Management of public health emergencies in European ATM

*specific medical aspects *preparedness programme of EUROCONTROL

Dr Roland Vermeiren, Head Medical Service EUROCONTROL

The European Organisation for the Safety of Air Navigation Different types of

• Tower • Approach • En - route • Flow control

• + technical staff ( engineers, network technici ) ! Differences …. Different from pilots !

• Also 1 ATC license and 1 medical certificate • But : - different ratings and endorsements - different controlled airspaces - different ( and changing ) complexity of air traffic => specific type of work

• Thus …. difficult to substitute

• Cockpits are similar or identical ( types of aircraft ) • OPS-rooms are all different ( tasks, tools, methodology…) Differences in the OPS room… ATC = work on demand

• At each center sectors can be divided into subsectors , or (re)combined

• But there is always a maximum capacity per (sub)sector and per centre

• about 65 centres in

ATM = Balance

• This capacity information goes to air traffic flow management ( « Environment » ) • Formally in Europe : different ATM centres -> • now all combined in one : EUROCONTROL CFMU in (and ) • Which manages the balance between demand ( from airlines ) and capacity ( at air traffic control centres )

• Flight Plan Data -> Flow Control <- Environment Data

• And accordingly attributes all « slots » in Europe • air traffic flow control positions at all ATC centres EUROCONTROL as SLOT machine ATC (centres) belong to ANSP’s

• Air Navigation Service Providers can : • Belong directly to States • Belong to organisations « owned » by States • Be privatised

• different legislations or working agreements apply ! Safety overview

• By Local safety managers at each centre • By NAA’s ( National Aviation Authorities ) , also responsable for ATC licenses

• Medical fitness for certification is checked by AME’s (certified aeromedical examiners) and supervised by the AMS (aeromedical section of the NAA) named in future the Medical Assessor ( EASA )

• At each level ( centre and NAA ) rules for contingency planning must be in place European cooperation

• All rulemaking concerning safety is done by EASA ( European Aviation Safety Agency ) , Agency of the • The final political decisions are made by the ( prepared by the EU Commission to be endorsed by the EU Parliament and the EU Council ) -> EU Regulations and Directives

• - Plans for the improvement of ATM, technical support to member states (SESAR) - air traffic flow control, EU network management are done by EUROCONTROL

• All have to cooperate to establish a pan-European reaction in a crisis situation ( such as the volcanic ash problem )

ATC related Safety risks caused by health problems : • Aircrew get sick during flight : diversion = work for ATC

• Passengers get sick during flight : information to ATC for – preparedness – taking into account country limitations (closures ?) –> diversions

• ATCO’s get sick during (or just before) duty time : capacity problems in the centre ? -> flow control actions : reroutings -> capacity problems in the centres in the vicinity ?

• Family of ATC get severely sick : idem ! ( ATC work under emotional stress = safety risk )

• ATM – flow controllers get sick : EU capacity problems ? ( today all concentrated at EUROCONTROL CFMU ! ) –> delays raise Capacity problems Major exposure risk factors

• being within 2 metres' proximity of an infected person • the density of individuals within this range of proximity • the proportion of infected individuals or infectious agents within this range of proximity • confined space • lack of turn-over of people within the proximity range, together with variable favourable factors: humid atmosphere, low temperature

Specific risks linked to ATC work

• All ATCO’s must sit together in one OPS-room • Mostly in teams of an « operator » and a « planner » • Near to other sectors ( lots of contacts needed ) • Which is airconditioned (needed for the technical systems) • Working in shifts thus contact with all colleagues • With common working tools ( no « personal » positions )

• = All risks to spread a disease

• Amongst persons which are difficult to replace ( > specific ratings in a specific OPS room for a specific airspace )

• Consequences ? - Closure of centre(s) ? - some control taken over by other centres ? Difficulties and opportunities

• - Identification of infected ATCO’s ( before displaying symptoms ) • - Availability of tests ( will come too late ) • - Availability of vaccines • - Side-effects of preventive medication

• + Acquired Immunity ( list these persons ! )

Preparedness of ANSP ’s ?

• ATCO’s seen as « essential staff » in states ? // policeman, fireman, … • Priority for vaccination, prevention, treatment ? ( beware of side-effects ! )

• Do individual ANSP plans exist ? ( sometimes secret ) • Need for coordination with national health services ! Integrated in national plans ? • Need for coordination between ANSP’s about health risk crises !

• Need for a pan-European cooperation plan ( similar to volcanic ash crisis which was technically operated by EUROCONTROL CFMU ) But …who will fly during a pandemic ?

• State, airport restrictions or closure : complexity of ATC up • « Regular » leisure and business flying will go down • Private and Evacuation flights will go up : complexity ATC up • Cargo flights may go up because of other transport problems and because of urgent need for medical supplies

• => irregular flights will increase

• General consequences on aviation will depend on health risk classification, even in phase VI ( « dangerousity » of the virus )

Still on holidays during pandemics ? conclusions

• Need for individual ANSP plans • To be linked to national plans of the public health authorities • Need for Coordination plans between ANSP’s – in case of closure of centres – possibilities for transmission of work • Contingency Plans : do exist , but mostly based on infrastructure or material problems – this time it has to deal with staffing ! – of difficult replacable ATCO’s – for possibly several weeks ! ( waves typically 4 to 6 weeks long, and come back )

Risks for EU coordination

• If flow control ( by CFMU and local flow controllers ) goes down, the capacity of the whole system will go down

• Role of EU Commission and Eurocontrol to establish a « crisis cell » ( as for the volcanic ash problem ) • but now : - should be virtual , not in a meeting room ! - need for protected internet platforms and communication tools !

• …BUT still : individual States decisive power !

Management of public health emergencies in European ATM

*preparedness programme of EUROCONTROL

Dr Roland Vermeiren, Head Medical Service EUROCONTROL

The European Organisation for the Safety of Air Navigation EUROCONTROL Contingency Plan

• The basics of this influenza contingency plan can also be used for any other circumstances in which high rates of employee absence are encountered and for any other bio-hazard, be it natural (other infections) or human caused (bio – terrorism).

• This response plan is designed for a scenario in which a large proportion of employees, perhaps as high as 50% in some areas, are absent from work due to a combination of infection, family commitments or simply the fear of infection. EUROCONTROL Contingency Plan basics

• Creation of a crisis committee and definition of powers (regulatory and budgetary) + local cells at each centre

• Coordination with national plans

• Contacts with national public health authorities (prevention and treatment)

• Preparation of a web page on our Intranet

• Drawing-up of lists

Drawing-up of list of people

• For "essential" functions – Operational – Special services (medical, prevention, drivers,security, reception, mail, maintenance,management + secretariats) – Percentage staffing of other services (15%?)

• For functions convertible to teleworking

Essential functions Example 1 : EUROCONTROL MUAC

• Delta-Coastal sectors : part of the North sea, The , Northern • Brussels sectors : , Luxemburg, part of Northern until Nancy • Hannover sectors : Mid – /Western Germany

• Above 24.500 feet, (7.5 km)

• Approximately 1.5 million controlled flights per year, 5000/day controlled zone – MUAC (704 employees):

Traffic 100 % 75 % 50 % 25 % demand Brussels 59 59 45 30 sector

Deco 47 47 36 24 sector

Hannover 64 64 48 32 sector

Flight Data 32 32 24 16

Flow Mgt 9 9 9 9 But don’t forget !

• Approximately 165 engineers will still be required to carry out all the essential support / maintenance work. ( Engineering and operational facility staff.)

• Key administrative staff are also required to maintain the business at minimal service levels, estimated at 25 employees.

• this core of 190 employees is in addition to the control centre staff in the table above, giving a total range of 301- 401 dependant upon demand levels. Mask compatible with the use of spectacles

Example 2 : CFMU (located at brussels and paris)

• Flight plans : - the service can be fully provided from Brussels or Paris . - Moreover, operators can work from one centre remotely with the system in the other centre.

• Environment : ( normally in Brussels ) - the Contingency system can be started up in Paris. - Operators can work remotely on the system in Brussels, and locally on the system in Paris.

• Flow Control : - the switch to the contingency system in Paris will have a significant impact on the users - Teleworking does not work for this service.

Hygiene and prevention

• 1) Standard principles of hygiene

• 2) Barrier measures

• 3) Vaccines

• 4) Antivirals

Side effects ?

EUROCONTROL plan Pandemic preparing tasks :

• succession plans for key players ( directors, senior management of operations, SPP advisors, medical advisors ) • authorities and procedures for immediate decisions • check the guarantee of key suppliers to deliver ( supplies and services ) • consider staff names to the (re-)established essential functions • additional laptops for teleworking • evacuation policy for suspected cases at work during a pandemic • communication plan : specific telephone helpdesk, special website • prepare physical lay-out changes during pandemic (individual occupancy of offices ) • plan for loss of community services ( transport, utilities ) EUROCONTROL plan Tasks during phase 3 :

• contact with staff committee and unions about implications • briefing and information/ training of staff considered for essential functions + informed consent • rules about sick leave and return to work during a pandemic • stock of disposable tissues and alcohol swabs EUROCONTROL plan Tasks during phase 4 :

• creation of an absence manager – contact with suspected/ infected staff • check of contingency plans from key suppliers • counseling to employees wanting to go to infection area’s (fi for familial reasons) • review teleworking support capability EUROCONTROL plan Tasks during phase 5 :

• restriction of access for visitors or employees coming from infected area’s • information about hygienic and protective measures – at work and at home • cancellation of meetings, training…closure of restaurants in infected area’s • send stock of medication, swabs and masks to appointed distribution points • ensure disinfectant cleaning of hot spots ( door knobs, light switches, elevator buttons ) and offices of suspected patients • distribution of laptops - start of teleworking Constraint or opportunity ? And then…

EUROCONTROL plan Tasks during phase 6 :

• implement changes in decision making • social distancing measures • restrict access to appointed staff • daily information updates to staff at work and at home • enforce hygiene measures basics during Phase 6 (Pandemic Phase)

• Aim of action plans: slow down the spread of the disease

• Principle: minimise contact (meetings, gatherings, public transport, etc.) to reduce the risks of contagion

• and develop alternative solutions to ensure continuity of work

Eurocontrol Phase 6 scenario’s

• 3 different scenarios

• Yellow: initial step Although level 6 has been declared, the situation is almost normal; air traffic as usual, no or few staff infected.

• Red: intermediate situation deteriorates; air traffic decreases rapidly, more and more staff are becoming infected.

• Black: extreme situation Air traffic reduced to a minimum. and airspace closing starts. Pandemic broadly spread. Most staff are sick or at home.

Essential staff during phase 6

120

100

80

60 Required staff

40

20

0 Yellow Red Black « Advice to staff in EC ops rooms »

• A number of containers with alcohol gel have been disposed in the operations room area, including rest rooms, kitchens and toilets. Staff should regularly disinfect their hands with this gel, in particular:

• - whenever they move to another part of the room and will touch equipment, i.e. phone, key boards, etc;

• - Always when they enter the room from outside. The gel will be located close to the advert in annex;

• - when entering the rest rooms. Same advert than in former bullet will be found close to the gel.

« Advice to staff in EC ops rooms »

• cleaning services will perform two daily (one in the afternoon and one in the evening) in depth disinfections of all equipment of common use (phones, keyboard, chairs, desks, etc).

• The medical services remind that some people may react on "disinfection" by alcohol and get skin irritations, since it changes the skin flora. They should then "wash" their hands with water and common soap.

• Normal soap does not kill the virus but will wash it away from the skin. Thus the difference between doing nothing and washing with normal soap is much bigger than the difference in effectiveness between washing with soap and disinfection with alcohol.

mouthmasks in ATC work ? = risk for communication !

After… It will stay in the heads

Postpandemic Period

• Psychosocial support • Provision for deceased or long-term sick employees • effect on the subsequent workload for those remaining employees • Provision for bereaved and fatigued employees

• Other implications • Impact on short and long-term cash flow • Neglected maintenance • Consider rate at which demand for services (flights) increases

First casualties of bird flu in Paris… Thanks for the invitation

• Any questions? The real star of the presentation

Details of the Eurocontrol preparedness plan Preparation : Coordination of intra-organisational measures

• Create central influenza crisis committee. • Decide composition and regulatory and budgetary power in case of a pandemic. • Integration of multi-disciplinary experts (legal, informatics, logistics, communication, social) - assign roles • Develop succession plans • Setup of local crisis cells. • Decide their composition and regulatory and budgetary powers during pandemic • Create a network throughout the organisation to react immediately • Establish authorities and procedures • Link contingency plan with existing procedures and committees Phase 6 Demand for Services

• Plan for business recovery accounting for the potential of additional waves to come Phase 6 National Response

• Implement any necessary changes in legal and regulatory authority and decision-making to enable quick and adaptive measures for issues related to the pandemic • Coordinate with national health authorities to implement any changes in health measures • Maintain regular contact with national health authorities and WHO. • Keep employees updated of any changes in recommendations Phase 6 Employee Behaviour

• Provide recommendations to employees to avoid all physical contact with infected individuals inside and outside the workplace • Implement social distancing measures, and communicate to employees the strong risk of socialising at this time • While feeling ill all employees should stay home - approval from the doctor is required before returning to work to ensure the employee is fully recovered • Provide psychological and social care for staff and families Phase 6 Communication with Staff

• Ensure diligent personal hygiene by placing signs in rest rooms, providing information leaflets, distributing tissues, masks and disinfectant soap • Stop all meetings and gatherings • All training except on-line training to be cancelled • Restrict access to all employees except those appointed as key employees on-site • Implementation of emergency workplace standards • reduce operations to skeleton staff in key teams as identified during the planning phase of this plan • Provide daily information updates to staff regarding measures they should take to safeguard themselves and their family. • Disseminate this information via the intranet, internet and leaflets • Ensure support facilities are in place in the event of fatalities • Daily updates between the influenza crisis cells, • check availability of medical officer and their alternative contact Phase 6 Absence Management

• Maintain regular contact with staff infected, suspected to be infected, and recovered. • Obtain updates of their condition and record information • Maintain telephone helpdesk resource for all employees Phase 6 Resource Management (Rostering)

• Apply business priorities and administrative measures to a significantly reduced service environment as demand for ATM services declines • Evaluate existing plans and consider whether any changes need to be made for a subsequent wave. • Considerations should include: potential availability of a vaccine, immunity rates and long-term effect on demand for flights Phase 6 Employee Services

• Isolate infected individuals immediately and place in quarantine isolation unit/hospital. • Inform relevant internal staff so they can stay in touch and monitor infected employees • Encourage quarantine - enforce absence for employees returning from missions to affected countries (provisionally 3 days quarantine if no symptoms, and until 14 days after symptoms emerge, but revise periods subject to WHO advice) • Maintain safe shelter Phase 6 Infection Control

• Reduce medical and prevention services to emergencies and advice to free up time for critical activities • Enforce quarantine for employees displaying symptoms • Distribute antivirals, pneumococcal, and vaccines (if available) to 'key' employees • Provide clear instructions to persons with symptoms, infected family members, and those starting symptoms at work • Maintain contact with influenza advisors and update employees with information related to preventative measures and vaccine availability • Implement emergency hygiene measures - enforcing use of paper tissues, masks, alcohol swabs, etc era Phase 6 IT Systems

• Start teleworking for all appointed functions that haven’t already • Ensure there is sufficient IT support for all teleworking employees Phase 6 Buildings, facilities, Infrastructure & Suppliers

• Close all staff restaurants • Revise arrangements for bus shuttles • Restrict delivery of supplies to essential supplies only • Leisure areas to be closed • Maintain necessary changes in the ventilation system to avoid cross-contamination • Close internal mail system • Secure a reasonable emergency stock of drinking water and non-perishable food covering office consumption for a period of 30 days to cover emergency quarantine requirements Phase 6 Financial measures

• Analyse business impact to date against predicted impact and make appropriate adjustments • Monitor cost base in relation to income stream and respond to demands to reduce ATM costs from airlines with long-term perspective and thinking Eurocontrol medical service tasks

• classification of countries for missions: visit to Medical Service obligatory, recommended or not necessary

• Information on Intranet or in Info Flashes

• Information by telephone from the traveller in the event of medical problems after his/her return

• Storage of antiviral medication, masks, alcohol swabs, gloves

• Participation in crisis committee meetings

At the medical service Organisation activities of the medical service

– Annual medical checks and medical examinations on recruitment suspended.

– Emergency services provided

– During working hours a medical stand-by telephone line for staff and managers

Suspected cases at work

• flu-like symptoms : phone medical service to be - examined and/or - returned home (best possible preventive conditions)

• medical services not suitable for isolation measure! no presentation at the medical services : would put medical service premises in the front line as focus of infection, and completely paralyse medical activity

• any person in whose family suspicious symptoms appear advised to stay at home