Emergency Preparedness and Response to natural and man-made disasters

Emergency Preparedness and Response to natural and man-made disasters

Aim of section: to provide an awareness of the principles for the planning, testing and response to incidents and emergencies.

This section covers:

Definitions and principles
The public health emergency response
Organisational response to emergencies
National organisational response to emergencies

Definitions and principles

For emergency and incident planning purposes, an incident is an event or situation that requires a response from the emergency services (UK government emergency responder interoperability lexicon – see https://www.gov.uk/guidance/preparation-and-planning-for-emergencies-responsibilities-of-responder-agencies-and-others).

The following definition for an emergency is adapted from the UK Civil Contingencies Act 2004 - an event or situation that threatens serious damage to human welfare or the environment, or a war or act of terrorism that threatens serious damage to security.

In this context, emergencies would likely also trigger a major incident – an event or situation requiring a response under one or more of the emergency services’ major incident plans.

Events that threaten serious damage to property, destruction of assets and economic and social disruption could also be considered as emergencies.

The National Health Service (NHS) Commissioning organisation (NHS England) definition is more specific to the health service, and includes events that may significantly impact on service delivery or cause such numbers/types of casualty such that special arrangements need to be implemented by a service in order to maintain services. This is a wider definition and could include incidents that may only have an indirect impact on health, for example industrial action or prolonged loss of water supply to a hospital.

A disaster is a more serious event, defined as “A serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources” (United Nations Office for Disaster Risk Reduction, UNISDR Terminology and Disaster Risk Reduction, Geneva 2009). The exceedance of the affected community’s ability to cope is a critical differential point compared to an emergency, and external help will be required to restore functioning.

Whether an emergency results in disaster is context specific - disasters are often described as a result of the combination of: the exposure to a hazard; the conditions of vulnerability that are present; and insufficient capacity or measures to reduce or cope with the potential negative consequences (UNISDR 2009). Resilience and response of the community can prevent an emergency becoming a full-scale disaster.

Types of emergencies:

‘Man-made’ e.g. transport-related, terrorism
Natural e.g. flooding, earthquake
Can also be defined by speed of onset e.g. ‘big bang’ - sudden events such as bombings or earthquakes; ‘rising tide’ gradual events such as famine, infectious disease pandemics.

Emergency planning has been defined as an aspect of emergency management concerned with developing and maintaining procedures to prevent emergencies and to mitigate the impact when they occur. It is a systematic and ongoing/cyclical process which should evolve as lessons are learnt and circumstances change (UK government emergency responder interoperability lexicon. See

https://www.gov.uk/guidance/preparation-and-planning-for-emergencies-responsibilities-of-responder-agencies-and-others).

Preparedness is the step beyond planning, implies a plan is in place, and has been tested: organisations and individuals are clear about their roles and responsibilities.

Types of responders:

In the UK, the Civil Contingencies Act 2004 (CCA) defines two categories or responders, with different roles and responsibilities when planning for and responding to emergencies:

Category 1 responders are agencies core to civil protection – emergency services, local government, acute hospitals and emergency departments, health service managers, public health agency, the environment agency, maritime and coastguard agency, port health authority
Category 2 responders have a role to co-operate to support the main effort – utility companies, highway authorities, railway, harbour and airport operators, health and safety executive, primary care organisations
The military are not categorised here because the Act governs responses to civil emergencies
Category 1 & 2 responders have a duty to cooperate and share information for the purpose of civil protection. Category 1 responders have additional duties to put in place emergency plans, business continuity arrangements, arrangements to keep the public informed during emergencies, and to provide advice and assistance to local business and voluntary agencies about business continuity.

The public health emergency response:

Before the emergency

Build resilience:

Build surveillance and forecasting systems so events can be detected early and their effects mitigated
Advocacy for political commitment to planning for emergencies to ensure commitment and the needed resources from all necessary partners at a high level. This includes non-health service partners.
Business continuity management systematically appraises potential organisational risks, threats and vulnerabilities and pro-actively plans to mitigate their effects, providing a framework for maintaining resilience and capability for an effective response.

Plan an effective response:

Develop a risk profile to determine which potential emergencies you should prioritise for planning
Plan how to minimise the impact of the emergency: what immediate actions can be taken, e.g. how will you know an event is an emergency (different services have usually defined situations that constitute an emergency or major incident), and how will you be alerted? What remedial actions can then be taken to reduce effects? What is the recovery plan following these actions?
Prioritise 3 groups in the plans: the vulnerable (less resilient in an emergency), the victims (direct, e.g. injured, and indirect, e.g. bereaved families), and the responders (consideration for welfare)
Define roles and responsibilities of partners in an emergency. In the UK the CCA 2004 legislation outlines the roles, responsibilities and powers of agencies in an emergency.
Decisions should be taken at the lowest appropriate level, with co-ordination at the highest necessary level, i.e. response should be as local as possible, with higher level of response only if necessary for resources or coordination
Establish lines of communication to other agencies and the public for use during the emergency response
Multi-agency planning exercises and drills to test protocols – move from paper planning to preparedness. Emergency plans should specify training and exercises required for preparedness.
Train responders
Maintain plans – they must be kept up to date.

(UK government emergency planning resources see https://www.gov.uk/guidance/preparation-and-planning-for-emergencies-the-capabilities-programme)

During the emergency

(adapted from J. Hawker. Communicable Disease Control Handbook. Blackwell 2005)

Gather information:

Details of incident: what type of incident; where and when; source of contamination/chemical/infection; what chemical/agent is involved (see the METHANE acronym at the end of this section)?
Adverse health effects or complaints: How many exposed; how many affected; what symptoms; how serious; decontamination started or not; antidotes or first aid given; weather conditions if plume?
Initial response: What agencies are involved; what are the command and control arrangements; should other agencies be called; is the site secure; has sheltering or evacuation been advised; what has been said to the media?

Assess risk to health:

Review health effects and exposure pathways (obtain expert clinical/toxicological advice, weather modelling of plume)
Define affected population
Consider sampling persons, animals, environment
Establish register of exposed/symptomatic persons.

Response:

Biological, chemical, or radiation release hazard: hazard containment, decontamination then primary treatment of victims, countermeasures, follow up
Infectious epidemic: containment by case detection and isolation and contact tracing, control measures, prophylaxis for exposed, arrange definitive treatment of cases, follow up.

Communications:

Advise partner agencies and professionals via a STAC (see below)
Media (statement/press release/briefings)
Public (telephone helpline)

Post acute-phase response – activate recovery plans:

Site clean up
Clinical follow up of those affected
Initiate epidemiological study

After the emergency

Long-term follow up/surveillance of cases/exposed and analytic study

Lessons learnt:

Written report
Audit of response
Review and revision of plans

Organisational response to emergencies

(Adapted from J. Hawker. Communicable Disease Control Handbook. Blackwell 2005)

In the UK there is an agreed framework to ensure a multi-agency combined and coordinated response.

The management of an emergency will involve one or more of 3 levels of coordination, command and control for emergency incidents:

Bronze (operational): on-scene responders
Silver (tactical): near to scene directing response and allocating resources
Gold (strategic): off-site e.g. at headquarters coordinating multi-agency response. Attended by senior representatives from responding agencies; they must be able to commit to decisions and expenditure.

A ‘bottom up’ approach (bronze upwards) is taken, as not all emergencies will require multi-agency strategic or on scene tactical coordination.

The Gold command is supported by a team providing health advice - Scientific and Technical Advisory Cell (STAC) in the UK. It is chaired by a senior public health consultant, e.g. Director of Public Health, or Consultant in Communicable Disease Control/Consultant in Health Protection. There should be multi-agency representation from the health services/commissioners.

Role of the STAC:

Provide understandable scientific and technical advice during the response to the emergency
Advise on impact on health of the population, and health impact of containment or evacuation policies
Agree all media statements and advice to the public related to health with the Gold command chair
Liaise with national departments of (public) health, other national and local agencies
Formulate advice to health professionals, e.g. ambulance service, primary care
Formulates advice on strategic management of the health service response.

National organisational response to emergencies

(Scientific advice and evidence in emergencies – UK Science and Technology Committee http://www.publications.parliament.uk/pa/cm201011/cmselect/cmsctech/498/49806.htm)

Where there are (or there is the potential to be) more than one emergency response over several regions, a further level of strategic oversight exists in the UK. The Cabinet Office Briefing Rooms (COBR) takes the strategic lead and is a forum of Ministers and senior officials from relevant Departments and agencies, brought together to make decisions on an emergency response. External representatives and experts are invited to attend COBR meetings as appropriate; discussions are confidential. COBR should facilitate rapid coordination of the Central Government response and effective decision-making. In an emergency where a central response is required, a Lead Government Department (LGD) is appointed. The LGD is responsible for ensuring that appropriate plans exist to manage the emergency, for ensuring that adequate resources are available and for leading on public and parliamentary handling. LGDs are also responsible for ensuring they have effective arrangements to access scientific and technical advice in a timely fashion in an emergency. This may involve establishing a Science Advisory Group for Emergencies (SAGE).

Acronym

M – Major Incident Declared?

E – Exact Location

T – Type of Incident

H – Hazards present or suspected

A – Access – routes that are safe to use

N – Number, type and severity of casualties

E – Emergency services present, and those required