MEASLES

Measles is a highly contagious, serious disease caused by a virus in the paramyxovirus family and it
is normally passed through direct contact and through the air. The virus infects the respiratory tract,
then spreads throughout the body. Measles is a human disease and is not known to occur in animals.
(WHO)

Signs and symptoms include fever, maculopapular rash (starts from face and spreads to body and
extremities), 3 Cs (cough, colds, conjunctivitis), may have Koplik Spots on the buccal mucosa, and
branny desquamation.

Before 1. Getting vaccinated is the best way to be protected from measles. For
children, this is a routine vaccination and given in 2 doses.

However, some groups shouldn’t receive a vaccination against measles.

These groups include:
 people who’ve had a previous life-threatening reaction to the
measles vaccine or its components
 pregnant women
 immunocompromised individuals, which can include people
with HIV or AIDS, people undergoing cancer treatment, or
people on medications that suppress the immune system

2. Understand the symptoms of the disease. Measles symptoms appear 7

to 14 days after contact with the virus. The symptoms include:
 High fever
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 Cough
 Runny nose
 Watery eyes
 Red rash may appear 3 to 5 days after the first symptom
 Tiredness
 White spots in the mouth
 Muscle pain
 Sensitivity to light
3. Practice personal hygiene; cleanliness and good sanitation at home, in
the workplace, and in the community.

4. Learn, observe, and practice health and safety protocols.

a. Inform and educate your family members about individual and
household infection prevention and control (IPC).
b. Make sure that everyone in your family has up-to-date
immunizations.
During 1. If you came from outside and think you may have been exposed to a
person with measles:
a. Immediately take a bath and put on clean clothes.
b. Stay away from others or observe self-quarantine.
c. If you’re pregnant and you think you’ve been exposed to measles,
you should contact your healthcare provider immediately.

2. If you are sick,

a. Immediately seek medical consultation and treat the symptoms
that are associated to measles since there is no direct cure for the
disease.
b. Take antimicrobials only if indicated (e.g. pneumonia, otitis
media, dysentery).
c. Undergo Immunoglobulin M (IgM) determination.
d. Stay at home/isolate yourself for four days after developing
measles rash and avoid close contacts with people to prevent
transmission.
e. Get plenty of rest and avoid exerting stress on your body.
f. Keep yourself hydrated with water and fruit juice to replace fluids
lost during a fever, diarrhea, or vomiting. You may also drink oral
rehydration solution (ORS).
g. Boost your immune system by eating more fruits and vegetables.
h. Always cover your mouth when coughing and sneezing.
i. Do not share food or utensils.
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3. If you have never had a measles vaccination, you can get a post-
exposure vaccination 72 hours after being around the virus. The vaccine
can lower your chances of getting it and can make your symptoms
milder if you do. However, you may want to delay your vaccination if
you are pregnant, think you might be pregnant, or have recently had a
blood transfusion. However, some people should not get the MMR
vaccine. You may need to skip it if you have:
a. Allergies to any of the ingredients
b. A condition that weakens your immune system
c. A family history of immune system problems
d. A condition that makes you bruise or bleed easily
e. Tuberculosis
f. Had another vaccine in the past 4 weeks
g. Any kind of illness that’s making you feel run down

4. If you are caring for a sick family member,

a. Always protect yourself with minimum personal protective
equipment i.e. gloves and masks when in contact with the sick.
b. Wash your hands with soap and water frequently.
c. Do not share food or utensils.

5. In addition, for infants and children diagnosed with measles, two doses
of vitamin A should be given 24-hours apart.

>12 months: 200,000 units

6 to 12 months: 100,000 units
<6 months: 50,000 units

This treatment restores low Vitamin A levels during measles and can
help prevent eye damage and blindness. Repeat the dose 4 weeks after
for patients with ophthalmologic evidence of Vitamin A Deficiency.

6. Monitor warning signs:

a. Tachypnea and/or difficulty of breathing
b. Chest in-drawing, retractions, stridor
c. Seizure or changes in sensorium
d. Dehydration
e. Immunocompromised status (malignancy, Acquired
Immunodeficiency Syndrome (AIDS), asthma, Down’s
Syndrome)
f. Grossly malnourished
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g. History of coriander (kulantro, uan-suy) intake or inappropriate

application
After 1. You should wait at least four days after you get the rash to go back to
work or school.

2. Seek another consultation with your doctor for final clearance if you
are already cleared of the virus.

3. Continue to exercise proper personal hygiene.

First Aid 1. If you have been exposed to a person with measles, remove and
disinfect your clothes and wash yourself with soap and running water
and put on clean clothes.

2. Contact your doctor over the phone as soon as possible.

3. The following tips may help manage symptoms:

a. Pain and fever: Tylenol or ibuprofen can help manage fever, aches,
and pains. A doctor can advise on options for young children.
Children under 16 years should not take aspirin.
b. Cough: Use a humidifier or put a wet towel on a warm radiator to
moisten the air. A warm lemon and honey drink may help, but do
not give honey to babies under 1 year.
c. Dehydration: Encourage the person to drink plenty of fluids.
d. Eyes: Take care of your eyes. Remove any crustiness with cotton
wool soaked in water. Dim or avoid harsh lights if the eyes hurt or
are hypersensitive.
e. Infections: Take antibiotics as prescribed by physician to treat
infections.
f. Body losses due to coughing, diarrhea, and perspiration: Give
supplementation to infants and children diagnosed with measles.

TUBERCULOSIS
Tuberculosis is an infectious disease caused by bacteria (Mycobacterium Tuberculosis) that
primarily affects the lungs and this condition is known as pulmonary tuberculosis. Other parts of the
body may also be affected by tuberculosis; this is known as extra-pulmonary tuberculosis. It may
affect the bones, meninges, joints, genito-urinary tract, intestines, liver, kidneys, and the heart.

TB is spread through the air when people with lung TB cough, sneeze or spit. A person needs to
inhale only a few germs to become infected. It is the leading cause of death of people with HIV and
also a major contributor to antimicrobial resistance. (WHO)
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Before As there is still a no sure-fire way to completely prevent the spread of TB,
the following are a number of measures that must be observed to reduce the
spread of the illness:

1. Health Professional must find the TB patient early and provide

treatment through DOT (directly observed treatment) to cure the
patient.

2. Get vaccinated with the Bacille Calmette-Guérin (BCG) Vaccine. This

is a live vaccine against TB. The vaccine is prepared from a strain of
the weakened bovine tuberculosis bacillus, Mycobacterium Bovis. The
BCG is currently the only licensed vaccine against TB, and has been in
use since 1921.
The BCG is:
 80% effective in preventing TB for 15 years
 more effective against complex forms of TB in children
 of limited effectiveness in people over the age of 35
 less effective when given in equatorial regions (due to high levels
of naturally occurring environmental mycobacteria).

3. Raise your awareness of TB. So, when you or someone you know
shows symptoms of TB, you must know where to seek help and how.

Symptoms of TB disease depend on where in the body the TB germs

are growing.

TB disease in the lungs may cause the following symptoms:

 Cough (lasting longer than 3 weeks)
 Coughing up sputum (phlegm from inside the lungs) or blood
 Chest pain
 Fever
 Night Sweats
 Chills
 Loss of appetite
 Weakness or fatigue
 Weight loss

Symptoms of TB disease in other parts of the body may include the

following:
 TB of the kidney may cause blood in the urine.
 TB meningitis may cause headache or confusion.
 TB of the spine may cause back pain.
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 TB of the larynx may cause hoarseness.

4. Manage your environment. As TB is an airborne infection, TB bacteria

are released into the air when someone with infectious TB coughs or
sneezes. The risk of infection can be reduced by using a few simple
precautions:
 Good ventilation: as TB can remain suspended in the air for
several hours with no ventilation
 Natural light: UV light kills off TB bacteria
 Good hygiene: covering the mouth and nose when coughing or
sneezing reduces the spread of TB bacteria.
5. A healthy immune system. Having a healthy immune system is the best
form of defense against TB; 60% of adults with a healthy immune
system can completely kill TB bacteria.

Immunity is your body’s defense against foreign organisms. Taking

care of yourself will help your immune system take care of you. Below
are some of the most effective steps to have a healthy immune system:
a. Eat a balanced diet. This means emphasizing external icon - plenty
of fruits and vegetables, lean protein, whole grains, and fat–free
or low–fat milk and milk products. Eating well also means
limiting saturated fats, cholesterol, salt, and added sugars.
b. Be physically active. Regular physical activity helps you feel
better, sleep better, and reduce anxiety. Combined with eating
well, physical activity can help a person maintain a healthy
weight.
c. Maintain a healthy weight. Excess weight can affect how your
body functions. Safe ways to help maintain a healthy weight
include reducing stress, eating healthy foods, getting enough rest
and sleep, and engaging in regular physical activity.
d. Get enough sleep. Scientific evidence is building that sleep loss
can negatively affect different parts of the immune system. This
can lead to the development of a wide variety of disorders.
e. Quit smoking. Smoking can make the body less successful at
fighting disease. Smoking increases the risk for immune system
problems, including rheumatoid arthritis.
f. Avoid too much alcohol. Over time, excessive alcohol use can
weaken the immune system.
g. Maintain personal hygiene.
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During Here are the measures you can adopt to help protect yourself and your loved
ones from tuberculosis:

1. Go for a check-up if you suspect that you could be suffering from TB.
2. Get treatment. Be sure to take your medicine exactly as prescribed, for
as long as it’s prescribed. If you stop, or don’t take it as ordered, you
can get sick again. Not only that, but you run the risk of infecting others.
There’s also the risk that the TB could be harder to treat a second time,
as the bacteria can become drug-resistant.

3. Isolate yourself until your doctor declares that you are no longer
infectious. In the beginning, while you’re being treated, you’ll need to
stay home – no work, no school, no visiting friends. That’s the best way
to avoid infecting others with the TB bacteria. Always use a tissue when
you cough or sneeze, and then throw it away in a closed plastic bag. Air
out your room whenever possible.

4. Keep track of all your TB meds. One way to do it is to get “Directly

Observed Therapy” (DOT). You’ll meet up with a health care
professional a few times a week or possibly every day, at an agreed-
upon location. There, you’ll take your medication in front of them. This
ensures that you’re not missing doses. It also helps the health care
worker to keep an eye out for side effects and answer any questions you
might have.

5. Change your lifestyle. Have plenty of rest, fresh air, and a nutritious
diet. Moreover, plenty of fluid intake to help you be hydrated to be in
the ideal state to process the medication.

6. Call a doctor. As with all medications, those you take for TB can have
side effects. Some can be serious. Call your doctor right away if you
have these or other symptoms:
 Lack of appetite
 Nausea/vomiting
 Yellowish tint to your skin or eyes (jaundice)
 A fever that is high (100.4 F) or lasts 3 or more days
 Abdominal pain
 Tingling in your fingers or toes
 Pain in your lower chest
 Heartburn
 Itchiness
 Skin rash
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 Easy bruising
 Bleeding from gums
 Nosebleed
 Dark or brown urine
 Aching joints
 Dizziness
 Numbness or tingling around your mouth
 Blurred or otherwise changed vision
 Hearing loss/ears ringing
After 1. Once your course of treatment is finished, you may have tests to make
sure you are clear of TB. You might need more treatment if tests show
there is still TB bacteria in your body, but most people will get the all-
clear.
2. After taking antibiotics for 2 weeks, most people are no longer
infectious and feel better. However, it's important to continue taking
your medicine exactly as prescribed and to complete the whole course
of antibiotics. Taking medication for 6 months is the best way to ensure
the TB bacteria are killed.

If you stop taking your antibiotics before you complete the course or
you skip a dose, the TB infection may become resistant to the
antibiotics.

This is potentially serious because it can be difficult to treat and will

require a longer course of treatment with different, and possibly more
toxic, therapies.
First Aid Follow these steps to help prevent tuberculosis infection and spread:
1. Seek medical attention if you have symptoms like prolonged cough,
fever and unexplained weight loss as early treatment for TB can help
stop the spread of disease and improve your chances of recovery.
2. Get tested for TB infection if you are at increased risk, such as if you
have HIV or are in contact with people who have TB in your household
or your workplace.
3. If prescribed treatment to prevent TB, complete the full course.
4. If you have TB, practice good hygiene when coughing, including
avoiding contact with other people and wearing a mask, covering your
mouth and nose when coughing or sneezing, and disposing of sputum
and used tissues properly.
5. Special measures like respirators and ventilation are important to
reduce infection in healthcare and other institutions.
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The following are measures that can be done on-site:

1. Advise patient to wear mask.
2. Sputum Acid-fast bacillus (AFB) smear x 2 collection, if available.
3. Chest radiograph, if available at health centers.
4. Refer to DOTS program once with result for anti-TB regimen.

In case of patient transport, observe the following measures before

transport:
1. Assess vital signs.
2. Cardiopulmonary Resuscitation (CPR), as indicated.
3. Start IV platelet-lymphocyte ratio/plain normal saline solution
(PLR)/PNSS.
4. Give O2 (2-4 L/min by nasal prong) inhalation for difficulty of
breathing and cyanosis.
5. Give Salbutamol nebulization (1 nebule) for wheezes among
patients WITHOUT hemoptysis.
6. Give Tranexamic Acid 500 mg IV.
7. Paracetamol 10-20 mg/kg/dose IV for fever.
8. Refer to hospital with referral note.

Procedures for diagnosis:

1. WHO recommends the use of rapid molecular diagnostic tests as
the initial diagnostic test in all persons with signs and symptoms of
TB.
2. Rapid diagnostic tests recommended by WHO include the Xpert
MTB/RIF Ultra and Truenat assays. These tests have high
diagnostic accuracy and will lead to major improvements in the
early detection of TB and drug-resistant TB.
3. A tuberculin skin test (TST) or interferongamma release assay
(IGRA) can be used to identity people with infection.
4. Diagnosing multidrug-resistant and other resistant forms of TB (see
multidrug-resistant TB section below) as well as HIV-associated
TB can be complex and expensive.
5. Tuberculosis is particularly difficult to diagnose in children.

Tuberculosis disease is treated with antibiotics. Treatment is recommended

for both TB infection and disease.

The most common antibiotics used are:

a. Isoniazid
b. Rifampin
c. Pyrazinamide
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d. Ethambutol
e. Streptomycin

 Latent TB (TB infection): INH for children 5 years old and

below only.
 Active TB: INH in combination with one or more of several
drugs, including rifampin (Rifadin), ethambutol (Myambutol).

To be effective, these medications need to be taken daily for 4–6 months.

It is dangerous to stop the medications early or without medical advice.
This can allow TB that is still alive to become resistant to the drugs.

Tuberculosis that doesn’t respond to standard drugs is called drug-resistant

TB and requires more toxic treatment with different medicines.

CHICKENPOX
According to Centers for Disease Control and Prevention, Chickenpox is a highly contagious disease
caused by the Varicella-zoster Virus (VZV). It can cause an itchy, blister-like rash (Papulo-vesicular
Eruption) among other symptoms. The rash first appears on the chest, back, and face, and then
spreads over the entire body.

Chickenpox can be serious, especially during pregnancy, in babies, adolescents, adults, and people
with weakened immune systems (lowered ability to fight germs and sickness).

Before 1. The best way to prevent chickenpox is to get the chickenpox vaccine.
Everyone—including children, adolescents, and adults—should get
two doses of chickenpox vaccine if they have never had chickenpox or
were never vaccinated.

Children should receive the chickenpox vaccine as part of their regular

vaccine schedule. The first dose should be received between 12 and 15
months of age. The second dose should be received between 4 and 6
years of age.

Adolescents or adults who aren’t vaccinated should receive two doses

of the vaccine spaced one month apart.

There are some groups who shouldn’t receive the chickenpox vaccine.
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They include:
 people who have had a severe allergic reaction to a previous
dose of the chickenpox vaccine or to one of its components
 women who are pregnant or may be pregnant
 individuals with a weakened immune system due to a disease or
medical treatment
 people who have recently received a blood or plasma
transfusion
 people with untreated, active tuberculosis
 individuals who are currently ill with something more severe
than a cold

Children and adults should avoid taking aspirin and other medications
containing salicylates for six weeks after vaccination. This is because
of the risk of Reye’s Syndrome, a rare but potentially fatal disease.

If you’re already taking aspirin or other medications containing

salicylates, your doctor will monitor you closely.

2. Understand the symptoms of Chickenpox. It usually takes about two

weeks to develop symptoms following exposure to VZV. However, in
some cases, symptoms can appear in as little as 10 days or as much as
three weeks.

The symptoms of chickenpox include:

 an itchy rash with fluid-filled blisters

 fever
 headache
 feeling tired or fatigued
 loss of appetite

Sometimes you may have a fever or feelings of malaise before the rash
appears.

3. Practice personal hygiene; cleanliness and good sanitation at home, in

the workplace, and in the community.

4. Properly wash your hands frequently.

5. Raise your awareness on how chickenpox may be spread because it is

very contagious, meaning that it can be spread from person-to-person.
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You can get chickenpox by making direct contact with chickenpox

blisters or through the air when someone with chickenpox coughs,
sneezes, or talks.

If you’ve been vaccinated against chickenpox and develop a

breakthrough chickenpox infection, you can still spread it to other
people.

Usually, once you’ve had chickenpox, you have immunity for life.
However, in rare cases, some people can get chickenpox more than
once, but this is not common.

Chickenpox is usually milder and shorter in people who have been

vaccinated. Symptoms may include a low fever and a milder rash that
often doesn’t fully develop into blisters.

Rarely, vaccinated people can develop symptoms similar to those in an

unvaccinated person.
During 1. To prevent spreading the infection, stay at home/isolate yourself until
all the spots have crusted over.

2. There is no specific treatment for chickenpox, but there are pharmacy

remedies that can alleviate symptoms.

Chickenpox usually runs its course in 5 to 10 days. But if you have the
itchy rash caused by the virus, that can feel like a very long time.
Fortunately, there are things you can do at home to ease your symptoms
while your body heals itself:

a. Use over-the-counter medicine or paracetamol (10-15 mkd) for

pain and fever. Avoid anti-inflammatory painkillers, like ibuprofen.
If you have chickenpox, it can make you very ill. Never give aspirin
to children under age 16. It can lead to a serious complication called
Reye’s Syndrome.

b. Don’t scratch that itch. Yes, it’s tempting. But scratching your rash
can put you at risk for a bacterial skin infection. It could also cause
scarring. Try these tips to calm your itchy skin:

 Tap or pat -- don’t scratch -- your itch.

 Take a cool oatmeal bath (you can buy it at your local
drugstore). Dab or pat (don’t rub) your skin dry.
 Wear loose, cotton clothing so your skin can breathe.
 Dab calamine lotion on your itchy spots.
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 Try an antihistamine, like Benadryl, to ease your symptoms.

c. Keep your cool. Heat and sweat make you itch more. Use a cool,
wet washcloth on super-itchy areas to calm your skin.

d. Stay hydrated. Drink lots of fluids to help your body rid itself of
the virus faster. It will also keep you from getting dehydrated.
Choose water over sugary drinks or sodas, especially if you or your
child has chickenpox in the mouth.

e. A soft, bland diet if chickenpox sores form in the mouth. Avoid

hard, spicy, or salty foods that can make your mouth sore.

3. For people exposed to chickenpox, call a healthcare provider if the

person:

a. Has never had chickenpox and is not vaccinated with the

chickenpox vaccine
b. Is pregnant
c. Has a lowered ability to fight germs and sickness (weakened
immune system) caused by disease or medication; for example:
 A person with HIV/AIDS or cancer
 A person who has had a transplant
 A person on chemotherapy, immunosuppressive
medications, or long-term use of steroids
 Is at risk of serious complications from chickenpox because
they:
i. Are less than 1 year-old
ii. Are older than 12 years of age
iii. Have a weakened immune system
iv. Are pregnant

OR

i. Develops any of the following symptoms:

ii. Fever that lasts longer than 4 days
iii. Fever that rises above 102°f (38.9°c)
iv. Any areas of the rash or any part of the body
becomes very red, warm, or tender, or begins
leaking pus (thick, discolored fluid), as these
symptoms may indicate a bacterial infection
v. Difficulty waking up or confused behavior
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vi. Difficulty walking

vii. Stiff neck
viii. Frequent vomiting
ix. Difficulty breathing
x. Severe cough
xi. Severe abdominal pain
xii. Rash with bleeding or bruising (hemorrhagic rash)
4. See a doctor for any of the following:
a. In seeking decision on the use of antiviral as can be determined by
systemic host factors, extent of infection, and initial response to
therapy.
b. In monitoring secondary bacterial skin infections where it is
necessary to give Cloxacillin (50-100 mkd) for 7 days.
c. In managing pruritus through Diphenhydramine (1 mkd).
d. In case of the following warning signs:
 Seizure or changes in sensorium
 Severe cough or difficulty of breathing
 Drowsiness or confusion
 Severe weakness and very ill
 Bleeding from any site including skin
 Immuno-compromised/special conditions i.e.
- Malignancy, AIDS, diabetes, or chronic debilitating
diseases
- Pregnant, newborn or persons > 50 y/o
After 1. Speed up recovery by consuming fruits and vegetables which are
packed with nutrients. However, it is always recommended to consume
non-acidic veggies and fruits such as banana, peach, melon, cucumber,
spinach, broccoli, and kale when you have chicken pox.

2. Relieve the itch and other symptoms with the following:

a. A cool bath with added baking soda, aluminum acetate or uncooked
oatmeal.
b. Calamine lotion dabbed on the itchy spots.
c. A soft, bland diet if chickenpox sores form in the mouth.
d. Antihistamines such as diphenhydramine (Benadryl) for itching.
e. Acetaminophen (Tylenol) for a mild fever.
First Aid 1. To prevent spreading the infection, stay at home/isolate yourself.
2. Rest as much as possible.
3. To help relieve symptoms:
a. Add 2 cups of oatmeal to a lukewarm bath. Pat (not rub) the body
dry.
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b. Put calamine lotion on itchy areas (but not on the face, especially
near the eyes, or on the genitals). Inquire with your doctor or
pharmacist about genital sore pain relief lotions.
c. Give an antihistamine (such as diphenhydramine [Benadryl, etc.])
for severe itching.
d. Give acetaminophen as needed for fever and to help relieve pain
from the sores on the skin or in the mouth (do not give aspirin or
ibuprofen).
e. To avoid a skin infection, try to keep the patient from scratching the
rash.
4. Consult your doctor before using an over-the-counter (OTC) itching
medication orally.

INFLUENZA
Influenza or seasonal influenza is an acute respiratory infection caused by influenza viruses which
circulate in all parts of the world.

Seasonal influenza is characterized by a sudden onset of fever, cough (usually dry), headache, muscle
and joint pain, severe malaise (feeling unwell), sore throat and a runny nose. The cough can be severe
and can last 2 or more weeks. Most people recover from fever and other symptoms within a week
without requiring medical attention. But influenza can cause severe illness or death especially in
people at high risk group.

There are 4 types of influenza viruses, types A, B, C and D. Influenza A and B viruses circulate and
cause seasonal epidemics of disease.

Influenza A viruses are further classified into subtypes according to the combinations of the
hemagglutinin (HA) and the neuraminidase (NA), the proteins on the surface of the virus. Currently
circulating in humans are subtype A(H1N1) and A(H3N2) influenza viruses. The A(H1N1) is also
written as A(H1N1) pdm09 as it caused the pandemic in 2009 and subsequently replaced the seasonal
influenza A(H1N1) virus which had circulated prior to 2009. Only influenza type A viruses are
known to have caused pandemics.

Influenza B viruses are not classified into subtypes, but can be broken down into lineages. Currently
circulating influenza type B viruses belong to either B/Yamagata or B/Victoria lineage.

Influenza C virus is detected less frequently and usually causes mild infections, thus does not present
public health importance.

Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.
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In terms of transmission, seasonal influenza spreads easily, with rapid transmission in crowded areas
including schools and nursing homes. When an infected person coughs or sneezes, droplets
containing viruses (infectious droplets) are dispersed into the air and can spread up to one meter, and
infect persons in close proximity who breathe these droplets in. The virus can also be spread by hands
contaminated with influenza viruses. To prevent transmission, people should cover their mouth and
nose with a tissue when coughing, and wash their hands regularly.

In temperate climates, seasonal epidemics occur mainly during winter, while in tropical regions,
influenza may occur throughout the year, causing outbreaks more irregularly. The time from
infection to illness, known as the incubation period, is about 2 days, but ranges from one to four days.

Before Take three actions to fight the flu.

1. One, get vaccinated.

a. The policy requires all healthcare workers to be vaccinated against
influenza or wear a mask in patient care areas throughout the
influenza season.
b. Get a flu shot. Getting a flu shot, or flu vaccine, is the single most
effective way to protect oneself and others from the illness. A
seasonal flu shot protects against the flu-causing viruses that
research indicates will predominate during the year’s flu season.
One shot usually protects against three or four different viruses.
However, the virus that causes COVID-19 is different from the
virus that causes the flu, so the seasonal flu vaccine will not protect
against COVID-19.

WHO recommends annual vaccination for:

 pregnant women at any stage of pregnancy

 children aged between 6 months to 5 years
 elderly individuals (aged more than 65 years)
 individuals with chronic medical conditions
 health-care workers

2. Two, help stop the spread of flu viruses. A few simple public health and
personal protective steps can minimize the spread of respiratory viruses,
including the flu:
a. Avoid close contact. If you are unwell, stay home and avoid contact
as much as possible. If another person is unwell, offer them support
from afar.
b. Cover the mouth and nose. Use a tissue to do so when sneezing and
coughing, and dispose of the tissue correctly and immediately after
use.
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c. Keep clean hands. Regularly wash the hands with soap and water at
least for 20 minutes and properly dry. When this is not available,
use an alcohol-based sanitizer, especially after handling patients
and specimen, before and after eating, after using the toilet, and as
necessary.
d. Try not to touch the eyes, nose, or mouth. Wash your hands first to
ensure that they are germ-free.
e. Clean and disinfect surfaces. This applies to any that people come
into contact with, at work, school, or home.
f. Wear surgical masks to reduce the spread of flu-like symptoms
which can be transmitted through breathing, coughing, and
sneezing.

3. Three, take antiviral drugs if your doctor prescribes them. There are
prescription medications that may prevent people from getting the flu.
The drugs work by fighting the flu virus and preventing it from
multiplying in the body. However, antiviral drugs are no substitute for
the flu vaccine.

4. In addition, boost the immune system. The immune system protects the
body from infection. When it is functioning properly, the immune
system launches an attack on threats, such as flu viruses.

The following strategies can benefit the whole body, including the immune
system:

 eat nutritious food, especially a diet rich in fruits and vegetables

 regular moderate exercise
 maintain a moderate Body Mass Index (BMI)
 sleep for at least 8 hours each night
 manage stress
 quit smoking
 take vitamin supplements may halve the risk of respiratory
infections (Vitamin D plays a vital role in the functioning of the
immune system)

While the immune system usually does a good job of regulating itself,
certain disorders, allergies, asthma, and some medications can limit
immune function.
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5. Understand the signs and symptoms of Influenza. The symptoms

usually begin around 2 days after being infected by someone who has
the virus. Below are the symptoms:

a. sudden onset of fever

b. cough (usually dry)
c. headache
d. muscle and joint pain
e. severe malaise (feeling unwell)
f. sore throat
g. runny nose

6. Practice social distancing. Distance yourself by at least 1 meter from

people who are coughing or have influenza.

a. Avoid crowded places.

b. Avoid close contact with sick people.
c. Stay home if you are sick until you are free from symptoms to
prevent the spread of the virus.
During 1. Patients with uncomplicated seasonal influenza

a. Most people with uncomplicated flu cases do not need treatment.

Symptoms typically improve with plenty of rest, fluids, and over-
the-counter medicines.
b. Patients that are not from a high risk group should be managed with
symptomatic treatment and are advised, if symptomatic, to stay
home in order to minimize the risk of infecting others in the
community.
c. Treatment focuses on relieving symptoms of influenza such as
fever. Patients should monitor themselves to detect if their condition
deteriorates and seek medical attention.
d. Patients that are known to be in a group at high risk for developing
severe or complicated illness, (see above) should be treated with
antivirals in addition to symptomatic treatment as soon as possible.

2. Patients with severe or progressive clinical illness associated with

suspected or confirmed influenza virus infection (i.e. clinical
syndromes of pneumonia, sepsis or exacerbation of chronic underlying
diseases) and patients with flu symptoms appearing are given antiviral
drugs within 2 days to reduce symptoms and shorten the duration of the
illness. The antivirals can also reduce the risk of death among people
with flu so severe that they require care in a hospital.
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So far, the Food and Drug Administration (FDA) have approved four
antiviral drugs that the Center for Disease Control (CDC) recommends
for combatting currently circulating flu viruses:

 Oseltamivir (Tamiflu)
 Zanamivir (Relenza)
 Peramivir (Rapivab)
 Baloxavir Marboxil (Xofluza)

a. Neuraminidase inhibitors (i.e. Oseltamivir) should be prescribed as

soon as possible (ideally, within 48 hours following symptom
onset) to maximize therapeutic benefits. Administration of the drug
should also be considered in patients presenting later in the course
of illness. Treatment is recommended for a minimum of 5 days, but
can be extended until there is satisfactory clinical improvement.

b. Corticosteroids should not be used routinely, unless indicated for

other reasons (e.g. asthma and other specific conditions); as it has
been associated with prolonged viral clearance,
immunosuppression leading to bacterial or fungal superinfection.

3. People at high risk or with severe symptoms should be treated with

antiviral medications as soon as possible. They include people who are:

a. pregnant
b. children under 59 months of age
c. aged 65 years and older
d. living with other chronic illnesses
e. receiving chemotherapy
f. living with suppressed immune systems due to HIV or other
conditions
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After Full recovery is within 2 weeks – while the body may have fought off the
infection successfully, the patient may not feel 100% recovered for up to 2
weeks after being infected.

Most of your symptoms should have subsided by this point, but it's normal
to feel weak and tired while the body recovers from the infection.
1. Get plenty of rest, even after your symptoms have eased.
2. Don’t return to work too quickly, and don’t be afraid to take some time
off.
3. Don’t exercise until at least a week after your symptoms have gone.
4. Get plenty of immune-boosting vitamin C into your diet.
5. Fill your diet with antioxidant-rich foods.
First Aid Usually, you'll need nothing more than rest and plenty of fluids to treat the
flu. But if you have a severe infection or are at higher risk of complications,
your health care provider may prescribe an antiviral medication to treat the
flu.

1. Stay home
Your body needs time and energy to fight off the flu virus, which means
that your daily routine should be put on the backburner.

You may be tempted to go grocery shopping or get ahead on laundry for

the week, but you’d be doing yourself a disservice. Stay home from work
or school, and put errands on hold until you start to feel better.

On top of helping you recover, staying home also prevents spreading the
flu to other people in your community or workplace. The flu can be
dangerous for older adults and small children, so it’s vital that you avoid
contact with others while you’re contagious.

2. Hydrate
One symptom of the flu is a high fever, which can lead to sweating. You
might also be dealing with bouts of vomiting or diarrhea. Your body needs
plenty of fluids to replace lost liquids, and even more to fight off the
infection.

Water is best, but you can also drink herbal teas or tea with honey. These
can have a soothing effect on your symptoms while keeping you hydrated.
Two things you should always avoid, though, are alcohol and caffeine.
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3. Sleep as much as possible

Sleep is the best medicine for your body while fighting the flu. Watching
TV curled up on the couch isn’t a bad idea, but you shouldn’t be binge-
watching your favorite Netflix show all night long.

Go to bed earlier than usual and sleep in. You can also take a nap during
the day to give your body more time to recover.

Rest and sleep also reduces your risk of serious flu complications, like
pneumonia.

4. Ease your breathing

It can be difficult to sleep with a stuffy nose and cough. Try these tips to
breathe easier and have a better night’s sleep:

Use an extra pillow to prop up your head and ease sinus pressure. Sleep
with a humidifier or vaporizer in the room. Take a hot bath or shower before
bed.

5. Eat healthy foods

You may be tempted to drown your sorrow in a bowl of ice cream and a
bag of potato chips, but your body needs better nutrition to recover from
the flu.

Fresh fruits and vegetables provide important vitamins, minerals, and

antioxidants that strengthen your immune system as it fights off the virus.

You might not have much of an appetite, but it’s still important to eat
regular meals to maintain your strength.

6. Add moisture to the air

Dry air can make your symptoms worse. A vaporizer or humidifier adds
moisture to the air and can help loosen up congestion.

There are many types of humidifiers and vaporizers available on the

market. Examples include cool-mist humidifiers and steam vaporizers.
These can be found easily for a reasonable price at your local big-box store,
pharmacy, or online.

7. Take Over the Counter (OTC) medications

The cold and flu aisle of your local drug store is most likely packed with
hundreds of different options. Some medications are used to deal with
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specific symptoms, like nasal congestion, while others treat many flu
symptoms at once.

Pain relievers help reduce a fever, headache, and body aches. Examples
include ibuprofen (Advil, Motrin) and acetaminophen (Tylenol).
Decongestants, like pseudoephedrine (Sudafed), help open your nasal
passages and relieve pressure in your sinuses.

Cough suppressants, such as dextromethorphan (Robitussin), can be used

to soothe a dry cough. Expectorants helps loosen thick mucus and are useful
for a cough that is wet and produces mucus. Antihistamines tend to have
sedative effects that may help you sleep.

Be sure to read the product’s label to learn the correct dose for each type of
medication and to make sure you’re not accidentally combining
medications. Medications like DayQuil are both a pain reliever and a fever
reducer, so you shouldn’t be taking another medication on top of that.

Children and teens should never take aspirin for the flu due to the risk of a
serious condition called Reye’s Syndrome.

8. Try elderberry
Elderberry has been used for hundreds of years in the treatment of colds
and the flu.

In one placebo-controlled study, people with the flu who consumed

elderberry lozenges four times a day experienced a reduction in fever,
headache, muscle aches, nasal congestion, and cough after 48 hours.

Elderberry capsules, lozenges, and syrups are available in stores or online.

You shouldn’t eat raw elderberries, as they can cause nausea, vomiting, and
diarrhea.

Remember, elderberry is a complementary therapy, so make sure you’re

also treating the flu with OTC or prescription medication.

9. Have a spoonful of honey to soothe a cough

Honey is a fairly common natural remedy for soothing a sore throat or
cough. Mixing honey with tea is a great way to stay hydrated while also
treating your flu symptoms.
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In one study, researchers found that a dose of honey was more effective at
controlling a nighttime cough than common cough suppressants in children
ages two to 18 years with upper respiratory tract infections.

One thing to note, though, is that you shouldn’t give honey to children who
are younger than a year old.

10. Ask your doctor about antiviral drugs

Antiviral drugs are only available by prescription, so you must see a doctor
first. These medications are typically reserved for people who are at high
risk of developing complications from the flu.

These drugs prevent the virus from growing and replicating. They work
best if you take them within 48 hours of having symptoms.
You may want to ask a doctor for a prescription antiviral if you:

- are under age 5

- are 18 or under and taking aspirin- or salicylate-containing
medications
- are at least 65
- are pregnant or have given birth in the last two weeks
- have a chronic medical condition or you’re taking other medications
that weaken your immune system
- live in a nursing home or long-term care facility
- are extremely obese, with a body mass index (BMI) of at least 40

Taking antiviral medications within two days of the onset of symptoms may
reduce both the duration of the flu by about one day and the severity of
symptoms.

11. Get a flu shot

The annual flu vaccine is produced based on scientists’ predictions of
which flu strain will dominate the next flu season. Sometimes, though, they
get it wrong. Getting a flu shot after you’ve already had the flu can protect
you from other strains of the virus.

You might think it’s too late or that you can’t get the flu again in one season,
but it’s still a possibility. So, it’s a good idea to protect yourself by getting
vaccinated.
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12. Stay positive

We often forget how much our emotions and attitudes affect how we feel
physically. While you may not be able to unclog your stuffy nose or lower
your fever with positive thoughts, maintaining a positive attitude during
your illness may help in your overall recovery.

PERTUSSIS
Pertussis, also known as whooping cough, is a highly contagious respiratory infection caused by the
bacterium Bordetella Pertussis. In 2018, there were more than 151,000 cases of pertussis globally.

Pertussis spreads easily from person to person mainly through droplets produced by coughing or
sneezing. The disease is most dangerous in infants, and is a significant cause of disease and death in
this age group.

Before 1. The best way to prevent pertussis is through immunization. The three-
dose primary series diphtheria-tetanus-pertussis (DTP3) vaccines
decrease the risk of severe pertussis in infancy. In 2018, 86% of the
global target population had received the recommended three doses of
DTP-containing vaccine during infancy.

It is recommended the first dose be administered as early as 6 weeks of

age; with subsequent doses given 4-8 weeks apart, at age 10-14 weeks
and 14-18 weeks. A booster dose is recommended, preferably during
the second year of life. Based on local epidemiology, further booster
doses may be warranted later in life.

Vaccination of pregnant women is effective in preventing disease in

infants too young to be vaccinated. National programs may consider
vaccination of pregnant women with pertussis-containing vaccine as a
strategy additional to routine primary infant pertussis vaccination in
countries or settings with high or increasing infant morbidity/mortality
from pertussis.

Children aren’t the only ones vulnerable to whooping cough. Talk to

your doctor about getting vaccinated if you:
 work with, visit, or care for infants and children
 are over the age of 65
 work in the healthcare industry

2. Educate yourself and your family about the signs and symptoms of
whooping cough:

 runny nose
 sneezing
 mild dry cough
 fever
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After these mild symptoms appear, the cough worsens.

The cough comes in long, uncontrollable bursts. This may happen at

night, which may make it difficult for you to sleep. When the cough is
severe, it may cause vomiting, fainting, broken ribs and poor bladder
control (urinary incontinence).

Whooping cough’s most well-known symptom is the ‘whoop’ sound.

Taking a quick breath between bouts of coughing causes this sound. Not
everyone who has whooping cough will make the ‘whoop sound’.
Babies may not have a cough at all. But they can have episodes of
turning blue or pauses in their breathing.

3. Other Tips to Prevent Pertussis

Wash your hands. Hand hygiene is a universal recommendation. When

possible, wash hands or use alcohol-based rubs after touching nasal
secretions.

Cover your nose and mouth when coughing or sneezing. Encourage

children to do the same.

During 1. Report cases of pertussis to the local public health department as soon
as possible to assist with preventing additional cases.

2. Early empiric treatment is important for infants <1 year of age with
suspected pertussis. Infants are typically hospitalized for treatment
because whooping cough is more dangerous for this age group. If your
child can't take liquids or food, intravenous fluids may be necessary.
Your child will also be isolated from others to prevent the infection
from spreading.

Treatment for older children and adults usually can be managed at

home.

Ideally, treat pertussis during the first 1 to 2 weeks before coughing

paroxysms occurs to prevent severity of symptoms. Treatment is
ineffective if started late in the course of illness. Antibiotics will not
alter the course of the illness or prevent transmission if they are given
later in the course of illness.

Clinicians should strongly consider treating prior to test results if any

of the following are present:

 Clinical history is strongly suggestive of pertussis

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 The person is at risk for severe or complicated disease (e.g.,

infants)
 The person has or will soon have routine contact with someone
that is considered at high risk of serious disease (e.g. pregnant
women)

A reasonable guideline is to treat

 Persons 1 year of age and older within 3 weeks of cough onset
 Infants younger than 1 year of age
 Pregnant women (especially if they are near term) within 6
weeks of cough onset

4. Administer antibiotics to kill the bacteria causing whooping cough and

help speed recovery. Exposed family members may be given preventive
antibiotics.

Unfortunately, not much is available to relieve the cough. Over-the-

counter cough medicines, for instance, have little effect on whooping
cough and are discouraged.

The recommended antimicrobial agents for treatment or

chemoprophylaxis of pertussis are:

 Azithromycin
 Clarithromycin
 Erythromycin
 Clinicians can also use Trimethoprim-sulfamethoxasole.

Clinicians should choose the antimicrobial after consideration of the

following:

 Potential for adverse events and drug interactions

 Tolerability
 Ease of adherence to the regimen prescribed
 Cost

Macrolides erythromycin, clarithromycin, and azithromycin are

preferred for the treatment of pertussis in persons 1 month of age and
older.

For persons 2 months of age and older, an alternative to macrolides is

trimethoprim-sulfamethoxazole.
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For infants younger than 1 month of age, use macrolides with caution
as an association between orally administered erythromycin and
azithromycin with infantile hypertrophic pyloric stenosis (IHPS) has
been reported.

However, azithromycin remains the drug of choice for treatment or

prophylaxis of pertussis in very young infants because the risk of
developing severe pertussis and life-threatening complications
outweighs the potential risk of IHPS.

Clinicians should monitor infants younger than 1 month of age who

receive a macrolide for the development of IHPS and for other serious
adverse events.

5. Self-care applies to anyone being treated for whooping cough at home

through adhering to the following tips on dealing with coughing spells:

 Get plenty of rest. A cool, quiet and dark bedroom may help you
relax and rest better.
 Drink plenty of fluids. Water, juice and soups are good choices.
In children, especially, watch for signs of dehydration, such as
dry lips, crying without tears and infrequent urination.
 Eat smaller meals. To avoid vomiting after coughing, eat
smaller, more-frequent meals rather than large ones.
 Clean the air. Keep your home free of irritants that can trigger
coughing spells, such as tobacco smoke and fumes from
fireplaces.
 Prevent transmission. Cover your cough and wash your hands
often; if you must be around others, wear a mask.
After 1. Recovery from whooping cough can be slow. The cough becomes
milder and less common as you get better. Coughing fits may stop for a
while but can return if you get other respiratory infections. Coughing
fits can return many months after the whooping cough illness started.

2. Effective measures of secondary prevention include post-exposure

antibiotic prophylaxis for individuals who are considered high-risk for
developing the disease or having serious complications. Antibiotic
prophylaxis regimens are similar to those used for treatment, and vary
with the individual's age.
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First Aid 1. Good management of whooping cough includes:

a. Recognition of complications and early referral for supportive
care.
b. THINK of pertussis in anyone with the following symptoms,
regardless of vaccination history:
 A cough of any duration in a person who has been
notified of a close exposure to pertussis.
 A paroxysmal cough of any duration, with whooping,
post-tussive vomiting/gagging or apnea.
 A persistent cough of unknown etiology, lasting more
than seven days.
c. Test for pertussis:
 Based on the guidance in the table, collect a specimen
using a nasopharyngeal (NP) swab, wash or aspirate for
PCR or culture. Collect serum for IgG.
 Do not test if symptoms are not present. It is unlikely
that B. Pertussis can be recovered through testing if the
patient is not experiencing symptoms.

2. Early antibiotic treatment to reduce transmission. Educating and

informing your patient about whooping cough.

3. TREAT and report suspected and confirmed cases:

a. Use Erythromycin, Azithromycin, Clarithromycin, or
Trimethoprim-Sulfamethoxazole for treatment. If 21 days have
already elapsed since cough onset, treatment is not
recommended, as it will not improve outcome.
b. Prescribe antimicrobial prophylaxis (same regimen as
treatment) to persons who are close contacts of pertussis cases.

4. Asymptomatic contacts receiving prophylaxis should not be excluded

from their usual activities.

5. Symptomatic contacts should be evaluated for pertussis.

6. Case contacts are managed following recommendations on pertussis

treatment and prophylaxis.

7. Laboratory confirmed and clinically diagnosed cases are reportable.

8. Call your local health department if you have questions.

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9. STOP TRANSMISSION. Inform patients with suspected pertussis to

stay at home and avoid close contact with others until they have:
 Completed the fifth day of an appropriate antibiotic, or
 Had cough symptoms for at least 3 weeks (cases are potentially
infectious for the first 3 weeks of cough).

10. Use a clean, cool mist humidifier to help loosen mucus and soothe the
cough.

11. Wash hands often with soap and water for at least 20 seconds.

12. Eat small meals every few hours to help prevent vomiting.

13. Get plenty of fluids, including water, juices, and soups, and fruits to
prevent dehydration (lack of fluids). Probiotics such as buttermilk,
yogurt, and curd can help fasten recovery. Kiwi is known for its many
benefits.

A.3.b. WATER BORNE

Waterborne illness is caused by recreational or drinking water contaminated by disease-causing
microbes or pathogens. Of note, many waterborne pathogens can also be acquired by consuming
contaminated food or beverages, from contact with animals or their environment, or through person-
to-person spread.

POLIO
Poliomyelitis (polio) is a highly infectious viral disease that largely affects children under 5 years of
age. The virus is transmitted by person-to-person spread mainly through the fecal-oral route or, less
frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the intestine,
from where it can invade the nervous system and cause paralysis. (WHO)

Before 1. There is no direct cure for Polio. However, you may prevent polio by
being vaccinated. Vaccination is usually done in childhood.

There are two types of vaccine that can prevent polio:

 Inactivated poliovirus vaccine (IPV) given as an injection in the

leg or arm, depending on the patient’s age.
 Oral poliovirus vaccine (OPV) is still used throughout much of
the world.
 Healthcare officials recommend four polio shots in childhood:
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o First shot at 2 months old.

o Second shot at 4 months old.
o Third shot between 6 and 18 months old.
o Booster shot between 4 and 6 years old.

If you’ve never been vaccinated for polio and it’s recommended you
get vaccinated as an adult, you’ll get three shots:
a. Two doses one to two months apart.
b. A third dose six to 12 months after the second.

Although polio mainly affects children under 5, you’re also at high risk
if you haven’t had the polio vaccine.
2. Know and understand how Polio is being transmitted.

The virus gets inside you through your mouth. You might get it by:

 Contact with feces from a person with polio. This can include
putting an object that has feces on it in your mouth or getting
feces on your hand and putting your hand in your mouth. Water
or food that is contaminated with infected feces can also spread
polio.
 Breathing in droplets from a cough or sneeze of a person with
polio. This is a less common way to get polio.

Even if you don’t have symptoms, you can pass on polio to others if it’s
in your body.

3. Know and understand the symptoms of Polio to prevent the spread.

Most people who catch the poliovirus don't have symptoms. About 1 in
4 people will have symptoms that look a lot like the flu, such as:

 Sore throat
 Feeling tired
 Upset stomach
 Fever
 Headache
 Back or neck pain or stiffness
 Muscle weakness
 Stomach pain
 Vomiting
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"Nonparalytic Polio" symptoms like these often don't cause you to

become paralyzed. They usually go away on their own within 10 days.

A smaller number of people have a more severe kind of polio that is

called "Paralytic Polio." If you have it, your symptoms will start off like
the mild ones above. Within a week, you'll also start to have:

 A loss of reflexes
 Severe muscle pain or weakness
 Floppy limbs
 A feeling of pins and needles in your legs
 Paralyzed arms, legs, or both
 Meningitis (an infection in your brain, spinal cord, or both)
During There are no specific medications to treat polio. If you have paralytic polio,
you’ll receive physical therapy. If your breathing muscles are weakened or
paralyzed, you’ll need mechanical ventilation, a machine that helps you
breathe.

If you have polio, your doctor will focus on making sure that you're
comfortable and try to prevent any other health issues. Some treatments and
tools for support include:

1. Pain relievers (like ibuprofen)

2. A ventilator (a device that helps you breathe)
3. Physical therapy that can help keep your muscles working
4. Bed rest and fluids for flu-like symptoms
5. Antispasmodic medications to relax muscles
6. Antibiotics for urinary tract infections
7. A heating pad for muscle aches and spasms
8. Corrective braces
9. Pulmonary rehabilitation to help with lung complications
10. A mobility aid such as a cane, wheelchair, or electric scooter
After Polio can be life-threatening if the muscles you use to breathe get so weak
that they no longer work.

Years after you have polio, you may start to have other symptoms. Known
as "post-polio syndrome (PPS)," you could have:

a. Problems with breathing and swallowing

b. Muscle loss
c. Sleep disorders like sleep apnea
d. Trouble handling low temperatures
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The following aid in managing the symptoms:

1. Physiotherapy is safe and effective when carefully prescribed and

monitored by experienced health professionals. It is important to help
people with PPS find suitable aids and interventions to lead independent
lives.

2. Progressive resistance training program consisted of 3 sets of 8

isometric contractions, 3 times weekly for 12 weeks resulted in
significant improvement in the Post- Polio Syndrome case’s strength.

3. Electrical stimulation has been used to strengthen weakened muscles or

to reeducate muscles weakened through disuse, as well as to decrease
pain.
First Aid Signs and symptoms of polio are similar to other viral diseases that affect
the nervous system. It is important to get a timely and accurate diagnosis.

There is no specific or effective drug treatment for polio. Painkillers are

usually enough if the infection is mild. If the infection is severe, the child
will need to go to hospital. In cases of bulbar polio, breathing has to be
maintained artificially by machine.

If you had polio before, see your healthcare provider if you have new or
worse signs or symptoms.

TYPHOID FEVER
Typhoid fever is a life-threatening illness caused by bacterium Salmonella Typhi (S. Typhi). It infects
your small intestines (gut) and causes high fever, stomach pain and other symptoms. Typhoid fever
is also called enteric fever.

You will commonly hear paratyphoid fever mentioned along with typhoid. Paratyphoid fever is
similar to typhoid with more mild symptoms. It is caused by Salmonella Paratyphi (S. Paratyphi).

Before 1. Understand the symptoms of the disease. Typhoid fever and

paratyphoid fever have similar symptoms; these are:
 Sustained fever (a fever that does not come and go) that can be
as high as 103–104°F (39–40°C). A sustained fever is.
 Weakness
 Stomach pain
 Headache
 Diarrhea or constipation
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 Cough
 Loss of appetite
 Rash of flat, rose-colored spots

2. Educate yourself and your family members the transmission of Typhoid

Fever.

3. Two basic actions can protect you:

a. Get vaccinated or immunized with WHO pre-qualified oral

injectable vaccines.
Typhoid conjugate vaccine, consisting of the purified Vi antigen
linked to a carrier protein, is given as a single injectable dose in
children from 6 months of age and in adults up to 45 years or 65
years (depending on the vaccine).

Two additional vaccines have been used for many years in older
children and adults at risk of typhoid, including travelers. These
vaccines do not provide long-lasting immunity (requiring repeat or
booster doses) and are not approved for children younger than 2
years old:

 an injectable vaccine based on the purified antigen for

people aged 2 years and above; and
 a live attenuated oral vaccine in capsule formulation for
people aged over 6 years.

Two typhoid conjugate vaccines have been prequalified by WHO

since December 2017 and are being introduced into childhood
immunization programs in typhoid endemic countries.

b. Practice safe eating and drinking habits. Carefully selecting what

you eat and drink when you travel is important because typhoid
fever vaccines do not work 100% of the time and there isn’t a
paratyphoid fever vaccine. Safe eating and drinking will also help
protect you from other illnesses, including travelers’ diarrhea,
cholera, dysentery, and hepatitis A.

Typhoid is quite common in areas with poor hygiene, so avoid

roadside stalls.
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Typhoid fever is common in places with poor sanitation and a lack

of safe drinking water. Access to safe water and adequate sanitation,
hygiene among food handlers and typhoid vaccination are all
effective in preventing typhoid fever.

Avoid handling food or any other household things if there is a risk

of spreading the disease.

Do not go for heavy meals, split your heavy meals and do frequent
small meals.

4. All travelers to endemic areas are at potential risk of typhoid fever,

although the risk is generally low in tourist and business centers where
standards of accommodation, sanitation and food hygiene are high.
Typhoid fever vaccination should be offered to travelers to destinations
where the risk of typhoid fever is high.

The following recommendations will help ensure safety while

travelling:
 Ensure food is properly cooked and still hot when served.
Always cover food to prevent contamination from flies and
other insects.
 Avoid raw milk and products made from raw milk. Drink only
pasteurized or boiled milk.
 Avoid ice unless it is made from safe water. Avoid popsicles
and flavored ices that may have been made with contaminated
water.
 When the safety of drinking water is questionable, boil it, or if
this is not possible, disinfect it with a reliable, slow-release
disinfectant agent (usually available at pharmacies).
 Wash hands thoroughly and frequently using soap, in particular
after contact with pets or farm animals, or after having been to
the toilet.
 Wash fruits and vegetables carefully, particularly if they are
eaten raw. If possible, vegetables and fruits should be peeled.
During 1. Typhoid fever can be treated with antibiotics. Antimicrobial resistance
is common with likelihood of more complicated and expensive
treatment options required in the most affected regions.

2. Even when the symptoms go away, people may still be carrying typhoid
bacteria, meaning they can spread it to others, through shedding of
bacteria in their feces.
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3. It is important for people being treated for typhoid fever to do the

following:

 Take prescribed antibiotics for as long as the doctor has prescribed.

 Wash hands with soap and water after using the bathroom and avoid
preparing or serving food for other people. This will lower the
chance of passing the infection on to someone else.
 Have the doctor test to ensure that no Salmonella Typhi bacteria is
in the body.

4. Hospital treatment

Hospital admission is usually recommended if the case have severe

symptoms of typhoid fever, such as persistent vomiting, severe diarrhea or
a swollen stomach.

As a precaution, young children who develop typhoid fever may be

admitted to hospital.

In hospital, antibiotic injections are administered while fluids and nutrients

can also be directly into a vein through an intravenous drip.

Surgery may be needed if the case develops life-threatening complications

of typhoid fever, such as internal bleeding or a section of the digestive
system splitting. But this is very rare in people being treated with
antibiotics.

Most people respond well to hospital treatment and improve within 3 to 5

days, but it may be several weeks until the case becomes well enough to
leave hospital.
After Most people who have typhoid fever feel better about a week after they
start treatment to kill bacteria, called antibiotics. But without treatment,
there is a small chance of death from typhoid fever complications. Vaccines
against typhoid fever can provide some protection.

There can also be cases manifested as:

1. Relapses
a. Some people who are treated for typhoid fever experience a relapse,
which is when symptoms return.
b. If this happens, the symptoms usually return around a week after
antibiotic treatment has finished.
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c. The second time around, symptoms are usually milder and last for
a shorter time than the original illness, but further treatment with
antibiotics is usually recommended.
d. Cases of relapse must see the General Practitioner as soon as
possible if the symptoms return after treatment.

2. Long-term carriers
a. After the symptoms have passed, another stool sample should be
tested to check if there are still Salmonella typhi bacteria in the stool.
b. If there are, the case had become a carrier of the typhoid infection.
This means the Salmonella typhi bacteria continue to live in the body
and can be spread as normal in stool or urine. However, the case will
not have any noticeable symptoms.
c. It is possible for the bacteria to live in the body for 12 months or
more after you first became infected. In this case, there is a need to
have a further 28-day course of antibiotics to "flush out" the bacteria.
d. Until test results show that the case is free of bacteria, he/she must
avoid handling or preparing food.
e. It is also very important that the case wash hands thoroughly after
going to the toilet.
First Aid See a health care provider right away if symptoms of Typhoid Fever are
manifested.

If one gets sick while traveling in a foreign country, know who to call for a
list of providers. For some, this might be the closest embassy or consulate.

If symptoms are manifested after return to home, consider seeing a health

care provider who focuses on international travel medicine or infectious
diseases. This might help get typhoid fever diagnosed and treated more
quickly.

Several antibiotics are effective for the treatment of typhoid fever.

Chloramphenicol was the original drug of choice for many years. Because
of rare serious side effects, chloramphenicol has been replaced by other
effective antibiotics. The choice of antibiotics is guided by identifying the
geographic region where the infection was contracted (certain strains from
South America show a significant resistance to some antibiotics.) If
relapses occur, patients are retreated with antibiotics.

 Antibiotics, such as ciprofloxacin, may be given to adults.

 Ceftriaxone (injectable antibiotic) may be given to pregnant women
and children.
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Those who become chronically ill (about 3%-5% of those infected), can be
treated with prolonged antibiotics. Often, removal of the gallbladder, the
site of chronic infection, will provide a cure.

Symptoms should begin to improve within 2 to 3 days of taking antibiotics.

But it is very important to finish the course to ensure the bacteria are
completely removed from the body.

Make sure the case have enough rest, drink plenty of fluids and eat regular
meals.

CHOLERA
Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the
bacterium Vibrio cholera. Cholera remains a global threat to public health and an indicator of
inequity and lack of social development.

Cholera is an extremely virulent disease that can cause severe acute watery diarrhea. It takes between
12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water (2).
Cholera affects both children and adults and can kill within hours if untreated.

Most people infected with V. cholera do not develop any symptoms, although the bacteria are present
in their feces for 1-10 days after infection and are shed back into the environment, potentially
infecting other people.

Among people who develop symptoms, the majority have mild or moderate symptoms, while a
minority develop acute watery diarrhea with severe dehydration. This can lead to death if left
untreated.

Before 1. Be educated on the symptoms of cholera:

A cholera infection can be mild, with no symptoms. But about 10% of

infected people develop severe symptoms, 12 hours to five days after
ingesting the bacteria. These symptoms include:

 Diarrhea, or extremely watery stool

 Intense thirst
 Lower amounts of urine
 Muscle cramps
 Restlessness or irritability
 Vomiting
 Weakness
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2. A multifaceted approach is key to control cholera, and to reduce deaths.

A combination of surveillance, water, sanitation and hygiene, social
mobilization, treatment, and oral cholera vaccines are used.

a. Social Mobilization or Community Engagement

Social Mobilization or Community Engagement means that people

and communities are part of the process of developing and
implementing programs. Local culture practices and beliefs are
central to promoting actions such as the adoption of protective
hygiene measures that include handwashing with soap, safe
preparation and storage of food, and safe disposal of the feces of
children and funeral practices for individuals who die from cholera
to prevent infection among attendees.

Social Mobilization or Community Engagement continues

throughout outbreak response with increased communication
regarding potential risks, symptoms of cholera, precautions to take
to avoid cholera, when and where to report cases and to seek
immediate treatment when symptoms appear. The communities
should be part of developing programs to address needs including
where and when to seek treatment.

b. Surveillance

Cholera surveillance should be part of an integrated disease

surveillance system that includes feedback at the local level and
information-sharing at the global level.

Cholera cases are detected based on clinical suspicion in patients

who present with severe acute watery diarrhea. The suspicion is
then confirmed by identifying V. Cholera in stool samples from
affected patients. Detection can be facilitated using rapid diagnostic
tests (RDTs), where one or more positive samples triggers a cholera
alert. The samples are sent to a laboratory for confirmation by
culture or PCR. Local capacity to detect (diagnose) and monitor
(collect, compile, and analyze data) cholera occurrence, is central to
an effective surveillance system and to planning control measures.

Countries affected by cholera are encouraged to strengthen disease

surveillance and national preparedness to rapidly detect and respond
to outbreaks. Under the International Health Regulations,
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notification of all cases of cholera is no longer mandatory. However,

public health events involving cholera must always be assessed
against the criteria provided in the regulations to determine whether
there is a need for official notification.

c. A WHO pre-qualified oral cholera vaccine is available for

travelers and people in endemic areas. It is given in two doses
and offers protection for 3 years.

Currently there are three WHO pre-qualified oral cholera vaccines

(OCV): Dukoral®, Shanchol™, and Euvichol-Plus®. All three
vaccines require two doses for full protection.

c.1. Dukoral® is administered with a buffer solution, that for

adults, requires 150 ml of clean water. Dukoral can be
given to all individuals over the age of 2 years. There
must be a minimum of 7 days, and no more than 6
weeks, delay between each dose. Children aged 2 -5
require a third dose. Dukoral® is mainly used for
travelers. Two doses of Dukoral® provide protection
against cholera for 2 years.

c.2. Shanchol™ and Euvichol-Plus® have the same vaccine

formula, produced by two different manufacturers. They
do not require a buffer solution for administration. They
are given to all individuals over the age of one year.
There must be a minimum of two-week delay between
each dose of these two vaccines. Two doses of
Shanchol™ and Euvichol-Plus® provide protection
against cholera at least for three years, while one dose
provides short term protection.

Shanchol™ is prequalified to be used in a Controlled

Temperature Chain, an innovative approach to vaccine
management allowing vaccines to be kept at
temperatures outside of the traditional cold chain of
+2°C to +8°C for a limited period of time under
monitored and controlled conditions.
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d. Water, sanitation, hygiene (WASH) interventions

The long-term solution for cholera control lies in economic

development and universal access to safe drinking water and
adequate sanitation. Actions targeting environmental conditions
include the implementation of adapted long-term sustainable
WASH solutions to ensure use of safe water, basic sanitation and
good hygiene practices in cholera hotspots.

In addition to cholera, such interventions prevent a wide range of

other water-borne illnesses, as well as contributing to achieving
goals related to poverty, malnutrition, and education. The WASH
solutions for cholera are aligned with those of the Sustainable
Development Goals (SDG 6) “Ensure access to water and sanitation
for all”. Specific measures are outlined as:

d.1. Be sure you drink and use only safe and clean water.
 Use bottled water with unbroken seals. Use bottled
water to brush your teeth, wash and prepare food, and
make ice or beverages.
 If bottled water is not available, use water that has been
properly boiled (upon reaching boiling point extend
boiling for 3 or more minutes), chlorinated, or filtered
using a filter that can remove bacteria.

d.2. Wash your hands often with soap and safe water in the
following occasions:
 Before, during, and after preparing food.
 Before and after eating food or feeding your children.
 After using the toilet.
 After cleaning your child’s bottom.
 After taking care of someone who is sick with diarrhea.

If you don’t have access to soap and water, use an alcohol-

based hand rub with at least 60% alcohol.

d.3. Observe proper use of toilets.

 Use toilets or safely managed sanitation facilities to get
rid of feces. This includes proper disposal of children’s
stool.
 Wash hands with soap and safe water after going to the
bathroom.
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If you don’t have access to a toilet facility:

 Defecate at least 30 meters (98 feet) away from any body

of water (including wells) and then bury your stool.
 Dispose of plastic bags containing stool in latrines or at
collection points if available, or bury it in the ground.
 Do not put plastic bags in chemical toilets.
 Dig new latrines or temporary pit toilets at least a half-
meter (1.6 feet) deep and at least 30 meters (100 feet)
away from any body of water.

d.4. Boil it, cook it, peel it, or leave it.

 Cook food well, keep it covered, eat it hot, and peel
fruits and vegetables.
 Eat foods that have been thoroughly cooked and are still
hot and steaming. Be sure to cook seafood, especially
shellfish, until it is very hot all the way through.
 Avoid raw vegetables and fruits that cannot be peeled.

d.5. Clean up safely.

 Clean food preparation areas and kitchenware with soap

and treated water and let dry completely before reuse.
 Bathe and wash clothes or diapers 30 meters (100 feet)
away from drinking water sources.
 Clean and disinfect toilets and surfaces contaminated
with stool: clean the surface with a soap solution to
remove solids; then disinfect using a solution of 1part
household bleach to 9 parts water.
 When finished cleaning, safely dispose of soapy water
and dirty rags. Wash hands again with soap and safe
water after cleaning and disinfecting.
 Keep surroundings clean to prevent flies and other
insects and rodents from breeding.
During Cholera requires immediate treatment because the disease can cause death
within hours. Cholera is an easily treatable disease through the following
regimens:

1. Rehydration. The goal is to replace lost fluids and electrolytes using a

simple rehydration solution, oral rehydration salts (ORS). The oral
rehydration salts (ORS) solution is available as a powder that can be
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made into a homemade solution by mixing 1 liter of boiled or bottled

water with 1 teaspoon of salt and 4 teaspoons of sugar.

The majority of people can be treated successfully through prompt

administration of oral rehydration solution (ORS). The WHO/UNICEF
ORS standard sachet is dissolved in 1 liter (L) of clean water. Adult
patients may require up to 6 L of ORS to treat moderate dehydration on
the first day.

Without rehydration, approximately half the people with cholera die.

With treatment, fatalities drop to less than 1%.

Intravenous fluids. Most people with cholera can be helped by oral

rehydration alone, but severely dehydrated people are at risk of shock
and require the rapid administration of intravenous fluids.

2. Antibiotics. While not a necessary part of cholera treatment, some

antibiotics can reduce cholera-related diarrhea and shorten how long it
lasts in severely ill people.

This can reduce the volume of rehydration fluids needed, and shorten
the amount and duration of V. Cholera excretion in the stool.
Mass administration of antibiotics is not recommended, as it has no
proven effect on the spread of cholera may contribute to antimicrobial
resistance.

3. Zinc supplements. Research has shown that zinc is an important

adjunctive therapy for children under 5 which might decrease diarrhea
and shorten the duration in children with cholera.

4. Seek immediate medical care if you develop severe diarrhea or

vomiting and are in or have very recently returned from a country where
cholera occurs.

5. If you believe you've been exposed to cholera, but your symptoms are
not severe, call your family doctor. Be sure to say that you suspect your
illness may be cholera.

6. When you make your appointment, ask if there are restrictions you need
to follow before your visit.
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Make a list of:

 Your symptoms, when they began and how severe they are
 Recent exposure to possible sources of infection, particularly if
you've traveled abroad recently
 Key medical information, including other conditions for which
you're being treated
 All medications, vitamins or other supplements you take,
including doses
 Questions to ask your doctor

Some questions to ask your doctor about cholera include:

 Are there other possible causes for my symptoms?
 What tests do I need?
 What treatment approach do you recommend?
 How soon after I begin treatment will I begin to feel better?
 How long do you expect a full recovery to take?
 When can I return to work or school?
 Am I at risk of any long-term complications from cholera?
 Am I contagious? How can I reduce my risk of passing my
illness to others?
 What to expect from your doctor?

Your doctor is likely to ask questions, such as:

 Have you had watery diarrhea? How severe?
 Is there anything else unusual about the appearance of your
stools?
 Have you been vomiting?
 Have you experienced symptoms of dehydration, such as
intense thirst, muscle cramps or fatigue?
 Have you been able to keep down any food or liquid?
 Have you recently eaten raw shellfish, such as oysters?
 Are you pregnant?
 What is your blood type, if you know?
After Ending Cholera: A Roadmap to 2030

In October 2017, Global Task Force on Cholera Control (GTFCC) Partners

launched a strategy for cholera control “Ending Cholera: A Global
Roadmap to 2030”. The country led strategy aims to reduce cholera deaths
by 90% and to eliminate cholera in as many as 20 countries by 2030.
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The Global Roadmap focuses on three strategic axes:

1. Early detection and quick response to contain outbreaks: the

strategy focuses on containing outbreaks—wherever they may
occur— through early detection and rapid multi-sectoral response
including community, engagement, strengthening surveillance and
laboratory capacity, health systems and supply readiness, and
supporting rapid response teams.

2. A targeted multi-sectoral approach to prevent cholera recurrence:

the strategy calls on countries and partners to focus on cholera
“hotspots”, the relatively small areas most heavily affected by
cholera. Cholera transmission can be stopped in these areas through
measures including improved WASH and through use of Oral
Cholera Vaccines (OCV).

3. An effective mechanism of coordination for technical support,

advocacy, resource mobilization, and partnership at local and global
levels: The GTFCC provides a strong framework to support
countries to intensify efforts to control cholera, building upon
country-led cross-sectoral cholera control programs and supporting
them with human, technical, and financial resources.

A resolution promoting control of cholera and endorsing "Ending Cholera:

A global roadmap to 2030" was passed in May 2018 at the 71st World
Health Assembly.
First Aid 1. Utilize appropriately and effectively the Cholera Kits

To ensure efficient and effective deployment of necessary materials for

the investigation and confirmation of cholera outbreaks, as well as the
treatment of cholera patients, the WHO has developed a set of cholera
kits.
In 2016, after consultation with implementing partners, WHO revised
the cholera kits to better meet field needs. There are 6 kits:
 1 for investigation
 1 with supplies for laboratory confirmation
 3 for treatment at each of the community, peripheral and central
levels
 1 support kit with logistical materials including solar lamps,
fencing, water bladders and taps.
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Each treatment kit provides enough material to treat 100 patients. The
revised cholera kits are designed to help prepare for a potential cholera
outbreak and to support the first month of the initial response.

2. Stay well hydrated. For diarrhea and vomiting that may be cholera-
related, use an oral rehydration solution.

In most developing countries, you can buy powdered packets of oral

rehydration salts (ORS) originally developed by the World Health
Organization to treat diarrhea and dehydration in infants with cholera.
Stir the powder into clean drinking or boiled water according to the
package directions.

If no oral rehydration solutions are available, make your own by

combining 1 quart (about 1 liter) of bottled or boiled water with 6 level
teaspoons (about 30 milliliters) of table sugar and 1/2 level teaspoon
(about 2.5 milliliters) of table salt.

3. If you develop any cholera symptoms, immediately contact a healthcare

provider. Mild symptoms may go away on their own in a few days. But
dehydration can become deadly very quickly. Early treatment can save
your life.

A.3.c. VECTOR BORNE

Vector-borne diseases results from an infection transmitted to humans and other animals by blood-
feeding anthropods, such as mosquitoes, ticks, and fleas. They cause a major burden in the
Philippines. Main diseases are malaria, dengue, lymphatic filariasis, schistosomiasis and Japanese
encephalitis.

Although once confined to urban and semi-urban areas, dengue is now widespread in rural areas of
the Philippine Archipelago. It has now become the most important vector-borne disease in the
country. Dengue control can be effectively addressed with community involvement.

DENGUE
Dengue is a mosquito-borne viral disease that is transmitted by female mosquitoes mainly of the
species Aedes aegypti and, to a lesser extent, Ae. albopictus. These mosquitoes are also vectors of
chikungunya, yellow fever, and Zika viruses. Dengue is widespread throughout the tropics, with local
variations in risk influenced by climate parameters as well as social and environmental factors.

Dengue causes a wide spectrum of disease. This can range from subclinical disease (people may not
know they are even infected) to severe flu-like symptoms in those infected. Although less common,
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some people develop severe dengue, which can be any number of complications associated with
severe bleeding, organ impairment and/or plasma leakage. Severe dengue has a higher risk of death
when not managed appropriately. Severe dengue was first recognized in the 1950s during dengue
epidemics in the Philippines and Thailand.

Dengue is caused by one of any of four related viruses: Dengue virus 1, 2, 3, and 4 (DENV-1, DENV-
2, DENV-3 and DENV-4). For this reason, a person can be infected with a dengue virus as many as
four times in his or her lifetime. Recovery from infection is believed to provide lifelong immunity
against that serotype. However, cross-immunity to the other serotypes after recovery is only partial,
and temporary. Subsequent infections (secondary infection) by other serotypes increase the risk of
developing severe dengue.

Dengue has distinct epidemiological patterns, associated with the four serotypes of the virus. These
can co-circulate within a region, and indeed many countries are hyper-endemic for all four serotypes.
Dengue has an alarming impact on both human health and the global and national economies. DENV
is frequently transported from one place to another by infected travelers; when susceptible vectors
are present in these new areas, there is the potential for local transmission to be established.

Dengue fever and dengue hemorrhagic fever are acute viral infections that affect infants, young
children, and adults.

Before 1. There is a vaccine called Dengvaxia for people who have had dengue
at least once and live in places where the disease is common.
2. The mosquitoes that spread dengue are active during the day. Lower the
risk of getting dengue by protecting yourself from mosquito bites by
using:

 clothes that cover as much of your body as possible

 mosquito nets if sleeping during the day, ideally nets sprayed
with insect repellent
 window screens
 mosquito repellents (containing diethyl(meta)toluamide
(DEET), Picaridin or IR3535)
 coils and vaporizers

To reduce the mosquito population, get rid of places where mosquitoes

can breed. These include old tires, cans, or flower pots that collect rain.
Regularly change the water in outdoor bird baths and pets' water dishes.
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3. Every member of the community has an important role to help prevent

dengue. So has programmatic preparation - “4S” against Dengue which
stands for search and destroy mosquito breeding places, seek early
consultation, secure self-protection, and support anti-dengue fogging or
spraying operations when necessary. The key public health messages
that communities can practice are:

a. Search and Destroy

 Cover water drums and pails.
 Replace water in flower vases once a week.
 Clean gutters of leaves and debris.
 Collect and dispose all unusable tin cans, jars, bottles and
other items that can collect and hold water.
c. Self-Protection Measures
 Wear long pants and long sleeved shirt.
 Use mosquito repellant every day.
d. Seek Early Consultation
 Consult the doctors immediately if fever persists after 2 days
and rashes appears.
e. Say Yes to fogging when there is an impending outbreak or a
hotspot.

4. Be educated about the signs and symptoms of dengue:

Most people with dengue have mild or no symptoms and will get
better in 1–2 weeks. Rarely, dengue can be severe and lead to death.

If symptoms occur, they usually begin 4–10 days after infection and
last for 2–7 days. Symptoms may include:
 high fever (40°C/104°F)
 severe headache
 pain behind the eyes
 muscle and joint pains
 nausea
 vomiting
 swollen glands
 rash

Individuals who are infected for the second time are at greater risk
of severe dengue.
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Severe dengue symptoms often come after the fever has gone away.
People with any of the following severe symptoms should get care
right away:

 severe abdominal pain

 persistent vomiting
 rapid breathing
 bleeding gums or nose
 fatigue
 restlessness
 blood in vomit or stool
 being very thirsty
 pale and cold skin
 feeling weak.

5. Understand the transmission of Dengue:

a. Through Mosquito Bites
Dengue viruses are spread to people through the bites of infected
Aedes species mosquitoes (Ae. Aegypti or Ae. Albopictus).
These are the same types of mosquitoes that spread Zika and
Chikungunya viruses.

These mosquitoes typically lay eggs near standing water in

containers that hold water, like buckets, bowls, animal dishes,
flower pots, and vases.

These mosquitoes prefer to bite people, and live both indoors

and outdoors near people.

Mosquitoes that spread dengue, Chikungunya, and Zika bite

during the day and night.

Mosquitoes become infected when they bite a person infected

with the virus. Infected mosquitoes can then spread the virus to
other people through bites.

b. From mother to child

A pregnant woman already infected with dengue can pass the
virus to her fetus during pregnancy or around the time of birth.
To date, there has been one documented report of dengue spread
through breast milk. Because of the benefits of breastfeeding,
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mothers are encouraged to breastfeed even in areas with risk of

dengue.

c. Dengue in pregnancy
Through infected blood, laboratory, or healthcare setting
exposures.

Rarely, dengue can be spread through blood transfusion, organ

transplant, or through a needle stick injury.
During 1. Most cases of dengue fever can be treated at home with pain medicine.
Preventing mosquito bites is the best way to avoid getting dengue.

There is no specific treatment for dengue. The focus is on treating pain

symptoms.

Acetaminophen (paracetamol) is often used to control pain. Non-

steroidal anti-inflammatory drugs like ibuprofen and aspirin are
avoided as they can increase the risk of bleeding.

2. For people with severe dengue, hospitalization is often needed.

After If you’ve had dengue before, you’re more likely to become seriously ill if
you get a different version of the virus in the future.

Consider getting vaccinated and taking additional precautions to protect

yourself from mosquito bites, especially if you live in a place where dengue
is common.

Patients recovering from dengue fever need time to fully recover,

sometimes it can take months. Therefore, a diet during the recovery period
after dengue fever is very important because it can help patients return to
normal more quickly.

Take note of the following foods to supplement in the recovery period after
dengue fever:

a. Coconut water: This is a source of essential minerals and salts for

the body.

Patients recovering from dengue fever should drink two cups of

coconut water per day during the recovery period. However,
some special people such as low blood pressure, history of
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diabetes, kidney failure or electrolyte disorders should consult a

doctor when using coconut water regularly.

b. Pineapple juice helps patients maintain normal electrolyte levels,

prevent dehydration due to high fever and reduce body weakness.

c. Water is very important in the recovery from dengue fever.

d. Liquid foods have the advantage of being quickly absorbed by

the body, both rehydrating and overcoming weakness.

e. Juice, especially citrus fruits, is the body's best source of

important vitamins and antioxidants. Oranges are full of essential
nutrients and vitamins, including immune-boosting vitamin C,
gut-friendly, and fiber to help ease digestive problems. In
addition, another fruit, kiwi, is known as a source of many
essential nutrients, so kiwi can be a food for that patients after
recovering from dengue fever should use.

f. Herbal Tea: Patients recovering from dengue fever can choose

from mixed teas containing cardamom, mint, ginger, cinnamon.
Another use of herbal tea is to create a good night's sleep, support
the body to rest for maximum time and speed up the recovery
process after dengue fever.

g. Porridge, soup: The patient's body after recovering from dengue

fever needs a lot of energy. The great advantage of the soup
porridge is that it is very easy to digest, helping the patient not
feel heavy and bloated after eating too much. Dishes such as lean
meat porridge, chicken porridge supplement many essential
nutrients for patients during the recovery period. Another
ingredient in the indispensable soup porridge is vegetables.

h. A possible meal for patients recovering from dengue fever should

be prepared in the form of soup or pureed vegetables, with tofu
or a little lean meat to increase protein. These dishes will provide
adequate energy, fiber and necessary minerals. Whole grains are
a good ingredient because they are high in fiber and other
nutrients.
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i. Other high-fiber foods such as oats can be easily digested, so it

is good for patients recovering from dengue fever because it
helps to fight the bad effects of the virus.
First Aid If you think you have dengue:
 See a healthcare provider if you develop a fever or have symptoms
of dengue. Tell him or her about your travel.
 Rest as much as possible.
 Take acetaminophen (also known as paracetamol) to control fever
and relieve pain.
 Do not take aspirin or ibuprofen as these increase the risk of
bleeding!
 Drink plenty of fluids to stay hydrated. Drink water or drinks with
added electrolytes.
 For mild symptoms, care for a sick infant, child, or family member
at home.

LEPTOSPIROSIS
Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the
genus Leptospira. In humans, it can cause a wide range of symptoms, some of which may be mistaken
for other diseases. Some infected persons, however, may have no symptoms at all.

Without treatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the
membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.

The bacteria that cause leptospirosis are spread through the urine of infected animals, which can get
into water or soil and can survive there for weeks to months. Many different kinds of wild and
domestic animals carry the bacterium.

These can include, but are not limited to:

 Cattle
 Pigs
 Horses
 Dogs
 Rodents
 Wild animals

When these animals are infected, they may have no symptoms of the disease.

Infected animals may continue to excrete the bacteria into the environment continuously or every
once in a while for a few months up to several years.
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Humans can become infected through:

 Contact with urine (or other body fluids, except saliva) from infected animals.
 Contact with water, soil, or food contaminated with the urine of infected animals.

The bacteria can enter the body through skin or mucous membranes (eyes, nose, or mouth), especially
if the skin is broken from a cut or scratch. Drinking contaminated water can also cause infection.
Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as
floodwaters. Person to person transmission is rare.

Before 1. Understand the causes to avoid contracting Leptospirosis:

A bacteria called Leptospira interrogans causes leptospirosis. Many

animals carry the organism, and it lives in their kidneys. It gets into soil
and water from their urine.

If you’re around soil or water where an infected animal has peed, the
germ can invade your body through breaks in your skin, like scratches,
open wounds, or dry areas. It can also enter through your nose, mouth,
or genitals. It’s hard to get it from another person, though it can be
passed through sex or breastfeeding.

You have a higher chance of getting the disease if you spend a lot of
time around animals or outdoors. Also, if you raft, swim, or camp near
affected lakes and rivers, you could get the disease.

You'll find leptospirosis more often in warm climates. And although the
bacteria live all over the world, it’s especially common in Australia,
Africa, Southeast Asia, Central and South America, and the Caribbean.

2. Observe Leptospirosis prevention

The best way to prevent leptospirosis is to avoid exposure to the

bacteria. Here’s what you can do to avoid the disease:

In people, follow these tips to prevent contracting leptospirosis:

 Avoid swimming in freshwater, like rivers or streams, that

might contain animal urine.
 Avoid swimming in bodies of water after heavy rainfall or
flooding.
 Avoid touching or swimming in floodwater.
 Treat unsafe water by boiling it first.
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 Keep rats and mice under control.

 Wear protective clothing or shoes when handling contaminated
water or soil.
 If you work with animals, wear protective clothing or shoes.

If your pet has leptospirosis, here’s what you can do to protect yourself:

 Give your pet the prescription antibiotics, as instructed by your

veterinarian.
 Avoid touching your pet’s urine.
 If your pet pees in the house, clean it immediately.
 Have your pet pee away from bodies of water or places people
will touch, like benches.
 Wash your hands after touching your pet.

In pets, here are what you can do to protect your pets from contracting
Leptospirosis:

 Keep your pets away from rodents, wild animals, and animal
carcasses.
 Keep your pets out of contaminated water, especially after
heavy rainfall or flooding.
 Make sure your pets only drink clean water.
 When possible, keep your pets away from other animals’ urine.
 Ask your veterinarian if your dog needs a leptospirosis vaccine.

3. Be educated about the signs and symptoms of Leptospirosis:

You usually start showing signs of leptospirosis within 2 weeks, though

in some cases, symptoms may not show up for a month or not at all.

When the disease does hit, it hits fast. You’ll get a fever. It may spike
to 104 degrees Farenheit or 40 degrees Celsius. Other typical symptoms
include:

 Headache
 Muscle ache
 Jaundice (yellowing of the skin and eyes)
 Vomiting
 Diarrhea
 Skin rash
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Many of these symptoms are similar to symptoms of other diseases,

including the flu and meningitis, so it’s important to get tested.
During 1. Undergo early Leptospirosis Diagnosis

To check for leptospirosis, your doctor does a simple blood test and
examines your blood for antibodies. These are proteins your body
produces to fight the bacteria. If you've had the disease in your system
before, the blood test may give a false positive (or show antibodies from
the previous infection). So your doctor will likely do a second test about
a week later to make sure the results are correct. You may also have a
urine test to look for signs of the bacteria.

Your doctor could order a DNA test. It’s more precise, but it's more
expensive and takes longer, and in many areas of the world, it’s not
available yet. Doctors can also spot the bacteria if it grows in a blood,
spinal fluid, or urine culture.

Severe symptoms of leptospirosis may need a chest X-ray, CT scan, or

other imaging. These tests will help show damage to your organs caused
by the bacteria.

2. The best treatment depends on the severity. Options include:

a. Fluids and fever management

Mild cases of leptospirosis may be treated with simple remedies,

such as:
 drinking plenty of fluids
 getting rest
 taking over-the-counter pain relievers
 initiating antibiotics to destroy harmful bacteria

The following antibiotics are used to treat Leptospirosis:

 doxycycline
 azithromycin
 amoxicillin
 penicillin (for severe cases)
 ceftriaxone (for severe cases)

For severe leptospirosis, antibiotics may be given intravenously.

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b. Other medical therapies

If you have severe leptospirosis, you’ll need to be admitted to the

hospital. That’s because severe cases affect multiple organs.

At the hospital, depending on your clinical condition and the

severity, you may require additional medical interventions, such as:
 dialysis
 mechanical ventilation
 vasopressors (medications to help support blood pressure)

3. Contact a doctor if you think you’ve been exposed to animal urine or

contaminated soil or water.

Other signs that prompts that a doctor must be contacted include:

 persistent fever
 unexplained stomach or muscle pain
 unexplained diarrhea or vomiting
 coughing
 red eyes
 chills
 jaundice
 neck stiffness
 headache

4. Always consider a medical emergency

Leptospirosis can have serious life threatening effects. Get medical
attention if cuts in your skin or your mucous membranes, such as your
eyes, have been exposed to the urine of unvaccinated animals or farm
animals, or contaminated water or soil.
After Follow-up care is a key part of your treatment and safety.
 Be sure to make and go to all medical appointments, and call your
doctor or nurse if you are having problems.
 It's also a good idea to know your test results.
 Keep a list of the medicines you take.
First Aid Get medical attention if cuts in your skin or your mucous membranes, such
as your eyes, have been exposed to the urine of unvaccinated animals or
farm animals, or contaminated water or soil. See a doctor and tell them you
have been exposed to leptospirosis.
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Immediately after exposure:

 Dry off the urine splash straight away (leptospires tend to dry out
easily), then wash the area.
 Wash out fresh or old cuts and grazes with water and disinfectant,
and dry well.
 Flush out your mouth and eyes, and any exposed skin, with lots of
running water.
 Wash your hands and face well:
o taking particular care with facial hair
o using soap and water, and drying thoroughly
 Have a shower, dry yourself carefully, and get into clean, dry
clothes.

Treatment has the most chance of success if it begins as soon as possible

after exposure is known or suspected.

MALARIA
Malaria is an acute febrile illness caused by Plasmodium parasites, which are spread to people
through the bites of infected female Anopheles mosquitoes. There are 5 parasite species that cause
malaria in humans, and 2 of these species – P. Falciparum and P. Vivax – pose the greatest threat. P.
Falciparum is the type of malaria that is most likely to result in severe infections and if not promptly
treated, may lead to death. Although malaria can be a deadly disease, illness and death from malaria
can usually be prevented.

Before 1. Malaria can be prevented by avoiding mosquito bites and by taking

medicines. Talk to a doctor about taking medicines such as
chemoprophylaxis before travelling to areas where malaria is common.

Lower the risk of getting malaria by avoiding mosquito bites:

 Use mosquito nets when sleeping in places where malaria is
present. Use longlasting insecticidal mosquito nets,
especially during nighttime.
 Use mosquito repellents (containing DEET, IR3535 or
Icaridin) after dusk.
 Use coils and vaporizers.
 Wear protective clothing. Wear longsleeved clothing and
pants.
 Clear hanging branches of trees along streams.
 Use window screens.
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2. Keep updated on where does malaria usually occur.

Malaria occurs all over the world and happens most often in
developing countries and areas with warm temperatures and high
humidity, including:
 Africa
 Central and South America
 Dominican Republic, Haiti and other areas in the Caribbean
 Eastern Europe
 South and Southeast Asia
 Islands in the Central and South Pacific Ocean (Oceania)

3. Recognize what causes malaria.

When a mosquito bites someone who has malaria, the mosquito

becomes infected. When that mosquito bites someone else, it
transfers a parasite to the other person’s bloodstream. There, the
parasites multiply. There are five types of malaria parasites that can
infect humans.

Usually, people get malaria by being bitten by an infective female

Anopheles mosquito. Only Anopheles mosquitoes can transmit
malaria and they must have been infected through a previous blood
meal taken from an infected person. When a mosquito bites an
infected person, a small amount of blood is taken in which contains
microscopic malaria parasites. About 1 week later, when the
mosquito takes its next blood meal, these parasites mix with the
mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an

infected person, it’s possible, but unlikely, for malaria to be passed
through blood transfusion, organ transplant, or the shared use of
hypodermic needles or syringes contaminated with blood. In rare
cases, people who are pregnant and who have malaria can transmit
it to her unborn infant before or during delivery called “congenital”
malaria.

However, Malaria is not a contagious disease. It is not spread from

person to person like a cold or the flu, and it cannot be sexually
transmitted. You cannot get malaria from casual contact with
malaria-infected people, such as sitting next to someone who has
malaria.
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4. Understand the signs and symptoms of malaria which are similar to flu
symptoms. These include:
 Fever and sweating
 Chills that shake your whole body
 Headache and muscle aches
 Fatigue
 Chest pain, breathing problems and cough
 Diarrhea, nausea and vomiting
 As malaria gets worse, it can cause anemia and jaundice
(yellowing of the skin and whites of the eyes)
 The most severe form of malaria, which may progress to a
coma, is known as cerebral malaria. This type represents
about 15% of deaths in children and nearly 20% of adult
deaths

The first symptoms – fever, headache and chills – usually appear 10–
15 days after the infective mosquito bite and may be mild and difficult
to recognize as malaria. Left untreated, P. Falciparum malaria can
progress to severe illness and death within a period of 24 hours.

Malaria symptoms can also appear within one month after the person
was infected. Depending on the type of parasite, symptoms can be
mild. Some people don’t feel sick for up to a year after the mosquito
bite. Parasites can sometimes live in the body for several years without
causing symptoms.

Some types of malaria, depending on the type of parasite, can occur

again. The parasites are inactive in your liver and then are released into
your bloodstream after years. The symptoms begin again when the
parasites begin circulating.

Have your blood examined if you have the signs and symptoms of
malaria.

5. In 2021, the World Health Organization (WHO) has recommended a

new vaccine, R21/Matrix-M, for the prevention of malaria in children.

Following the RTS, S/AS01 vaccine, the R21 vaccine is the second
malaria vaccine recommended by WHO. Both vaccines are shown to
be safe and effective in preventing malaria in children and, when
implemented broadly, are expected to have high public health impact.
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Malaria, a mosquito-borne disease, places a particularly high burden on

children in the African Region, where nearly half a million children die
from the disease each year.
During 1. The diagnosis of malaria will be done as follows:

a. Microscopy will continue to be the "gold standard" for diagnosing

malaria. All areas with a functional laboratory will at all times
employ this standard. Microscopy standards will be maintained by
a quality assurance system.
b. Diagnosis Through Rapid Diagnostic Test kits that have passed
quality control tests will be used in the following situations: (i) there
is no microscopy center; (ii) requires client more than 2-hours travel
to the nearest microscopy centers as in inaccessible coastal or island
areas; (iii) areas where there are outbreaks; and (iv) selected
hospitals without a trained microscopist in emergency situation.

2. Treatment of malaria shall follow the recommended therapeutic

regimen:

a. The Artemether-Lumefantrine (AL) combination will be the

first line medicine in the treatment of confirmed uncomplicated
and severe Plasmodium falciparum malaria, replacing CQ+SP
combination;
b. If AL is not available, whether the patient is conscious or
unconscious, and in case of treatment failure, Quinine (QN) in
combination with either Tetracycline or Doxycycline or
clindamycin (QN+ T/D/C x 7 days), will be the second-line
treatment;
c. In severe malaria cases wherein the patient is unconscious, and
the facility has no capacity to adequately manage the patient
(e.g. nasogastric tube or intravenous therapy), Artesunate (AS)
suppository can be introduced pending transfer of patient to the
next level of care;
d. Artemisinin-based combination therapy (ACT) can be used for
all Plasmodium species and mixed infections;
e. All anti-malarial drugs will be selected based on pre-
qualifications by WHO or Good Manufacturing Procedures
(GMP) certifications; and
f. Direct Observed Treatment (DOT) will be adopted as the mode
of treatment of all patients, with the first 3-day doses of AL
treatment supervised by a trained health worker, BHW or
treatment partner.
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g. Immediate referral of patients will be done as deemed necessary

with pre-referral treatment of appropriate anti-malarials
administered by trained health workers especially of cases with
severe malaria and in patients who are pregnant and children
below 5 years old.
h. Competent health care providers will carry out diagnosis and
treatment of malaria. Re-orientation and re-training will be
conducted especially in endemic areas.
i. Diagnosis and treatment of malaria will be supported with
adequate and quality drugs and other logistics required.

The DOH shall provide for the national requirements of anti-

malarial medicines while the provision of laboratory supplies
shall be a shared responsibility between the DOH-Centers for
Health Development (CHDs) and the LGUs. Anti-malarial
drugs will be made available to all public and private health
facilities. Remaining unexpired stocks of sulfadoxine-
pyrimethamine (SP) must be used before shifting to AL.

j. Malaria cases must be appropriately recorded and reported

using the Philippine Malaria Information System (PhiiMIS). In
areas where PhiiMIS has not been introduced or not yet
functional, the regular Field Health Service Information System
(FHSIS) will be used. PHILMIS and FHSIS will be
mainstreamed under the Philippine Integrated Disease
Surveillance and Response (PIDSR).

3. Know the side effects of medications to treat malaria.

Antimalarial drugs can cause side effects. Be sure to tell your provider
about other medicines you’re taking, since antimalarial drugs can
interfere with them. Depending on the medication, side effects may
include:
 Gastrointestinal (GI) issues such as nausea and diarrhea
 Headaches
 Increased sensitivity to sunlight
 Insomnia and disturbing dreams
 Psychological disorders and vision problems
 Ringing in the ears (tinnitus)
 Seizures
 Anemia
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4. Support the treatment for malaria through:

 Stay in an air-conditioned office for at least a few hours a day.
 Sleep in a ventilated, cool bedroom.
 Move away from a tropical climate, avoiding humid weather.
 Avoid excessive clothing and tight clothing.
 Avoid excessive soap and irritants.
After Artemether-lumefantrine (Coartem®) is the preferred follow-on treatment
but adequate alternatives are Atovaquone-proguanil (Malarone™), quinine
plus Doxycycline or Clindamycin, or Mefloquine.

If your symptoms do not improve or get worse, consult your doctor. Also,
seek medical attention if you have a fever, chills, muscle pain, or headache
soon after you finish your treatment. This could be a sign that you are still
infected with malaria.

Drink plenty of water to keep yourself hydrated. You can even include
coconut water, lemon water and fruits that contain a high amount of water
like cucumber, oranges. Water helps to flush out toxins from the body and
helps you recover faster.
First Aid Treat malaria as soon as possible. Medications can cure malaria.

It’s important to start treatment as soon as possible by prescribing

medications to kill the malaria parasite. Some parasites are resistant to
malaria drugs.

With early treatment, most people with malaria will make a full recovery.

Artemether–lumefantrine (AL) is a first-line agent for uncomplicated

malaria caused by Plasmodium Falciparum.

If AL is not available, whether the patient is conscious or unconscious, and

in case of treatment failure, Quinine in combination with either
Tetracycline or Doxycycline or Clindamycin will be the second line
treatment.

The main antimalarial drugs are:

 Artemisinin drugs (artemether and artesunate). The best
treatment for Plasmodium falciparum malaria, if available, is
artemisinin combination therapy
 Atovaquone (Mepron®)
 Chloroquine but there are parasites that are resistant to this
medication
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 Doxycycline (Doxy-100®, Monodox®, Oracea®)

 Mefloquine
 Quinine
 Primaquine

The treatment period usually lasts 2 days.

Treatment for individuals with the disease includes:

 medication to eliminate the parasite from the bloodstream

 supportive care
 hospitalization for those with severe symptoms
 intensive care, in some cases

However, the type of medication and length of treatment may vary,

depending on:

 the type of Plasmodium that caused malaria

 the severity of the symptoms
 where the person caught malaria
 if they took antimalarial drugs before
 if the person is pregnant

Additionally, people who develop complications may need a combination

of medications.

Some drugs are given in combination with other drugs. The type of parasite
will determine what type of medication you take and how long you take it.

In “High Risk Areas”, fever cases are given presumptive treatment with
1500 mg Chloroquine (over 3 days) and 45 mg Primaquine (adult single
dose). Therefore, radical treatment with Primaquine is not required if they
are found positive for Pf microscopically. Dose of Artesunate is 4 mg /kg
body weight for 3 days.

B. Human-induced
Human-induced hazards originate from technological or industrial accidents, dangerous procedures,
infrastructure failures, or certain human activities, which may cause the loss of life or injury, property
damage, social and economic disruption, or environmental degradation (e.g., industrial pollution,
nuclear activities, etc.).
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B.1 Technological
Technological hazards originate from technological or industrial conditions, dangerous procedures,
infrastructure failure or human activity. Chemical, biological, radiological and nuclear (CBRN)
hazards are all types of technological hazards.

Examples of technological hazards may include industrial pollution, nuclear radiation, toxic wastes,
dam failures, transportation accidents, factory explosions, fires, and chemical spills. Technological
hazards also may arise directly as a result of the impacts of a natural hazard or man-made incident
or event.

FIRE
Fire is FAST. In just two minutes, a fire can become life-threatening. In five minutes, a home can be
engulfed in flames.

Fire is DARK. Fire produces gases that make you disoriented and drowsy. Instead of being awakened
by a fire, you may fall into deeper sleep.

Fire is HOT. Heat and smoke from fire can be more dangerous than the flames. Inhaling the superhot
air can destroy your lungs.

Before 1. Understand the signs of the emergency.

a. The first sign you might have if there is a fire elsewhere in the building
is a fire alarm or detector going off.
b. An obvious sign of fire is smoke. If you have to pass through a smoky
room, then stay as close to the ground as possible.
c. Even if you cannot see a fire, you might smell it, and if you smell it before
you see it then you will stand a better chance of escaping.
d. Learn, understand and follow the Early Warning Systems (EMS) in the
community.

2. Prepare your home.

a. Talk to children regularly about the dangers of fire, matches, and lighters
and keep them out of reach, preferably in a locked cabinet.
b. Keep items that can catch on fire at least three feet away from anything
that gets hot, such as stoves.
c. Unplug appliances after every use. Do not leave lighted candles, gas
lamps, and mosquito coils unattended.
d. Inspect electrical cords and plugs regularly, use extension cords
temporarily and avoid overloading an electrical outlet. Speak to a
certified electrician to install additional electrical outlets.
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e. Never smoke in bed or when drowsy or medicated.

f. Do not throw cigarette butts on dried leaves, garbage, and other
flammable materials.
g. Do not leave the kitchen unattended when cooking. Turn off the stove if
you leave the kitchen for even a short period of time.
h. Install a fire extinguisher where it is easy to reach. Follow the
manufacturer's directions for taking care of your extinguisher and be sure
to check the pressure gauge once a month.

Learn and practice proper ways on how to use fire extinguishers.

P – Pull the pin
A – Aim at the base of the fire
S – Squeeze the nozzle / handle / lever
S – Sweep side to side

i. Ensure that all household members know ways to escape from every
room of your home.
j. Teach household members to STOP, DROP, and ROLL if their clothes
should catch on fire.
k. If a fire occurs in your home, GET OUT, STAY OUT, and CALL FOR
HELP. Never go back inside for anything or anyone.

3. Participate in preparedness activities.

a. Participate in the conduct of community drills and other information
sharing activities.
b. Participate in formulating emergency, rehabilitation, and relief
distribution plans in your community.
c. Practice community evacuation plans and map out your routes from
home and work.
d. Plan and designate a meeting place in case you and your family get
separated.

4. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you have an

Emergency Go Bag/E-balde in places you frequently visit or you might have to
stay for 24 hours.
a. This includes ready to eat food, tools, clothes, first aid kit, sleeping bags,
flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean water for
the whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes, packaged
biscuits, and other easy-to-eat food.
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c. Include a small amount of cash (ATMs will not work without power).
d. Make sure that everyone knows the location of the Emergency Go Bag/E-
balde.

During 1. If you are inside a burning house or building:

a. Do not panic and follow your escape plan.
b. Check if closed door handles are warm before opening using the back of
your hand. Never open doors that are warm to touch.
c. Leave the door closed if warm or smoke is coming out and find another
way out like a window.
d. If the door you intend to escape through is cold, open it slowly and make
sure that fire and/or smoke is not blocking your escape route. If clear,
leave immediately and close the door behind you.
e. Be prepared to crawl low under the smoke towards the exit route.

2. If you cannot get out:

a. Signal for help at the window using light-colored cloth or flashlight.
b. Cover cracks around the door with linens or tape and cover vents to keep
smoke out.

3. If your clothes catch a fire:

a. STOP immediately, do the Stop, Drop, and Roll. DROP to the ground,
cover your face with your hands and ROLL over back and forth until the
fire is extinguished.

4. When you are out of the burning building:

a. Stay out!
b. Do not go back inside for any reason.

After 1. Only return home once you are told it is safe to do so.
a. Pay close attention and instructions from authorities if you can safely get
back to your home.

2. Inspect your home for damage.

a. Carefully check your home’s walls, floors, doors, windows, and
staircases for damage.
b. If you see structural damage, like cracks in the foundation or missing
support beams, you may need to relocate to a shelter or another safe
location.
c. Check gas, electrical, and water lines for damage.
d. Do not use matches, lighters, appliances, or light switches until you are
sure there are no gas leaks. Sparks from electrical switches could ignite
gas, causing an explosion.
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3. Use caution when re-entering buildings or homes.

a. Check the outside of your home before you enter. Damage on the outside
can indicate a serious problem inside.
b. If the door is jammed, don’t force it open – it may be providing support
to the rest of your home.
c. Damaged objects, such as furniture or stairs, may be unstable. Be very
cautious when moving near them. Avoid holding, pushing or leaning
against damaged building parts.

4. If the power is out, use flashlights instead of candles.

a. If you must use candles, keep them away from anything that can catch
fire.
b. Always stay near lit candles.

5. Avoid areas impacted by the emergency.

a. Delay return home as you might hamper rescue and other emergency
operations and be at further risk from the residual effects of the fire.

6. Take care of any wounds or injuries to prevent infection.

a. Get first aid quickly to help heal small wounds and prevent infection.
b. If you can, help others in need. Make sure you are not hurt, then help
others.

7. Help injured or trapped persons.

a. Give first aid where appropriate.
b. Call for help.
c. Do not move seriously injured persons unless they are in immediate
danger of further injury.
d. Follow the minimum public health protocols when helping others, or
when staying in evacuation areas.

8. Stay connected and be informed.

a. Listen to receive emergency information and instructions from your
battery-operated TV or radio, social media, or cell phone text alerts.
b. Save phone calls for emergencies – text messages may be more reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how to seek
help.

9. Once you are safe, follow the emergency plan that you have prepared to
communicate and reconnect with family members.
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First Aid Burns

 Burns result from direct contact with large amounts of heat energy. The
scope of problems varies in severity among the various types of burns. In
order to give the correct first aid, it is important to recognize the type of burn.
 Burns can include: thermal burns, which are caused by contact with flames,
hot liquids, hot surfaces, and other sources of high heat; chemical burns; and
electrical burns.

For burns, immediate care can be life-saving. The level of first aid care depends on
the depth of burn.

1. First-Degree Burns affects only the top layer of the skin (superficial).
Sunburn is an example of first-degree burn. Signs include redness of
affected area, painful and can be swollen but has no blisters.

2. Second-degree burns reach up to the second layer of the skin, but do not
destroy the entire thickness (partial thickness). Signs include redness,
moist, and swollen affected area that has blisters and are very painful.

3. Third-degree burns extend through all layers of the skin (full thickness).
Signs include dry and leathery affected area that is white, dark brown or
charred in color, hard to touch and has numbness.

4. Fourth-degree burns (full thickness involving the bones, fat, tendons,

and/or muscles). The injury extends to all layers of the skin. Often there
is no pain and the burnt area is stiff. Healing typically does not occur on
its own.

First aid for First-Degree and Second-Degree Burns

 Quickly remove the victim from burn source.

 Remove clothing over burnt area except if stuck to the skin.
 Encourage victim to drink plenty of liquids.
 Do NOT break or prick blisters of second-degree burns.
 Do NOT apply ice directly to a burn.
 Apply cool, wet compresses, or immerse affected area in cool, fresh
water. Continue for 10 to 15 minutes or until pain subsides.
 Dry with clean cloth and cover the burn with a sterile, non-adhesive
bandage or clean cloth.
 Do not apply ointment or butter to burn; these may cause infection.
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 Over-the-counter pain medications may be used to help relieve pain and

reduce inflammation.
 Elevate burned arms or legs.
 First-degree burns usually heal without further treatment. However, if a
first-degree burn covers a large area of the body, or the victim is an infant
or elderly, seek emergency medical attention.
 Do not attempt to treat serious burns unless you are a trained health
professional.

First aid for Third-Degree and Fourth-Degree Burns

 If trained, assess airway, breathing and circulation accordingly.

 Cover burned area with clean, loose sterile dressing.
 Check nose and mouth for soot and ash.
 Do not apply ointments or butter to burns; these may cause infection.
 Take steps to prevent shock: lay the victim flat; elevate the feet about 12
inches.
 Have person sit up if face is burned.
 Elevate burned area higher than the victim’s head when possible. Keep
person warm and comfortable, and watch for signs of shock.
 Do not place a pillow under the victim’s head if the person is lying down
and there is an airway burn. This can close the airway.
 Immediate medical attention is required. Do not attempt to treat serious
burns unless you are a trained health professional.
 Bring victim to health care facility.

TRANSPORTATION ACCIDENTS (AIR, LAND, WATER)

A transport accident is any accident (or incident) that occurs during any type of transportation,
including accidents occurring during road transport, rail transport, marine transport and air transport.
It can refer to:

 a road traffic accident (including vehicle collision, pedestrian–bicycle collisions, pedestrian–

pedestrian collisions etc.）
 a marine accident (sailing ship accident, including man overboard)
 railroad accidents (including train wreck)
 an aviation accident and incident

This section focuses on road accident being the most common.

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Before The best way to prepare for a car accident is to be proactive. There are steps
you can take to be safe and prepared ahead of an accident occurring.

1. Ensure that you have all the necessary documentation in your car, such
as a valid driver’s license, car insurance, valid Department of
Transportation and Communications (DOTC) Test and registration.

Remember that safety should always be your top priority when driving,
and taking precautions can help avoid accidents altogether.
2. Ensure that your car is in good working condition, with all lights,
brakes, and tires functioning correctly.
3. Always wear your seatbelt and ensure that your passengers do the same.
4. Avoid distracted driving, such as texting or using your phone while
driving, which is both illegal and can increase the likelihood of an
accident.
5. Have a flashlight in the glove box. In an emergency, you can use it to
signal for help or even break a window to escape.
6. Keep a first aid kit in your vehicle. All road users should have basic
first aid supplies with them, even if it is just a couple of calico triangular
bandages.
7. Consider stocking your trunk with several small orange cones.

For cyclists who are particularly vulnerable road users and are more at risk
in the event of a road accident.

8. It is vital that all cyclists know what to do (and what not to do) if there
is an accident. If you are cycling with children or teenagers, reinforce
the importance of not overtaking trucks/lorries, buses and other large
vehicles on the inside lane. Explain about their blind spots.
9. The simplest way to protect yourself is to wear a helmet every time.
Even if it’s a quick cycle around the block or down to the park.

For drivers, it’s mind boggling the difference speed makes to a person’s
chances of survival if hit by a car; 20 mph means most individual will
survive, just more than 20 mph and nearly all will die, or at the least
experience serious life-changing injuries.

10. It is incredibly important to slow down in built-up areas or where you

seeing children playing. It only takes a moment to take a life.
11. Avoid the temptation to look at your phone when driving. If you get
into the habit of keeping it out of reach, it makes that easier.
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12. No matter how short your journey, remember to use the right child car
seat or booster seat for your child’s weight and height.
During 1. Ensure your own safety.
2. If you find yourself involved in an accident, the first thing to do is to
stay calm. Panic can lead to irrational decisions, which can cause
further harm.
3. Check for injuries on yourself and others involved in the accident. If
anyone is injured, call for emergency medical assistance immediately.
4. Move to a safe location, preferably to the side of the road or a path, and
away from the traffic flow.
5. If the car is still operational, turn on the hazard lights to warn other
drivers of the accident; or use a reflective triangle if you have one.
6. Note if there is any fuel spillage or potential fire risk – turn off car
ignitions if possible.
7. It is also important to exchange information with the other driver
involved in the accident, once you know they are okay; such as name,
phone number, license plate number, and insurance information.
8. Do not admit liability or apologize for the accident, as this may be used
against you in legal proceedings. Make sure to take pictures of the
accident.
9. Call the police to report the accident. If other people are around; get
them to phone the emergency services. Let the investigator take
command of the situation, and institute measures to prevent the accident
from getting worse.
10. If you are a medical responder,
a. Check the Quiet Ones First: People screaming, crying and
making a noise have to be breathing – your initial priority is
therefore to check anyone quiet and not moving.
b. Quickly check if quiet casualties are responsive: – if there is no
response check if they are breathing. If they are unresponsive
and breathing ensure they are in a position where they are
leaning forward or to one side in a position where the airway
will remain open.
c. Move them the minimum necessary and avoid twisting them.
d. Keep talking to the casualty calmly as they can hear you even if
they are unconscious.
e. Keep them warm.

Important checkpoints:
1. If the person is not breathing, there is a need to resuscitate. If you are
on your own, immediately call an ambulance and if trained, do
compressions now although this is not easy to do in a car.
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2. Only remove an unconscious person from a vehicle if there is an

immediate danger to their life from fire, flood, and explosion.
3. Ask the emergency services over the phone for their advice as to what
you should do. It is very difficult to remove an unconscious person from
a vehicle and there is a major danger that you could worsen their injuries
and injure yourself in the process.
4. Conscious casualties should be in the care of bystanders and removed
from the wreckage to a safe area.
5. Be aware of confused and dazed casualties who may wander into
danger.
6. Brief the bystanders to keep the casualties warm and calm and help
them to contact the next of kin.
7. Look for any major bleeding and life threatening injuries and treat these
first.
8. Note the nature of the wreckage and be aware of possible injuries as a
result: bodies are softer than metalwork, so if there is major damage to
the vehicle it is possible that there could be internal injuries to the
casualty – ensure the bystanders notify you if there is any change in the
casualty’s condition.
9. You should monitor anyone trapped in a vehicle carefully and notify
the emergency services immediately, this includes the exact time of the
accident. If there are additional people around, show them how to
support the person’s neck to avoid them twisting as there is the
possibility of a spinal injury.
10. Wear gloves and apply dressings if trying to control severe bleeding.

Be careful how and when to move the victims:

1. Only remove a motorcyclist’s helmet if they are unconscious and there
is no other way to assess their breathing or their airway is in danger.
There is usually a way of lifting the visor, it may be sensible to loosen
their chin strap.
2. If a casualty has been hit by a car and they are lying on their back
unconscious and breathing – they should be carefully rolled into the
recovery position to keep their spine in line. This should ideally include
the support of others to avoid twisting the spine.
3. If a casualty has been hit by a vehicle or thrown from one and they are
conscious in the road, they should try to keep still.
4. Ensure that someone is directing traffic and maintaining safety.
5. Support their head and neck, keep them warm and dry and wait for the
emergency services.
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After 1. After the accident, it is essential to seek medical attention, even if you
feel fine. Some injuries may not be immediately apparent, and delaying
treatment can lead to complications.

2. Notify your insurance company of the accident and provide them with
all the necessary information. Depending on your insurance, hopefully,
you will be able to get the assistance you need.

3. If the accident was severe, contact a personal injury lawyer who can
guide you on legal proceedings.
First Aid Six life-saving steps if you're first on the scene in an accident:

Step 1: Identify and mitigate potential dangers.

Step 2: Call for help.
Step 3: Check for a response.
Step 4: Check the casualty's airway.
Step 5: Check the casualty is breathing.
Step 6: Check the casualty's circulation.

For crash injury:

1. Administer basic first aid - Cover the area with a moist cloth or
bandage. Then, raise the area above the level of the heart, if possible. If
there is suspicion of a head, neck, or spinal injury, immobilize those
areas if possible and then limit movement to only the crushed area.
2. Call emergency services.

CHEMICAL EMERGENCIES
A chemical incident results from an unexpected release of a substance that is potentially hazardous
either to humans, other animals or the environment. Chemical releases arise from technological
incidents, impact of natural hazards, and from conflict and terrorism, or are related to chemical,
biological, radiological, nuclear and explosives (CBRNE) emergencies.

Chemical agents can cause death but are difficult to deliver in deadly amounts because they dissipate
quickly outdoors and are hard to produce.

Before 1. Understand the signs related to the emergency.

a. A chemical emergency occurs when hazardous chemicals are
released and has a potential for harming people’s health.
b. Chemical releases can be unintentional, as in the case of an
industrial accident, or intentional, as in the case of a terrorist
attack.
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c. Many hazardous chemicals are used in industry (for example,

chlorine, ammonia, and benzene). Others are found in nature
(for example, poisonous plants).
d. Some could be made from everyday items such as household
cleaners. These types of hazardous chemicals also could be
obtained and used to harm people, or they could be accidentally
released.
e. The presence of many dead insects or birds may indicate a
chemical agent release.
f. Learn, understand, and follow the Early Warning Systems
(EMS) in the community.

2. Prepare your home.

a. Store chemical products properly. Non-food products should be
stored tightly closed in their original containers so you can
always identify the contents of each container and how to
properly use the product. Better yet – do not store chemicals at
home.
b. Always read and follow the directions when using a new
product. Some products should not be used in small, confined
spaces to avoid inhaling dangerous vapors. Other products
should not be used without gloves and eye protection to help
prevent the chemical from touching your body.
c. Avoid mixing chemicals, even common household products.
Some combinations, such as ammonia and bleach, can create
toxic gases.
d. Do not use hair spray, cleaning solutions, paint products, or
pesticides while smoking or near an open flame such as a lighted
candle, fireplace, wood burning stove, etc. Although you may
not be able to see or smell them, vapor particles in the air could
catch fire or explode.
e. Dispose of unused chemicals properly. Improper disposal can
result in harm to yourself or members of your family,
accidentally contaminate our local water supply, or harm other
people or wildlife.

3. Be ready for a possibility of evacuation.

a. Identify the safest and quickest way to a safe place.
b. Plan and designate a meeting place in case you and your
family get separated.
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4. Participate in preparedness activities.

a. Participate in the conduct of community drills and other
information sharing activities.
b. Participate in formulating emergency, rehabilitation and relief
distribution plans in your community.
c. Practice community evacuation plans and map out your routes
from home and work.

5. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you

have an Emergency Go Bag/E-balde in places you frequently visit or
you might have to stay for 24 hours.
a. This includes ready to eat food, tools, clothes, first aid kit,
sleeping bags, flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean
water for the whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes,
packaged biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without
power).
a. Make sure that everyone knows the location of the Emergency
Go Bag/E-balde.
During 1. Follow instructions and orders from authorities.
a. If there is a chemical attack, authorities will tell you either to
evacuate the area immediately, or to seek a safe shelter.

2. If you become aware of a suspicious substance:

a. Try to quickly figure out which areas are affected or where the
chemical is coming from.
b. Cover your mouth and nose with layers of fabric that can filter
the air but still allow breathing.
c. Get away from the area quickly.

3. If you are inside your home or office building, you should:

a. If the chemical emergency is inside your building, get out of the
building without passing through the contaminated area.
b. If you cannot get out of the building without passing through the
affected area, move quickly and stay as far away as possible.
c. Seek shelter in an internal room with your emergency supplies.
Close doors and windows and turn off all ventilation, air
conditioners, vents, and fans. Seal the room with tape, plastic,
linens or sheets.
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d. Listen to the radio or television for instructions from authorities.

4. If you are caught in or near a contaminated area outdoors, you should:

a. Quickly decide what the fastest way to find clean air is.
b. Move away immediately in a direction upwind of the source.
c. Find the closest building for shelter.

5. If you came from outside and think you may have been exposed to a
chemical agent:
a. Take off your outer clothes, put them in a plastic bag, seal the
bag, and follow official instructions for disposal of
contaminated items.
b. Wash yourself with soap and water and put on clean clothes.
c. Contact authorities and seek medical assistance. You may be
advised to stay away from others or even to quarantine.
After 1. Only return home once you are told it is safe to do so.
a. Listen for further alerts and instructions about evacuation zones
and shelters.
b. Pay close attention to all official warnings and instructions on
how to proceed.
c. Wait for advice from authorities as to when you can safely get
back to your home.
d. Clean-up within buildings may entail the use of gas or liquid
decontaminants to kill the agent. Decisions regarding how
much clean-up is necessary will depend on:
 The amount of agents released.
 How far the agent has spread.
 How the space will be used following clean up.

2. Inspect your home for damage.

a. Carefully check your home’s walls, floors, doors, windows,
and staircases for damage.
b. If you see structural damage, like cracks in the foundation or
missing support beams, you may need to relocate to a shelter
or another safe location.
c. Check gas, electrical, and water lines for damage.
d. Do not use matches, lighters, appliances, or light switches until
you are sure there are no gas leaks. Sparks from electrical
switches could ignite gas, causing an explosion.

3. Use caution when re-entering buildings or homes.

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a. Inspect foundations for cracks or other damage that can render

a building uninhabitable.
b. Look for fire hazards such as broken or leaking gas lines,
electrical circuits, or damaged furnaces or electrical appliances.

4. If the power is out, use flashlights instead of candles.

a. If you must use candles, keep them away from anything that
can catch fire.
b. Always stay near lit candles.

5. Avoid areas impacted by the emergency.

a. Delay return home as you might hamper rescue and other
emergency operations and be at further risk from the residual
effects of the attack.
b. Avoid weakened bridges, overhanging structures, damaged
buildings, power lines, and trees.

6. Take care of any wounds or injuries to prevent infection.

a. Get first aid quickly to help heal small wounds and prevent
infection.
b. If you can, help others in need. Make sure you are not hurt,
then help others.

7. Help injured or trapped persons.

a. Give first aid where appropriate.
b. Call for help.
c. Do not move seriously injured persons unless they are in
immediate danger of further injury.
d. Follow the minimum public health protocols when helping
others, or when staying in evacuation areas.

8. Check food supplies.

a. Throw out any food that has come in contact and contaminated
with chemical agents.
b. Do not eat dead animals; the chemical agents could
contaminate their meat.
c. Make sure that the food you eat is prepared with clean water.

9. Stay connected and be informed.

a. Listen to receive emergency information and instructions from
your battery-operated TV or radio, social media, or cell phone
text alerts.
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b. Save phone calls for emergencies – text messages may be more

reliable.
c. Connect with family, friends, and others in your community.
d. Take care of yourself and each other and know when and how
to seek help.

10. Once you are safe, follow the emergency plan that you have prepared
to communicate and reconnect with family members. Take your
disaster supplies kit with you.
First Aid Signs of a chemical release include difficulty breathing, eye irritation, and
loss of coordination, nausea or burning in the nose, throat, and lungs.

How to decontaminate:

1. Remove all clothing and other items in contact with your body.
2. Cut off clothing normally removed over the head to avoid contact
with the eyes, nose and mouth.
3. Put contaminated clothing into a plastic bag and seal.
4. For other items like jewelry and eyewear, put in a pan,
decontaminate using household bleach, rinse, and let dry.
5. Wash hands with soap and water.
6. Flush eyes with water.
7. Gently wash face and hair with soap and water before thoroughly
rinsing with water.
8. Proceed to a medical facility for screening and professional
treatment.

OIL SPILL
Oil Spill is the release of a liquid petroleum hydrocarbon into the environment, especially the marine
ecosystem, due to human activity, and is a form of pollution. The term is usually given to marine oil
spills, where oil is released into the ocean or coastal waters by accidental leak from oil tankers, but
spills may also occur on land.

Large oil spills are major, dangerous disasters. These tend to happen when pipelines break, big oil
tanker ships sink, or drilling operations go wrong. Consequences to ecosystems and economies can
be felt for decades following a large oil spill.

Pathways of exposure can be through skin contact, ingestion, or inhalation. Oil contaminants can
also adhere to the fur of pets, and the contamination can be transferred to people. Oil contains volatile
compounds that may have negative impacts on health.
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Health Effects can include the following:

 prolonged dermal contact with crude oil and petroleum products can cause skin erythema
(reddening), edema, and burning.
 repeated exposure to the waters contaminated with oil may result in;

o dermatitis,
o irritation/corrosion to the eyes, gingiva and mucous membranes
 skin effects can be exacerbated by subsequent exposure to ultraviolet light from sunlight
 extreme cases may result to inflammation of the upper respiratory tract and chemical
pneumonitis
 nasal irritation and feelings of nausea may be experienced.
 acute inhalational poisoning may result to:

o euphoria
o giddiness
o vertigo or headache
o vasomotor disturbance
o cyanosis and arrhythmia
o chest pain

 risks are greatest to workers heavily exposed to oil during some cleanup activities, but the
risks to these workers is considered to be low.

Before 1. Understand the signs or the emergency.

a. Listen to latest news and be informed of updates especially if you are
living near the coastal area.
b. Report any unusual observation in coastal areas to the authorities.
c. Do not stand or come in contact with unknown liquids or substances.
d. Regardless of how they are released, all petroleum products – gasoline,
diesel fuel and motor oil –
i. Are toxic to people, plants and wildlife;
ii. Endanger public health, imperil drinking water, devastate natural
resources, and disrupt the economy; and
iii. Containing deadly metals, fuel and oil lower water’s oxygen
levels, block life-giving sunlight and generally degrade water
quality.

2. For Boaters:
a. Don not overfill fuel tanks – fill to only 90 percent capacity to reduce the
chance of spills.
b. Use oil absorbent pads in the bilges of all boats with inboard engines.
c. Regularly inspect through-hull fittings often to reduce the risk of sinking.
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d. Recycle used oil and filters.

3. For Marinas:
a. Routinely inspect storage tanks as required by law.
b. Use automatic nozzle shutoffs to reduce the potential for overfilling fuel
tanks.
c. Set up an oil-recycling program to deliver used oil to a designated
collection site.
d. Keep spill control equipment readily available.
e. Properly dispose of used oil and fuel-absorbent materials.
1. Stay away from the area when you see or smell oil on the beach.
2. Stay indoors in an air-conditioned area and avoid strenuous outdoor activity.
During 3. Do not swim in areas affected by the oil spill.
4. Avoid contact with sediment, sand, soil, or outdoor/indoor surfaces with visible
oil contamination.
5. Do not use oil-contaminated water for human or animal consumption.
6. Do not fish in oil spill-affected waters.
7. Do not eat fish, shellfish, and other seafood from the area with oily residue, or
fish that has petroleum odor.
8. Prevent pets from entering oil-contaminated areas.
9. Wash skin, which has come in contact with oil-contaminated water, with soap
and water.
10. If you get oil or tar balls on your skin,
a. Wash immediately with alkaline or mild soap and water.
b. Take precautions to avoid accidental ingestion (wash hands before
eating).
12. If you get oil on clothing, wash it the usual way, but avoid using harsh detergents,
solvents or other chemicals.
13. Bathing, swimming, laundering and wading in the oil-contaminated water
should be prohibited.
14. Warning signs should be posted in the immediate areas informing the general
public of the oil spill incident.
15. Do not fish in areas with visible sheens (brightness) or slicks (films of oil floating
on top of bodies of water).
16. Extreme cases may result in inflammation of the upper respiratory tract and
chemical pneumonitis. Consult your doctor or proceed to the nearest health
facility, if symptoms do not improve.
17. Do not engage in providing assistance unless you are trained and if not equipped
with proper PPE.
18. Avoid bare skin contact with sediment, soil, and indoor surfaces with visible oil
contamination.
19. Take reasonable precautions to avoid accidental ingestion (wash hands before
eating).
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20. Don't burn debris (for example, soiled waste or driftwood) contaminated with
oil.
21. Do not fish in areas with visible oil sheens or slicks. Fish and shell fish
caught/harvested within the water body and other nearby tributaries affected by
the oil spill should not be sold nor consumed for safety and health reasons.
22. The most prudent action is not to consume dead fish, fish with oily residue or a
petroleum odor and fish harvested directly from the oil spill-affected waters.
23. Oil in the river system may still be flammable, thus, extreme caution should be
observed to ensure that other oxidizing and reducing materials are not mixed into
the water bodies since it may ignite and emit highly toxic fumes and heat.

For Responders and Clean-up Workers:

1. Wear protective gear, like gowns, gloves, boots, and goggles.
2. Dispose of used gloves properly.
3. Wash oiled clothing and goggles after each clean-up operation.
After 1. THE PRIMARY tools used to respond to oil spills are mechanical containment,
recovery, and cleanup equipment.

a. Such equipment includes a variety of booms, barriers, and skimmers, as

well as natural and synthetic sorbent materials.
 A key to effectively combating spilled oil is careful selection and
proper use of the equipment and materials most suited to the type
of oil and the conditions at the spill site.
 Most spill response equipment and materials are greatly affected
by such factors as conditions at sea, water currents, and wind.
b. Damage to spill contaminated shorelines and dangers to other
threatened areas can be reduced by timely and proper use of
containment and recovery equipment.

2. Do not fish in areas with visible sheens or slicks bodies of water unless you are
told by the authorities that it is safe to do so.

3. Do not swim near or in areas affected with the oil spill until clearance from the
authority has been released.
First Aid Control of preventable temporary impact:

a. Population to avoid going on site since slips, trips, and falls on oiled surfaces
are common.

b. Wear masks since breathing in oil mist can cause headaches, nausea, and
respiratory problems.
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c. Wear personal protective equipment because getting oil on the body surface
can lead to skin and eye irritations.
d. Evacuate children and individuals with health problems, such as respiratory
conditions like asthma, who are particularly susceptible to oil effects. In
addition, evacuate residents near the spill since they may likely suffer from
anxiety, posttraumatic stress disorder, and depression.

Prevention of the long-term effects which are grouped into respiratory damage, liver
damage, decreased immunity, increased cancer risk, reproductive damage, and
higher levels of some toxics (hydrocarbons and heavy metals) are to be considered.

RADIATION AND NUCLEAR EMERGENCIES

Radiation emergencies can be accidental or deliberate, when caused by terrorists. They refer to non-
routine situations where there is a release of radiation or risk of exposure. Regardless to whether the
accident is an isolated event or a large-scale catastrophe, such as Chernobyl, radiation emergencies
can greatly impact life, property and the environment.

Radiation emergencies include:

 nuclear emergencies, such as the explosion of a nuclear weapon

 dirty bombs
 radiological exposure devices
 nuclear power plant accidents
 transportation accidents involving radiation
 occupational accidents, such as over-exposure to radiation in health-care facilities.

Persons who have been exposed to or contaminated by radioactive materials may be at risk of long-
term health effects, since deaths and injuries are not expected at low levels. The health effects in
exposed/contaminated persons are not contagious. The protection principle is to lower the
exposure/contamination levels so as to lower the risks, since radiation exposure, no matter how small,
carries risks of harmful effects.

Hazards related to nuclear explosions may include:

- Bright FLASH can cause temporary blindness for less than a minute.
- BLAST WAVE can cause death, injury, and damage to structures several miles out from the
blast.
- RADIATION can damage cells of the body. Large exposures can cause radiation sickness.
- FIRE AND HEAT can cause death, burn injuries, and damage to structures several miles out.
- ELECTROMAGNETIC PULSE (EMP) can damage electrical power equipment and
electronics several miles out from the detonation and cause temporary disruptions further out.
- FALLOUT is radioactive, visible dirt and debris raining down from several miles up that can
cause sickness to those who are outside.
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A nuclear emergency involves the explosion of a nuclear weapon or improvised nuclear

device (IND). The explosion produces an intense pulse of heat, light, air pressure, and radiation.
Nuclear explosions produce fallout (radioactive materials that can be carried long distances by the
wind).

1. Understand the signs related to the emergency.

Before a. A nuclear explosion may occur with or without a few minutes warning.
b. Fallout is most dangerous in the first few hours after the detonation when
it is giving off the highest levels of radiation.
c. It takes time for fallout to arrive back to ground level, often more than
15 minutes for areas outside of the immediate blast damage zones.
d. A dose is determined from a one-time time radiation exposure or
accumulated exposure over time. The higher the dose, the longer the
exposure, the higher the risk.

2. Prepare your home or shelter.

a. A fallout shelter is an enclosed space specially designated to protect
occupants from radioactive debris or fallout resulting from a nuclear
explosion.
b. The safest place in your home during a radiation emergency is a room
located at the center of your house or basement. This area should have as
few windows as possible. The further your shelter is from windows, the
safer you will be.

3. Participate in preparedness activities

a. Learn, understand and follow the Early Warning Systems (EMS) in the
community.
b. Participate in the conduct of community drills and other information
sharing activities.
c. Participate in formulating emergency, rehabilitation, and relief
distribution plans in your community.
d. Practice community evacuation plans and map out your routes from
home and work.

4. Prepare an Emergency Go Bag/E-balde ahead of time. Make sure you have an

Emergency Go Bag/E-balde in places you frequently visit or you might have to
stay for 24 hours.
a. This includes ready to eat food, tools, clothes, first aid kit, sleeping bags,
flashlight, batteries, toiletries, etc.
b. Store food supply and water with a long shelf life.
 Ensure that you have an adequate supply of food and clean water for
the whole family that would last for at least 3 days.
 Include easy-open canned goods, dried fruits or trail mixes, packaged
biscuits, and other easy-to-eat food.
c. Include a small amount of cash (ATMs will not work without power)
d. Make sure that everyone knows the location of the Emergency Go Bag/E-
balde.
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5. Identify the best shelter location near you to spend a lot of time, such as home,
work, and school. The best locations are underground and in the middle of larger
buildings.

6. Avoid living near conflict areas or location near nuclear power plants.

7. Make plans to stay with friends or family in case of evacuation. Plan and
designate a meeting place in case you and your family get separated.

8. Be inside before the fallout arrives. The highest outdoor radiation levels from
fallout occur immediately after the fallout arrives and then decrease with time.
During 1. Stay tuned:
a. Tune into any media available for official information such as when it is
safe to exit and where you should go.
b. Battery operated and hand crank radios will function after a nuclear
detonation.
c. Cell phone, text messaging, television, and internet services may be
disrupted or unavailable.
d. Ignore malicious information being spread through text messages.
e. Follow the government’s public advisories

2. If advised to evacuate, listen for information about routes, shelters, and

procedures. If you have evacuated, do not return until you are told it is safe to do
so by local officials.

3. If you are indoors,

a. Family members should stay where they are inside for 24 hours unless local
authorities provide other instructions. Close and lock all windows and doors.
b. Go to the basement or the middle of the building. Stay away from the outer
walls and roof. Radioactive material settles on the outside of buildings; so
the best thing to do is stay as far away from the walls and roof of the building
as you can.
c. Reunite later to avoid exposure to dangerous radiation. Keep your pets
inside.
d. If possible, turn off fans, air conditioners, and forced-air heating units that
bring air in from the outside.
e. Take a shower or wash with soap and water to remove fallout from any skin
or hair that was not covered. Do not use disinfectant wipes on your skin.
Hand sanitizer does not protect against fall out.
f. Remove contaminated clothing and wipe off or wash unprotected skin if you
were outside after the fallout arrived.
g. Avoid touching your eyes, nose, and mouth, if possible.
h. Continue to practice social distancing by wearing a mask and by keeping a
distance of at least six feet between. Children under two years old, people
who have trouble breathing, and those who are unable to remove masks on
their own should not wear them.
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4. If you are outdoors,

a. If warned of an imminent attack, immediately get inside the nearest building
and move away from windows to avoid radiation. Brick or concrete are best.
These will help provide protection from the blast, heat, and radiation of the
detonation.
b. If you are outdoors when a detonation occurs take cover from the blast
behind anything that might offer protection.
c. Lie face down to protect exposed skin from the heat and flying debris.
d. Avoid touching your eyes, nose, and mouth, if possible.
e. After the shock wave passes, get inside the nearest, best shelter location for
protection from potential fallout. You will have 10 minutes or more to find
an adequate shelter.
f. Do other steps similar to when you are already indoor.

5. If you are in a car, bus, or other vehicle,

a. If you are in a vehicle, stop safely, and duck down within the vehicle.
b. Get inside a building right away. Cars do not provide good protection from
radioactive material.
c. Do other steps similar to when you are already indoor.

6. If you cannot get inside immediately,

a. Cover your mouth and nose with a mask, cloth, or towel. These can help
reduce the amount of radioactive material.
After 1. Stay connected and be informed.
a. Only return home once you are told it is safe to do so.
b. Listen to receive emergency information and instructions from your
battery-operated TV or radio, social media, or cell phone text alerts.
c. Save phone calls for emergencies – text messages may be more reliable.
d. Connect with family, friends, and others in your community. Take care
of yourself and each other and know when and how to seek help.
e. Engage virtually with your community through video and phone calls.
Know that it is normal to feel anxious or stressed. Take care of your body
and talk to someone if you are feeling upset.
f. If you are sick or injured and need medical attention, contact your
healthcare provider or listen for instructions on how and where to get
medical attention when authorities tell you it is safe to exit.

2. Avoid areas impacted by the emergency.

a. Radiation will stay on the areas for an indefinite years, therefore avoiding
the place as far as possible is the safest way until levels of radiation
normalize.

3. Take care of any wounds or injuries to prevent infection.

a. Get first aid quickly to help heal small wounds and prevent infection.

4. Help injured or trapped persons.

a. Follow the minimum public health standards when helping others or
when staying in evacuation areas.
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b. As much as possible, provide emergency assistance to injured persons

only if there is an available set of PPE - gloves and facemasks.
c. If you can, help others in need. Make sure you are not hurt, then help
others.
 Give first aid where appropriate.
 Call for help.
 Do not move seriously injured persons unless they are in immediate
danger of further injury.

5. Check food supplies.

a. It is safe to eat or drink packaged food items or items that were inside a
building
b. Do not consume food or liquids that were outdoors uncovered, they may
be contaminated by fallout.
c. Make sure that the food you eat is prepared with clean water.

6. Caring for pets

a. Clean any pets that were outside after the fallout arrived. Gently brush
your pet’s coat to remove any fallout particles and wash your pet with
soap and water, if available.
First Aid Management of signs and symptoms related to exposure to radiation

 If you have skin burns, nausea, or begin vomiting shortly after radiation
exposure, seek medical attention as soon as it is safe to leave your building
or place of shelter.
o These may be symptoms of acute radiation syndrome (ARS),
which is caused by exposure to large amounts of radiation over a
short period of time.
o Symptoms can appear within minutes to several days after you
were exposed to large amounts of radiation.

 If you were exposed to a small amount of radiation, you will not see any
health effects right away, and may not have any long-term health effects.
Radiation health experts will monitor people affected by radiation
emergencies for any medical issues.

 Treat non-radiation related cuts, bruises or injuries with basic first aid. Keep
cuts and abrasions covered when washing to keep radioactive material out
of the wound.

B. 2 SOCIETAL
Anthropogenic hazards can be grouped into societal hazards (criminality, civil disorder, terrorism,
war, industrial hazards, engineering hazards, power outage, fire), hazards caused by transportation
and environmental hazards.
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Social hazards, also called complex emergencies, seriously limit a population's access to health
services, water, food, and transportation, all of which are determinants of health. They also often lead
to a lack of safety and tend to come hand in hand with natural disasters such as floods.

CONFLICT

Conflict disrupts disaster risk governance and the implementation of disaster risk reduction
strategies, curtails funding and ultimately reduces people's capacities to cope with, prevent and
reduce the impacts of natural hazards.

Some examples are wars, proxy wars, civil wars, armed insurgencies, genocides, gang wars, riots,
terrorist attacks, demonstrations, riots, strikes, public nuisances, and criminal activities. Civil
disturbance incidences may include resistance or rejection of all different types of control and
authority.

According to International Committee of the Red Cross (ICRC), the Complex Emergencies are
typically characterized by:

 Extensive Violence
 Displacements of Populations
 Loss of Life
 Widespread Damage to both Societies and Economies
 Need for Large-scale, Humanitarian Assistance across Multiple Agencies
 Political and Military Constraints which impact or prevent Humanitarian Assistance
 Increased Security Risks for Humanitarian Relief Workers

“An armed conflict exists whenever there is a resort to armed force between States or protracted
armed violence between governmental authorities and organized armed groups or between such
groups within a state.” Armed conflicts have marked human existence throughout history and have
always caused peaks in mortality and morbidity. Numerous armed conflicts are currently taking place
around the world, including those involving warring parties within a single state (non-international
armed conflicts) and those involving armed forces from two or more states (international armed
conflicts).

Conflicts are much less predictable than disasters, often with no one single surge of trauma cases but
rather peaks and troughs depending on conflict activity. Additional security constraints, including
the targeting of health staff, mean that conflict and protracted conflict and their associated
displacement of populations make it an extremely complex setting for early rehabilitation provision.
Injury mechanisms and the complexity of injuries often require long-term specialist interventions
difficult to provide within conflict settings, so for many individuals, rehabilitation may only begin
once the patient is removed from an area of active fighting, with patients being stabilized and then
transferred to safer areas for definitive care, including rehabilitation.

Before 1. Conflict prevention is about making societies' resilient to violent

conflict by strengthening the local capacities for peace (systems,
resources, structures, attitudes, skills).
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2. A good preparedness program allows you to respond “automatically”:

a. limiting the effects of your emotional shock;
b. contributing to your protection in armed conflicts and other
situations of violence, regardless of fear and the hazardous
environment, by preventing you from being injured or sick;
c. enhancing your skills and strengthening your flexibility, despite the
highly specific nature of the situations, casualties and tasks.

3. These principles are useful suggestions and pointers that will help you
prepare for a productive, constructive collaborative problem solving
experience.
 Listen Actively.
 Think Before Reacting.
 Attack the Problem - NOT each other!
 Accept Responsibility.
 Use Direct Communication.
 Look for Common Interests.
 Focus on the Future.

4. In addition to preparations before a conflict situation, families are

informed of how to quickly recognize the signs of an attack, where to
take cover, and how to protect their bodies from the impact of a blast.

5. To prepare for conflict situations before they occur, communities are

taught how to create and identify a safe room to hide in case of attack
(on a lower level, away from windows, away from external walls, etc.),
and how to prepare “hibernation kits” with sufficient food, clean water,
medicine and hygiene supplies. They are also taught about the
importance of preparing an Emergency Go Bag/E-balde with essential
items such as cash, first aid supplies, original legal documents, water,
food, a flashlight and a charged phone, in case of an emergency
evacuation.

6. It is an added value to help secure people with disabilities who might

be in a household during a conflict.
During 1. If people are in a building when an attack occurs, they should move
away from windows, doors and anything pinned to the walls. They can
take immediate cover under a sturdy piece of furniture and lie face-
down, flat on the ground, covering their eyes and ears, keeping their
mouth open to prevent internal damage from blast pressure.

2. Acquaint yourself with what's happening and be open about the

problem. Let individuals express their feelings. Some feelings of anger
and/or hurt usually accompany conflict situations. Before any kind of
problem-solving can take place, these emotions should be expressed
and acknowledged.
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a. Conflict can be managed

b. Try to stay calm.
c. Try to put emotions aside.
d. Don't interrupt the other person while they are speaking.
e. Actively listen to what they are saying and what they mean.
f. Check that you understand them by asking questions.
g. Communicate your side of the story clearly and honestly.

3. Take Care of Yourself and Your Loved Ones. Try to eat healthy, avoid
using alcohol and drugs, and get some exercise when you can—even a
walk around the block and deep breathing can make a difference to
relieve stress.

4. Health care providers to ensure the provision of essential health service

package to manage the health effects of conflict which include trauma;
mental health; non-communicable diseases (NCDs); child health;
sexual, reproductive and maternal health; and infectious diseases.
After 1. Support the livelihoods.
2. Sustain support for essential health service packages particularly on the
provision of psychosocial interventions.
3. Training and employment of internally displaced persons, with a view
to promoting their socio-economic and labor market integration.
First Aid On Mass Casualty Management, always:
 behave safely and be equipped with the required protective
equipment;
 set priorities for actions to be taken.

1. Assess by means of an initial examination (the Airway, Breathing,

Circulation, Disability, Exposure (ABCDE) sequence: think life-
threatening conditions.
2. Act to achieve emergency resuscitation (immediate care): perform
immediate life-saving measures.
3. Assess by means of a complete examination (from head to toe): think
wounds, bone or joint traumas, burns, and harm caused by the elements
(extreme temperatures, sun, rain, wind, etc.).
4. Act to stabilize the casualty (supplementary care): perform dressings,
immobilizations, etc.
5. Assess and act to evacuate the casualty: determine the
casualty’s condition and prepare him for evacuation.
6. Help the casualty rest in the most comfortable position, rehydrate and
provide psychological support; and
7. Monitor the casualty regularly until he receives advanced or specialized
care, or until assistance is no longer needed.

At the same time:

 prevent cross-infection between yourself and the casualty;
 provide psychological support;
 protect the casualty against the elements;
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 rehydrate the casualty;

 monitor the casualty’s condition and the effectiveness of measures
taken.

You will be able to handle properly the ordinary everyday settings and
health problems as well as new ones relating specifically to the situation only
if care is provided in an organized way and resources managed correctly, in
response to needs and according to the context.

MASS GATHERING
World Health Organization (WHO) defines mass gatherings as “events attended by a sufficient
number of people to strain the planning and response resources of a community, state or nation”.
Mass gatherings can include concerts, sporting events, religious ceremonies and demonstrations are
part of a vibrant public life, but they also carry health risks.

Mass gatherings have becoming increasingly international in attendance, natural, accidental and
deliberate risks to health security, including but not limited to those posed by communicable diseases,
that these must be addressed during the planning of public health measures. These have also a
potential to place a severe strain on the local health care system and can increase the risk of disaster
because of the high crowd density, restricted points of access, limited crowd control and lack of
sufficient on-site medical care and emergency response.

Participants can suffer from stress-related illnesses or sustained exposure to extreme temperatures,
and even be injured or die as a result of uncontrolled crowd behaviors.

Before 1. Keep informed and updated.

a. Check for latest updates regarding the event.
b. Listen to latest news and updates including weather condition to be
informed of any potential risk to your health and what you can do to
stay safe and healthy during the event.
c. Determine if you really need to attend the event.

2. Take notice of the surroundings.

a. Identify potential emergency exit routes. Be informed of the
emergency evacuation before and during the event.
b. Listen to the public address system for the instructions of the
event organizers. Follow the instructions of organizers and
security staff assigned in crowd control.
c. Know the site access, not only for participants but also for on-site
emergency medical services.
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d. Be aware of unusual behaviors, unattended objects, and

unexplained odors.
e. Report any suspicious items or activities to law enforcement
and/or onsite security personnel.
f. Do not attempt to enter the venue once the mass gathering
capacity is reached.

3. Create a travel size emergency kit.

a. First-aid supplies, including a first aid reference card, bandages,
antiseptic, aloe, and a thermometer.
b. For foreign travelers, important papers, including hardcopies of
passports and medical insurance cards.
c. For those with co-morbidities and special medications, personal
needs, including prescriptions and over-the-counter medicines for
diarrhea, allergies, asthma, and motion sickness.
d. Items specific to your destination with consideration on the time
of year and your planned activities, including water purification
tablets, sunscreen, and insect repellent.

4. Prepare other basic necessities.

a. Bring food and water both sealed for safety.
b. Bring a hat, umbrella, or poncho for protection in case of extreme
hot and rainy event to avoid heat and cold related illnesses.

5. Establish locations to meet if separated from your group.

During 1. If an attack occurs,
a. Run to the nearest exit, making use of available concealment
while moving away from the source of hazard.
b. Cover your nose and mouth if you notice unusual odors and eye
for irritation.
c. If necessary, be prepared to defend yourself by attempting to
incapacitate the assailant with any means available.

2. If no secure areas are available,

a. Protect yourself from harm by seeking cover behind any available
natural or artificial objects that eliminate direct line of sight from
the source of hazard.

3. If you are unable to safely evacuate,

a. Hide in a secured area where access can be blocked or entryways
can be locked.
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b. If necessary, be prepared to defend yourself by attempting to

incapacitate the assailant with any means available.
After 1. Remain alert for potential secondary attacks.

2. Take care of any wounds or injuries to prevent infection.

a. Maintain situational awareness while providing assistance to
others.
b. Get first aid quickly to help heal small wounds and prevent
infection.
c. If you can, help injured or trapped persons and others in need.
Make sure you are not hurt, then help others.
 Give first aid where appropriate.
 Call for help.
 Do not move seriously injured persons unless they are in
immediate danger of further injury.
 Follow the minimum public health protocols when helping
others, or when staying in evacuation areas. Practice cough
etiquette and observe good hygiene.
d. When help arrives, follow instructions given by law
enforcement and first responders.

3. Perform post event evaluation

a. Evaluate lessons learned and experiences gained from the event in
attending future planned events.
First Aid WHO’s work to address deliberate risks to health security and public health
concerns include:

 Ensuring that correct standards are applied to risk assessment,

surveillance and response, including outbreak management,
infection control and vaccination;
 Supporting planning for the management of mass casualties and
emergencies in local communities, at event venues;
 Ensuring that adequate diagnostic capacities, including human
resources, and transport procedures are in place;
 Ensuring that procedures are in place to provide updated health
advice and guidance for visitors on topics such as vaccinations,
food and water safety, and emergency contact numbers; and
 Carrying out activities before and during mass gatherings to
encourage healthy behaviors, such as increased physical activity,
cessation of tobacco use, avoidance of excess alcohol and safe sex
practices.

Management of common health issues:

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a. Stress-related illnesses
Expand your stress management toolkit by mastering these four strategies for
coping with stress: avoid, alter, accept and adapt.

b. Prolonged exposure to extreme temperatures

b.1. Heat exhaustion and heatstroke treatment

 Get out of the heat quickly and into a cool place, or at least shade.
 Lie down and elevate your legs to get blood flowing to your heart.
 Take off any tight or extra clothing.
 Apply cool towels to your skin or take a cool bath.
 Drink fluids, such as water or a sports drink.

b.2. Hypothermia
 Cover the person completely with foil or a space blanket, or use
your own body heat to help warm him/her.
 Use warm compresses on the neck, chest, and groin.
 Remove the person wet clothing.
 Give warm, sweet fluids. (Any fluids given should be
nonalcoholic, as alcohol interferes with the blood's circulation.)
 Remove their wet clothing.
 If victim has no pulse, begin cardiopulmonary resuscitation
(CPR).

c. Injuries – minor wounds the most common followed by lacerations

Wounds including minor cuts, lacerations, bites and abrasions can be

treated with first aid.

 Control bleeding.
Use a clean towel to apply light pressure to the area until bleeding
stops (this may take a few minutes). Be aware that some
medicines (e.g. Aspirin and warfarin) will affect bleeding, and
may need pressure to be applied for a longer period of time.

 Wash your hands well.

Prior to cleaning or dressing the wound, ensure your hands are
washed to prevent contamination and infection of the wound.

 Rinse the wound.

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Gently rinse the wound with clean, lukewarm water to cleanse

and remove any fragments of dirt, e.g. gravel, as this will reduce
the risk of infection.

 Dry the wound.

Gently pat dry the surrounding skin with a clean pad or towel.

 Replace any skin flaps if possible.

If there is a skin flap and it is still attached, gently reposition the
skin flap back over the wound as much as possible using a moist
cotton bud or pad.

 Cover the wound.

Use a non-stick or gentle dressing and lightly bandage in place;
try to avoid using tape on fragile skin to prevent further trauma
on dressing removal.

 Seek help.
Contact your General Practitioner (GP), nurse or pharmacist as
soon as possible for further treatment and advice to ensure the
wound heals quickly.

 Manage pain.
Wounds can be painful, so consider pain relief while the wound
heals. Talk to your GP about options for pain relief.
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REFERENCES

 An Introduction to Risk Communication, Gaya Gamhewage, 2014

 Biological Attack Human Pathogens, Biotoxins, And Agricultural Threats, e National Academies
and the U.S. Department of Homeland Security, 2004
 Communication Risks and Benefits: An evidence-based Users’ Guide; Published by the Food and
Drug Administration (FDA), US Department of Health and Human Services, August 2011.
 Key Health Messages for Emergencies and Disasters Philippines, Second Edition, 2013
 Philippine Health Advisories, 2012
 Public Health for Mass Gatherings: Key Considerations, World Health Organization, 2015
 Risk Communication and Behavior: Best Practices and Research Findings, National Oceanic and
Atmospheric Administration Social Science Committee, United States Department of Commerce,
April 2016
 National Center for Biotechnology Information’s National Library of Medicine

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