1. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman BCRN Management Perspectives Nasser H. Al-Azri BSc, MD, MRCS(A&E), MACEP PDO

2. 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

3. Disasters Man-MadeNatural Earthquakes Cyclones TransportationCBRN Fire Wars Fires

4. 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

5. 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!

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

7. Strategic Plan Prevention Preparedness Response Recovery

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

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

10. BCRN - Definition Biological Agents Chemical Agents Radiological Nuclear

11. Bioterrorism Industrial settings Healthcare facilities

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

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

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

16. PRE-EVENT

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

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

19. Medical ParaMedicalNon-Medical

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

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

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

23. BCRN – Building Capacity Emergency care training

24. BCRN – Building Capacity Emergency care facilities

25. BCRN - Building Capacity Emergency exercises

26. Plan TrainingExercise

28. 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

29. DURING THE EVENT PREHOSPITAL

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

31. Pre-Hospital: Coordination EMS Police Army Firemen Logistics Others

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

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

35. DURING THE EVENT HOSPITAL

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

37. Hospital: Coordination

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

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

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

42. POST-EVENT

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

44. Post-Event: Coordination

45. Post-Event: Communication

46. Post-Event: Capacity Long-term health effects

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