First National Course on Public Health Emergency Management 12 – 23 March Muscat, Oman BCRN Management Perspectives Nasser H. Al-Azri BSc, MD, MRCS(A&E), MACEP PDO

Introduction Disaster Management: an overview BCRN: Definition and Historical Overview BCRN: the unique disasters BCRN Disasters: management perspectives BCRN Disasters – Pre-Event – Event Pre-Hospital Hospital – Post-Event Discussion

Disasters Man-MadeNatural Earthquakes Cyclones TransportationCBRN Fire Wars Fires

HospitalPre-HospitalPre-Event PLAN System Testing Resources & Capabilities Calling List Staffing Communication Post-Event Testing Command & Roles Supporting Agencies TriageTreatTransport Staff Care Hospital Care Surge Patient Tracking Families Hospital Disaster Notification

Planitis Syndrome Symptoms: itchy need to have a plan placed over your desktop or on the shelf of the department Signs: neat clean document seen only by HoD and heard of by staff Investigations: on testing staff knowledge, none, or very few, aware of the involved procedures!

Planitis Syndrome Treatment: Advanced Plan Life Support! Prognosis: Very good if treated early

Strategic Plan Prevention Preparedness Response Recovery

Paralysis Deafness Multi-Organisation Failure Acute Incident Failure Coordination Capacity Communication Success

Disaster Management: All Hazards Approach 80% Generic (to all disasters) 15% Specific (to the hazard) 5% Unique (to the event)

BCRN - Definition Biological Agents Chemical Agents Radiological Nuclear

Bioterrorism Industrial settings Healthcare facilities

BCRN Threat Assessment Threat Assessment: Threat Intent x Capability x Vulnerability

BCRN – Brotherhood? (relatively) New threats Unconventional weapons Less predictable targets Mass effects beyond the scene

BCRN Threats are Unique Vertical Healthcare (prehospital/ hospital) Supporting services Horizontal Direct Indirect Diagonal Risk Assessment & Emergency Planning Security (environment, science, agriculture, industry, …)

PRE-EVENT

Paralysis Deafness Multi-Organisation Failure Acute Incident Failure Coordination Capacity Communication Success

Pre-Event: Coordination RA (variables, data) Maintaining surveillance/ monitoring Dividing roles and responsibilities Incident Command System Finance/ administration

Medical ParaMedicalNon-Medical

Pre-Event: Communication Risk communication training Community education Communicating with action parties

Pre-Event: Prevention Biosafety Bio-security Infection Control Quarantine Early Warning Environmental detection and monitoring

Pre-Event: Capacity Developing protection/ sheltering programmes Reviewing response plans Emergency treatment/ triage/ decontamination/ facilities/ training Logistics

BCRN – Building Capacity Emergency care training

BCRN – Building Capacity Emergency care facilities

BCRN - Building Capacity Emergency exercises

Plan TrainingExercise

Biological Agents Chemical AgentsRadiological/ Nuclear Threats Characterizing functions for managing risks Health surveillance Early warning Quarantine Sampling and analysis Vaccination and prophylaxis Epidemiologic al investigation Infection control Biosafety in health facilities First response Environmental detection Decontamination Incident site management First response Environmental detection Facility design Decontamination

DURING THE EVENT PREHOSPITAL

Paralysis Deafness Multi-Organisation Failure Acute Incident Failure Coordination Capacity Communication Success

Pre-Hospital: Coordination EMS Police Army Firemen Logistics Others

Pre-Hospital: Communication Intra-agency communication Inter-agency communication Community communication

Pre-Hospital: Capacity EMS and supporting services PPE for first responders On-site incident management system Mass casualty/ fatality management Preparing hospitals for surge

DURING THE EVENT HOSPITAL

Paralysis Deafness Multi-Organisation Failure Acute Incident Failure Coordination Capacity Communication Success

Hospital: Coordination

Hospital: Communication Inter-departmental communication Families Non-diagnosed cases

Hospital: Capacity Trained staff PPE/ Occupational safety Isolation facilities / control measures Decontamination/ Treatment/ Vaccination Protection of facility infrastructure Waste management

Surge Capacity Field Based Triage, Treatment, Transport Facility Based Space, Staff, Stuff Community Based Partners, Players, Plan B Sites

POST-EVENT

Paralysis Deafness Multi-Organisation Failure Acute Incident Failure Coordination Capacity Communication Success

Post-Event: Coordination

Post-Event: Communication

Post-Event: Capacity Long-term health effects

BCRN Management Hazards Vulnerabilities Risks Management – Prevention – Preparedness – Response – Recovery