Public Health Risk Assessment Bonnie Henry, MD, FRCPC Doug Sider, MD, FRCPC Public health CBRN course

Case 1 A tornado has just hit your community; dozens of walking wounded are appearing at the local hospital, as well as individuals looking for loved ones Ambulance communications notifies the local hospital to expect at least 30 patients of varying severity in the next hour Municipal officials have called you to the EOC and asked you to prepare some public safety messages (re food, water, shelter)

Case 2 An explosion has occurred at the Bloor station in the Toronto subway system CBRN team is responding due to a phone call to a local TV station from a terrorist group chanting “Death to Canada” and claiming that a radioactive substance has been released

Case 3 A mysterious influenza-like illness beginning in Southeast Asia has been found to “jump” from birds to people Over 400 people of all ages have been affected; mortality is 50% Recent reports indicate some human to human transmission

Case 3 The disease is making its way west; cases are turning up in Europe The WHO announced that the world may be entering Phase IV of the Pandemic phases (human cases found with subtype; established human spread)

Questions to ask: 1.Is my organization/community prepared to respond to these events? 2.Does my organization/community need to be prepared anyway? 3.What are our priorities?

Have you done your risk assessment?

Goals of Session Describe the need for and context of risk assessment in emergency health planning Describe and prioritize the risks faced by of your organization/community to better prepare for public health emergencies

Phases of an Emergency ( F/P/T National Framework) 1.Risk assessment 2.Mitigation 3.Preparedness 4.Response 5.Recovery

Public Health Emergency Preparedness and Response GOAL: To enable and ensure a consistent response to public health emergencies and emergencies with public health impacts. Hazard Identification and Assessment Immediate Outcomes Awareness of the hazards which are relevant to the catchment area of the board of health. Risk-based emergency planning and programming to guide ongoing board of health preparedness efforts. Requirement 1.The board of health shall, in accordance with the Provincial Protocol on Public Health Emergency Preparedness, 2007, identify and assess the relevant hazards and risks to public health within the health unit area.

What’s your risk? Naturally occurring events Technological/infra- structure events Human related events

Natural events - examples Hurricane Tornado Extreme heat/cold Ice storm Snow storm Flood Epidemic/pandemic

Epidemic/pandemic Influenza SARS E Coli Smallpox

Technological/ Infrastructure events Electricity system failure Transportation emergency Water system emergency Structural collapse HAZMAT events Fire Nuclear power station events

Human Related Events Terrorism – biological, chemical, nuclear, radiological Civil disturbance Labour actions Armed conflict Large public gatherings

What is your risk for each? Risk = Probability x Impact

Risk = Probability x Impact

Components of Risk Probability? A.Highly likely? B.Likely? C.Possible? D.Unlikely? Impact? 4. Catastrophic 3. Critical 2. Serious 1. Marginal

Probability Probability Rating DescriptionDetail A Highly Likelynearly 100% probability in next year B Likely between 10 and 100% probability in next year, or at least one event in next 10 years C Possible between 1 and 10% probability in next year, or at least one event in next 100 years D Unlikelyless than 1% probability in next 100 years

Components of Impact Impact Human Physical infrastucture Business Impact 4. Catastrophic 3. Critical 2. Serious 1. Marginal

Impact - Human 4. high probability of death 3. high probability of injury or illness; low probability of death 2. low probability of injury, illness or death 1. unlikely to cause injury, illness or death in community members/providers

Impact – Physical Infrastructure 4. extensive physical infrastructure damage with substantial service disruptions, high costs and extended recovery time 3. moderate physical infrastructure damage 2. minor physical infrastructure damage 1. unlikely to cause physical infrastructure damage causing service disruption with resultant costs/recovery challenges

Impact - Business 4.numerous public/private sector entities unable to provide services 3. significant/widespread or long term service interruptions 2. minor or limited or short term service interruptions 1. unlikely to cause public/private sector service interruptions

Overall Impact Rating 11-12Catastrophic Community cannot assure core public/private services without extensive assistance from provincial or federal resources 8-10Critical Community can only assure a normal level of services with assistance from outside the region or the community is reduced to providing a minimal level of service with normal resources existing within the community 5-7Serious Community can assure a normal level of services with assistance from within region or reduced levels of service with resources existing within the community 3-4Marginal Normal level of functioning or increased level of public/private services required within the community

Risk Assessment - examples ThreatProbabilityImpact (H+P+B) Risk TornadoB3+3+2B8 Dirty BombB/C/D3+1+2B/C/D6 Pandemic influenza B4+1+4B9

Impact/Probability A Highly Likely B Likely C Possible D Unlikely 11-12:CatastrophicA11-A12B11-B12C11-C12D11-D : CriticalA8-A10B8-B10C8-C10D8-D : Serious A5-A7B5-B7C5-C7D5-D : MarginalA3-A4B3-B4C3-C4D3-D4 Risk Rating

Priorities 1.Pandemic ‘flu’ 2.Tornado 3.Dirty bomb

Priorities Perform this exercise for all: Naturally occurring events Technological/infrastructure events Human related events

Summary Assessment of risks is first step in planning Helps focus efforts and ensures no possibilities are missed Helps prioritize efforts in preparedness

“The only thing more difficult than preparing for an emergency is having to explain why you didn’t”