2.12. National Programme for Emergency Preparedness, Health Sector

WHO/EHA

EMERGENCY HEALTH TRAINING PROGRAMME FOR AFRICA

2. TOOLS

Conceptual Framework

Panafrican Emergency Training Centre, Addis Ababa, July 1998

WHO/EHA/EHTP Draft 1 - 1999 2.12. National Programme for Emergency Preparedness, Health Sector, Conceptual Framework

Overhead Transparencies

2.12.1. National Programme for Emergency Preparedness, Health Sector: Conceptual Framework 2.12.2. Co-ordination 2.12.3. Technical Programmes 2.12.4. Master Contingency Plan 2.12.5. Technical Procedures, Mass Casualty Management 2.12.6. Technical Procedures, Epidemiology and Disease Control 2.12.7. Technical Procedures, Nutrition 2.12.8. Technical Procedures, Environmental Health 2.12.9. Technical Procedures, Health in Temporary Shelter and Displaced Camps 2.12.10. Training and Research 2.12.11. Resources and Logistics 2.12.12. Essentials for Contingency and Preparedness Planning for the Health Sector, Summary 2.12.13., 2.12.14. Essentials for Contingency and Preparedness Planning for the Health Sector, Hand out

WHO/EHA/EHTP Draft 1 - 1999 2.10. National Programme for Emergency Preparedness, Health Sector, Conceptual Framework

Trainers' Guide

Objective: To illustrate in detail and to introduce the range of different capacities (rules, information, resources, institutions) which are needed for good emergency management. (Knowledge/Attitudes)

Key-message: Preparedness and planning for it are complicated, complex and difficult.

2.12.1. National Programme for Emergency Preparedness, Health Sector: Conceptual Framework This is the basic frame. Explain boxes 1, 2, and 3. The points 3.1. to 3.4. will be developed in the next OHTs The OHTs are complex but self-explanatory.

2.12.2. Co-ordination

2.12.3. Technical Programmes: Master Contingency Plan and Technical Procedures Special contingency plans need to be prepared for each specific hazard. Technical procedures have to be decided for and/or developed and taught.

2.12.4. Master Contingency Plan

2.12.5. Technical Procedures, Mass Casualty Management

2.12.6. Technical Procedures, Epidemiology and Disease Control

2.12.7. Technical Procedures, Nutrition

2.12.8. Technical Procedures, Environmental Health

2.12.9. Technical Procedures, Health in Temporary Shelter and Displaced Camps

2.12.10. Training and Research Exhaustive plan of all levels of training that can be tackled.

2.12.11. Resources and Logistics

WHO/EHA/EHTP Draft 1 - 1999 Exhaustive plan of components of resources and logistics essential for emergency preparedness.

2.12. 12. Essentials for Contingency and Preparedness Planning for the Health Sector, Summary Two pages showing a crowded table. It is best to hand out a copy and show a summary page as OHT explaining the use of the table. Capacities needed, 1. Capacity building through training of technical subjects of the health sector and 2. Support: all other ways of capacity building, i.e. inter-sectoral collaboration, specific training, etc.

2.12.13., 2.12.14. Essentials for Contingency and Preparedness Planning for the Health Sector, Hand out Hand out a copy.

Stand-alone. Reference. Attention, to be used only with very small and very motivated audience.

Essential Reading: . UN-DMTP Training Modules, UN-UDMTP, 1990

WHO/EHA/EHTP Draft 1 - 1999 2.12.1. National Programme for Emergency Preparedness, Health Sector: Conceptual Framework National Programme for Emergency Preparedness Conceptual Framework

Co-ordination 1 2 3 General country Inter-sectoral legal Institutional capacity profile framework of the Natural Technical Health System programmes Sectoral capacity & Health Profile Health Profile capabilities for Training and Emergency research Management Resources and Logistics

General description Acts, Laws & Bills for Analysis of the Health Sector: Basic indicators: Disaster Prevention Policies & Strategies geographic & emergency Budget social management Personnel cultural National policies and Network economic strategies Programmes demographic Signature of Operational indicators land use International Health Emergency urbanism Conservation and management: Disaster profile Resolutions mandate main hazards Institutions/structures structure main factors of for Civil Protection levels of responsibility vulnerability Disaster Prevention operational capacity past disasters and/or Emergency record of performance performance of Management budget emergency services Campaigns for Public Main health hazards Awareness mortality & morbidity Allocation of State by disasters Budget past performance of Mention of Ministry of health sector Health in National Preparedness Plan

WHO/EHA/EHTP Draft 1 - 1999 2.12.2. Co-ordination

Different MOH departments Political Technical Administrative Intra-sectoral National NGOs / Community leaders Army medical corps Private health services

Civil defense DEFINE: Home affairs (Police) Level of co-ordination Foreign affairs Liaison officers Local government Activities that will be Finance implemented jointly in Communications the various phases Public works Procedures for the Co-ordination Inter-sectoral Social affairs mobilization of internal (MOH Emergency cell) Commerce resources Food security Strategy for the mobilization Technical services: and co-ordination of agriculture, land external assistance water (emergency Appeals) meteorology Media

Neighboring countries Regional institutions United Nations International Embassies/bilateral agencies International NGOs

WHO/EHA/EHTP Draft 1 - 1999 2.12.3. Technical Programmes

Special plans

Epidemics of infectious origin

Other Natural Emergencies 3.2.1.Master contingency plan Technological Emergencies

Complex Emergencies

Major Public Functions

3.2.Technical Programmes

3.2.2.1.Casual management

3.2.2.2.Epidimiology and disease control

3.2.2.Technical procedures 3.2.2.3.Nutrition

3.2.2.4.Environmental Health

3.2.2.5.Health management of temporary shelter

WHO/EHA/EHTP Draft 1 - 1999 2.12.4. Master Contingency Plan

Diseases known to have Contingency Planning occurred Epidemics of Worst-case scenarios infectious origin Planning on the basis of New Emerging Diseases Country/Aria history and global trends Mass Food Poisoning by Hazard mapping and Risk Natural causes assessment Specificity and Draught Sensitivity of information systems Floods Early-warning indicators and cut-off values Cyclone Containing the crisis Management of Emergencies by Tidal Surge & Tsunami individual and mass Other Natural casualties Causes Earthquake Objectives, timetable. Tasks, responsibilities Landslide and resources Vulnerability of health Volcanic Eruption network and systems

Bush fire

Transportation incident

Fire in Human Settlement

Industrial explosion, fire or Master contingency Special spill Reduction of Hazards plan Plans and of Vulnerabilities Technological Collapse of Man-made Emergencies structure Failure of Lifeline Systems

Mass Food Poisoning by Human Causes Procedures for Activation of Plan Activation of center of Armed conflict command & Teams Rapid need Assessment Mass Labour Unrest Mobilization of resources Complex Deployment of resources Terrorist Attack Emergencies Technical procedures References systems Refugee/Displace Influx Coordination of operations Information systems and State visit reporting procedures Media management and Major public Pilgrimage information functions Large scale entertainment

WHO/EHA/EHTP Draft 1 - 1999 2.12.5. Technical Procedures, Mass Casualty Management

Mandates/responsibilities Role of Health services Chain of Gold, Silver, Bronze Command Information management Media management

Access Communications Security Special procedures Special procedures Collection of evidence investigations

Tasks Methods/procedures Pre-Hospital Search and Resources rescue Identifications of victims

Training Triage Vital signs Tagging criteria

First Aid on- Medical rescue chain Inventory of resources site medical Chain of command care 3.2.2.1 Mass Resources 3.2.2.Technical Casualty Evaluation Routes procedures Management Destinations

Chain of authority Hospital capacity Accessibility Personnel, equipment, supplies Support services Lifeline systems Record-keeping Information for the Public Hospital Hazards & Hospital Vulnerability assessment Hospital preparedness plan Training/information of staff Roster of staff; Duty roster, call roster Drills and simulations Updating the Plan

WHO/EHA/EHTP Draft 1 - 1999 2.12.6. Technical Procedures, Epidemiology and Disease Control

Epidemiology of disasters Notifiable conditions and case-definitions Community-based records Support and reference Early laboratories warning Access to H. services Epidemiological Data base & series surveillance Monitoring Health Info. System Transmission/processing Cut-off values for Morbidity & Mortality Notifications/bulletins

Natural disasters Roster of experts Stockpiles Roster of manufacturers WHO guidelines Epidemic Field teams Decentralization of control resources/authority Mass control measures Case management Vulnerability of health Operations network

3.2.2.2 3.2.2.Technical Specific drugs Epidemiology Endemic Vector control procedures and disease control in Self-kept records control emergency Contingency plans situations

Mostly local planning: Type of hazard Systems to be set in Population at risk Technological place according to Special resources disasters specific risk-assessment Reference centres Hazard awareness Political/public attitudes

Complex Availability of information for Special plans emergencies Contingency Planning Special agreements Political acceptability of Special procedures Major Public Scenario-setting Functions

WHO/EHA/EHTP Draft 1 - 1999 2.12.7. Technical Procedures, Nutrition

WHO/EHA/EHTP Draft 1 - 1999 2.12.8.Technical Procedures, Environmental Health

 Co-ordination with Disease Control  Technical inter-sectoral liaisons  Health emergency standards  Inventory of resources Water supply  Vulnerability assessment  Contingency plans  Supplies for treatment: - Stockpiles - Local market/manufactures  Logistics

 Contingency plans  Emergency standards Water supply  Inventory of resources  Technical liaisons  Local materials 3.2.2.4  Sustainable technologies Environmen- 3.2.2 tal Health  Assessment and map of hazards Technical  Health/environmental education procedures  Equipment Environmental  Mandate/authority pollution  Indicators & cut-off values  Roster of experts  References centres  Technical liaisons

 Legal & technical standards  Experts Food safety  Reference centres  Procedures for quality control  Enforcement

WHO/EHA/EHTP Draft 1 - 1999 2.12.9.Technical Procedures, Health in Temporary Shelter and Displaced Camps

Security Accessibility Selection of site Water Vital space Site planning Health referral systems Host communities Length of accommodation Security Advocacy Registry of population Death registry Day-to-day management Supervision of burial site Food: rations, production, commerce Plans for resettlement Water Fuel, household kits, soap Shelter, blankets Latrines, waste dumps

Mapping Temporary/transit centres Ad-Hoc or stand-by facilities: Inventory Specific 3.2.2.5 Health Others: schools, barracks, etc 3.2.2.Technic in temporary Accommodation centres Liaisons with responsible bodies: al procedures shelter and Local authorities, Education, displaced Defense, etc camps Figures, trends & demographic  Triage structure Health/nutrition  Measles vaccination Mortality, Heath & screening on entry  Vitamin supplementation nutrition data must  Health information enter H. Info. System  Disease surveillance & Health infrastructures control Cold chain  Immunizations Personnel On-going Primary  MCH & Reproductive Health Drugs & materials Health Care  Essential drugs Support & materials  Nutrition Volunteers  Water & sanitation NGOs  Health education  Community H. workers

Information on availability of Referral system referral facilities Access to communications and transport

WHO/EHA/EHTP Draft 1 - 1999 2.12.10.Training and Research

Integrate Health issues in general Disaster awareness campaigns General awareness building Integrate Disaster awareness in Health education Media IDNDR day Schools

Medical schools Post-graduation courses Professional training Type and contents of On-the Job training training Duration Supervision Frequency Training Audience Methods Civil Defense Inter-sectoral participation and collaboration National NGOs Roster of trainees 3.3.Training and United Nations research Private sector Others Audience Manuals Format Technical aids Contents Simulation exercises Production Others: videos, etc… Distribution

Research institutions Case studies Protocols Presentation/circulation Institutional memory

WHO/EHA/EHTP Draft 1 - 1999 2.12.11. Resources and Logistics

Sectoral advocacy Preparedness advocacy Ordinary funds: Preparednes Liaisons with National s Ministry of Finance External External assistance Special line for contingencies Budget Special procedures Emergency funds: “Contingency projects” Donor’s procedures Response National Lead time External

Full-time Professional status/career Part-time Recurrent costs National NGOs Training and supervision Volunteers Team spirit International NGOs Turn-over versus institutional Personnel memory National level Roles & responsibilities Intermediate level Incentives/insurance District level Local level Resources and Ambulances, etc. Logistics Medical Rescue Procedures & Care Intensive Care Units Investment Special Care Units Trained personnel Maintenance Equipment Power supply Phone/Fax Accessibility Transmissions Radio Reliability Pouch Restrictions and liaisons Electronic Mail Satellite

Revolving stocks Emergency Warehousing stockpiles Shelf-life Decentralization

Mobilization Emergency Authority procedures Accountability

Sectoral capacity Warehousing Deployment Other sectors Transports Public services Private sector

WHO/EHA/EHTP Draft 1 - 1999 2.12.12. Essentials for Contingency and Preparedness Planning for the Health Sector, Summary

Essentials for Contingency Planning and Preparedness Planning for the Health Sector Type of Primary Primary Causes of Main Responsibility Risk to Health Capacities Needed Emergency Hazard Death & Illness of the Health Sector Network Technical Support Epidemics of Known Agent-specific Alert & Assessment, + Epidemiology & Disease Communications, Infectious disease Case management, control, Laboratory facilities & supplies, Origin Outbreak control Medical/Nursing care, Inter-sectoral collaboration, Environmental health, Funds Emergencies by Floods Drowning, Trauma, Search & Rescue, + Mass casualty Special training for staff & Other Natural Diarrhoea, ARI, Triage, management, volunteers, Causes Vector-borne diseases Need assessment, Environmental health & Inter-sectoral collaboration, Co- Disease control, Vector control, ordination of relief Assistance in Health care in temporary temporary shelter shelter Emergencies Transport Trauma, Drowning, Search & Rescue, + Mass casualty Intensive care facilities from Incident Burns, Suffocation Triage, management Technological (Road, Casualty Causes railways, air, Management sea etc.) Complex Armed Trauma, Malnutrition, Need assessment & +++ Epidemiology & Disease Special agreements & procedures, Emergencies Conflict ARI, Diarrhoea, advocacy, control, War surgery facilities/capacities, Measles, Meningitis, Disease control, Nutrition, Safe transfusion facilities, Vector-borne Diseases Nut. surveillance & War surgery, Co-ordination, International aid Selective feeding, Health care in temporary Injury management shelters Major Public Pilgrimage Epidemic diseases, Disease control, - Epidemiology & Disease Intensive care facilities, Functions Illness among Readiness for crowd control, Temporary outreach facilities spectators, Crowd incidents, Environmental health, incidents (stampede Back-up for increased Mass casualty etc.) demand management

WHO/EHA/EHTP Draft 1 - 1999 2.12.13., 2.12.14. Essentials for Contingency and Preparedness Planning for the Health Sector, Hand out

Essentials for Contingency Planning and Preparedness Planning for the Health Sector Type of Primary Primary Causes of Death & Main Responsibility of the Risk to Capacities Needed Emergency Hazard Illness Health Sector Health Network Technical Support Epidemics of Known Agent-specific Alert & Assessment, Epidemiology and Disease control, Communications, Laboratory Infectious disease Case management, Medical/Nursing care, facilities & supplies, Inter-sectoral Origin Outbreak control + Environmental health, collaboration, Funds New Agent-specific Alert & Assessment, As above, plus field research, crash training As above , plus access to more Emerging IDENTIFICATION OF of personnel, new, specific health education sophisticated Reference Centers, Disease AGENT +++ possibly Cordon Sanitaire greater capacity for Isolation, Case management, special drugs or vaccines Outbreak control Emergencies by Mass Floods Agent-specific Assessment identification of Epidemology Medical/Nursing care Communications, Logistics and Other Natural Poisoning by cause case management Education Funds for Outreach. Supplies inter- Causes nature causes information and education – sectoral collaboration and coordination of relief Drought Diarrhoea, Malnutrition , Any other Need assessment disease + Epidemiology Communication. Logistics & Funds cause, by decreased access to health control Nutritional surveillance Disease control, Nutrition. for Outreach. Supplies Inter-sectoral services and higher vulnerability collaboration and coordination of relief Floods Drowning, Trauma, Diarrhoea, Search & Rescue/Triage + Mass Casualty Management Special training for staff and ARI, Vector – borne diseases Need assessment volunteers Disease Control Env.Health/Vector Control Inter-sectoral collaboration and Assistance in temporary Health Care in temporary shelters coordination of relief shelters Cyclone Trauma, Drowning, Diarrhoea, , Same as above + + Same as above Same as above ARI, Vector – borne diseases Tidal Surge Drowning, Trauma, Diarrhoea, , Same as above + Same as above Same as above and Tsunami ARI, Vector – borne diseases Earthquake Trauma, Suffocation, Burns Search & Rescue/Triage + + + Mass Casualty Management Need assessment Intensive Care facilities Casualty management Hospital vulnerability assessment Assistance in temporary and reduction shelters Health Care in temporary shelters Landslide Trauma, Suffocation Same as above + Same as above Same as above Volcanic Trauma, Suffocation, Burns, Acute Need assessment .+ Mass Casualty Management Intensive Respiratory Care Unit Eruption Respiratory Distress Casualty management Assistance in temporary shelters Health Care in temporary shelters Bush Fire Burns Trauma, suffocation Same as above - Same as above Burns Care facilities

WHO/EHA/EHTP Draft 1 - 1999 2.12.14. Essentials for Contingency and Preparedness Planning for the Health Sector, Hand out Type of Primary Primary Causes of Main Responsibility Risk to Capacities Needed Emergency Hazard Death & Illness of the Health Sector Health Network Technical Support Emergencies from Transport Incident Trauma, Drowning, Burns, Search & Rescue/Triage + Mass Casualty Management Intensive care facilities Technological Causes (road, railways, air, Suffocation Casualty Management sea, etc) Fire in Human Burns, Trauma, Search & Rescue/Triage +++ Mass Casualty Management Burns Care facilities Settlement Suffocation Casualty Management Intensive Care Unit Hospital vulnerability assessment and reduction Industrial Blast, trauma, Burns, Search & Rescue/Triage + Mass casualty Management Specific Intensive Care facilities Explosive, fire, Acute respiratory Distress, Casualty Management medical/nursing care Special Decontamination facilities Access to special Spill, Radiation Suffocation, Agent- Reference Centre specific Collapse of man- Trauma, Suffocation Search & Rescue /Triage +++ Mass casualty Management Intensive Care facilities made Structure Drowning, other, casualty Management Hospital vulnerability assessment and reduction according to type of Assistance in temporary structure shelters Failure of Lifeline Any cause, by lack of Prompt back-up Casualty +++ Mass Casualty Management Hospital vulnerability assessment and reduction Systems critical support care Management Back-up systems Trauma by crowd panic Mass Food Agent - specific Alert and Assessment + Epidemiology Specific Medical/Nursing care Toxicology Poisoning by Identification of Agent Environmental health Special Decontamination facilities Human Causes Case Management Access to special reference Centres Complex Emergencies Armed Conflict Trauma, Malnutrition, Need Assessment 7 +++ Epidemiology & Diseases Control Nutrition War Special Agreements & Procedures war surgery ARI, Diarrhoea, Measles, Advocacy Disease surgery facilities/capacities safe Transfusion facilities Co- Meningitis vector -born control Nut. Surveillance ordination of International Aid diseases & Select feeding Injury Management Mass Labour Unrest Trauma, Any cause by lack Mass casualty + Mass Casualty Management Special Agreements & procedures of critical support care Management Terrorist Attack Blast, Trauma , Fire, Mass Casualty - Mass Casualty Management Intensive Care facilities Suffocation, Acute Resp. Management Distress, Other specific (e.g. Toxic gas) Refugee/Displaced Diarrhoea, ARI, Diseases control Nut. - Epidemiology & Diseases Control nutrition Recruitment of volunteers Influx Malnutrition, Measles, Surveillance & Select Health Care in temporary shelters Outreach and supervision Meningitis, Vector -born feeding Assistance in Co-ordination of International Aid diseases camps/transit points Major Public State Visit Any illness of state guests Back - up for possible - Medical/Nursing Care Intensive Care facilities Functions illness among spectators special, high -profile crowd incidents( stampede, medical emergency etc.) readiness for crowd incidents Pilgrimage Epidemic diseases illness Disease Control - Epidemiology & Intensive Care facilities among spectators Crowd Readiness for crowd Disease control, Environmental Health Mass Temporary outreach facilities

WHO/EHA/EHTP Draft 1 - 1999 incidents (stamped, etc0 incidents back-up for casualty Management increased demand Mass Entertainment Illness among spectators Back-up for increased - Mass Casualty Management Intensive Care facilities Crow incidents demand readiness for (stampede) crowd incidents

WHO/EHA/EHTP Draft 1 - 1999