2. Planning for Health Emergency Management First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

3. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Learning Objectives By the end of this module, the participant should be able to:  Describe the steps of emergency response planning process in terms of inputs, outputs and outcomes  Create flowcharts for emergency response planning  To identify the various plans that must be developed and the harmonization between them

4. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Quick brain storming……  What is an emergency response plan?  Why to develop emergency response and recovery plans?  How are emergency response planning processes different from routine planning processes for the health sector?

5. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman  An integrated set of long-term, multi- sectoral development activities Emergency Preparedness Program – Reminder

6. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Goal: to achieve an increasing level of “readiness” within communities to cope with any situation which demands an emergency response, using their own resources. This requires the development and maintenance of : 1.Political authority, policy for EM 2.Plans and Procedures for EM and Recovery training and education 3.Institutional and human resources for EM 4.Public awareness & education 5.System for the collection, analysis and distribution of information related to emergencies Emergency Preparedness Program

7. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Just remember the overall context……. Public Safety Risk ManagementEmergency Management Hazard Reduction Vulnerability Reduction Emergency Preparedness Damage Assessment & Needs Analysis Epidemiology and Reporting Mass Casualty Management Hospital Planning Curative Care Shelter and Security Water and Sanitation Control of Communicable Disease Food and Nutrition Reproductive Health Psychosocial Needs Medical Supplies and Logisics Media and Public Information Recovery and Rehabilitation safer communities + Response plans

8. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Difference between Emergency Response Planning and Routine Planning  ERP focuses on: Coordination and management systems of resources from several sectors emergency management and incident management systems Management of information  arrangements for intra-sectoral and inter-sectoral coordination of activities and mobilization of resources (surge capacity)  What are the characteristics of routine planning in your field of activity?

9. Quick brain storming……  What may be the different activities, situations and risks….that the Health Sector must think of when developing response plan and contingency plans ?  With what the response plan of the Health Sector must deal with ?

10. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Health Sector Response Plan must deal with…..  Casualty management (first aid, triage, transport, pre-hospital care, in-patient care, out-patient care)  Communicable disease control (surveillance, tracking, treatment, prophylaxis, isolation and quarantine)  Continuity of delivery of critical services for emergency patients  Management of the dead and missing  Management of information (public information; support activities; health info system)  Mental health  Environmental health  Reproductive health  Public health programs (continuity of essential programs)

11. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Planning for Emergencies Planning based on risk analysis is planning for any emergency, by predicting:  what might happen  when it might happen  where it might occur  how big it might be  what effect it might have  how long it might last (emergency + recovery period)  What are the strategies to respond and recover

12. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Disaster Management is: 80% generic15% specific5% unique to all disastersto the hazardto the event 1. Organization EOC earthquake time coordination large numbers of trapped and injured place communications large numbers of homeless and displaced weather transport large numbers of dead and missing logistics and suppliesgeography information and media dead, injured and missing staff climate reporting and surveillance damaged critical infrastructure / resources (hospitals, vehicles) loss of water, gas, electricity, phone, transport, fuel networks security 2. Response loss of road, sea, air, rail infrastructure / access search and rescuepolitics evacuation long period of SAR, victim extraction economy mass casualty management high demand for FA, stretchers, triage, medical transport governance management of dead and missing high demand for beds, surgery, blood products, referral security wound infections, amputations, tetanus, dust inhalation emergency management capacity temporary shelter, clothing and utensils high demand for orthotics, prosthetics, disability, dental logistics capacity emergency water, sanitation and energy demand for specialized spinal and head injury care disposal of inappropriate donations emergency food supplies high demand for temporary shelter, food, utensils, stoves, emergency public and environmental health water, energy, clothing, tents, blankets leadership emergency engineering and public works high demand for psychosocial support of victims and staff solidarity management of donated supplies / foreign teamsmorale 3. Recovery few outbreaks of communicable diseases corruption variable demand for medicines and equipment crime curative and public health care (acute / chronic injury care - high, infectious disease - low, looting education potentially unstable chronic disease - medium) agriculturecompensation claims trade and commerce contamination of water, air and soil insurance claims toxic chemical, sewerage and gas leaks / spills 4. Rehabilitation and Reconstruction urban fires, explosions ownership disputes people contaminated, infested and unsafe foods property disputes property increased vector breeding services livelihoods loss of livelihoods, markets, distribution networks environment THIS IS WHAT WE PLAN FOR ….

13. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Key characteristics of an ERP Emergency Response Plan and Recovery Plan  an agreed set of arrangements for responding to, and recovering from emergencies  plans involve the description of responsibilities management structures resource and information management Logistics management Training and exercises  plans focus on protecting life, property and environment  outcomes

14. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman A response plan will define and discuss : a line of authority and clear responsibilities of all the stakeholders involved the management systems: ICP; EOC; EEC the communications system alert and warning mechanisms public information arrangements resource management (human, financial and material) Monitoring, reporting and accounting arrangements Core Elements of an Emergency Response Plan

15. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Main characteristics  Clear responsibilities (who, what, when, how, with whom, where)  All key stakeholders need to be involved in the planning process, including: agencies with disaster responsibilities community members / groups Institutions and legal authorities  Relevant to emergency events: large scale; complex; relatively rare; hard to predict  Consequences of poor decisions can be acute  Scrutiny of mistakes is often in detail and in public

16. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Community Risk Management Plan Provincial Emergency Disaster Plans National Emergency Disaster Plan Hazard Specific Plans Agencies Specific Plans (hospitals) Sectoral Plans Intersectoral in nature Context of emergency plans for a community

17. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman The following sectors are involved in the emergency planning process: How these sectors can contribute to the development of the health sector response plan? Essential Services communications police relief and rescue health social welfare transport public works also agriculture, media, education, fire, ambulance, engineering, meteorology

18. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Policy, guidelines, standards National level National level Communities Should be allowed Communities Should be allowed Develop and implement Preparedness activities Vulnerability reduction plans Emergency response plans National & provincial levels = support communities in their work Mobilise extra-resources International org & assistance Provincial level Provincial level Emergency Preparedness Program Mitigation plans Rehabilitation and recovery plans Policy - Guidelines – Standards – Community Plans and Role of the MOH

19. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman The Roles of National Government (1) The role of national authorities is to support local planning processes by establishing the planning framework:  setting national policies for risk reduction, emergency preparedness, emergency response and disaster recovery  issuing technical guidelines and administrative procedures for the process of planning and for the implementation of the policy (contents of the plans, etc.)  developing national plans (multi-sectoral; sectoral; contingency) for those situations that are not under the direct responsibility of local authorities

20. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman The Roles of National Government (2)  developing procedures for how national resources can be deployed in an emergency  allocating funds to support the development of new local capacity and for local risk reduction  planning for those hazards that are not the primary responsibility of local government e.g. Security  international cooperation and assistance WHAT ARE THE PRESENT CONSTRAINTS IN YOUR COUNTRY ?

21. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Main responsibilities of MOH in emergency planning  Reduce the vulnerabilities of its own infrastructures andsystems: hospital mitigation; EMS System; etc.  Raise awareness first of the health staff then of the general public (in collaboration with other sectors)  Reduce health consequences of crisis and major emergencies (core function of the health sector). A “health emergency management program/unit” should be institutionalised within the MOH; development of emergency response plans  Assume its normative role and lead function (guidance) in health (emergency preparedness and risk management)

22. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Overall strategy of the MOH  Integration strategy  Vulnerability reduction and hazard mitigation  Community risk management framework  Inter-sectoral cooperation  Planning based on existing resources (all types)  Decentralization of the response capacity  Community participation (and end-users)  Institutionalization of an emergency/disaster Unit within the MOH

23. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman THE EMERGENCY PLANNING PROCESS

24. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman The Process

25. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman The Planning Process  Determine the authority responsible for the process  Establish a planning committee and objectives; management structure of the process  Conduct a risk assessment - hazards and community vulnerabilities (core elements)  Assign responsibilities  Identify and analyse capacities and resources  Develop the emergency management systems and arrangements  Document the plan  Test the plan; Review and update the plan on a regular basis

26. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Outputs of the intersectoral emergency planning process  A set of emergency response plans – who does what when using existing capacity: search and rescue plan evacuation / temporary shelter plan mass casualty plan / hospital plans sectoral relief plans (food, water, health, lifelines etc.) security plans Mitigation; EWS (MCM: all hazards)  A disaster recovery and reconstruction plan (education, agriculture, public works etc.)

27. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Outcomes of the emergency planning process The planning process is a sequence of steps whereby a planning entity (e.g. government, community) agrees on ways to enhance and protect its own safety. It is an interactive and iterative process that should lead to:  better understanding of the roles and responsibilities of all members of the community in prevention, mitigation, and response  greater awareness of risk reduction in the community  higher levels of readiness to respond and to recover  an emergency response plan and a recovery plan (and contingency plans when relevant)  increased public safety (including for the health sector such as safer hospitals, etc.)

28. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Evaluate the Plan How do we know a plan is a functional plan?  it meets the national planning criteria and policy ?  it conforms to the national planning format ?  it has been developed through a true emergency planning process (from vulnerability analysis up to participation of end-users) ?  it is tested, validated and regularly exercised ?  all key staff are familiar with the details of the plan and know their responsibilities ?  WHAT DO YOU WANT TO ADD?

29. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman After the Plan has been developed It is essential to:  simulate an emergency to test the plan  familiarise all staff with the plan  brief all new staff about the plan  familiarise local government, emergency services and the community with the plan  train those staff with special roles and responsibilities in the plan  review and update the plan after an emergency, after each simulation and whenever new resources are acquired  conduct regular exercises

30. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Common Planning Mistakes  the plan (paper document) is given more importance than the planning process itself  not key community members (or staff of the institutional plan) are aware of the existence of a plan  revision is overlooked  emergency planning is not integrated into normal activities (integration strategy) whenever possible  different plans are developed for different hazards by different agencies – the all hazards approach should be preferred (no synergy; no compatibility)  no or weak training programs  what do you want to add?

31. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Common Planning Mistakes Plans are out of date as soon as they are published PLANS NEED REGULAR REVIEW Procedures, policies and guidelines are needed to guide the planning process at local level

32. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Organizational Capacity  implemented selectively by those agencies which have been delegated that responsibility by the Government or by the community  it is vital that…..agencies……  professionally managed  adequately resourced  highly trained  demonstrated competence  emergency management family

33. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Emergency Risk Management – Principles for Agencies goal : to increase efficiency, effectiveness, readiness and integration of the agency into the overall organization of the emergency management process and system

34. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Principles for Agencies and emergency planning needs Objectives :  to improve the decision making process at all levels (within agency)  to facilitate the choice of the most suitable strategies  to rely on specific decision making procedures  to ensure efficient communication : – internal and external  to ensure safety and well being of staff /community  to promote and preserve the activities efficiency : synergy, complementarities, adaptability, cooperation  to promote adequate training : personnel / exercises….

35. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Define the ERM policy of the Agency Enter the planning process (ERM) Allocation of required resources of all kind Implementation: activities – role - functions Monitoring – reevaluation process ERM process for an Agency Risk management and Planning - Principles for Agencies

36. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Group Work Activity……20 minutes As part of an overall emergency response plan for the Asian Games, you are requested to prepare the Health Sector Response Plan……. Instructions as follows: 1.to identify a city in one country of your choice 2.to discuss potential problems, which can impact on health in this city 3.to identify the stakeholders who will be involved to contribute to the management of these health problems 4.to identify the key headings of the components of your Emergency Response Plan (for Health Sector in this city)

37. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Updating the information on hazard and vulnerabilities... Why Emergency Response Plans must be regularly revised ?  update the current political, social and economic situation  update hazard reduction, emergency preparedness and vulnerability reduction activities in all sectors and by all organisations  update changes in resources, systems and procedures  update early warning information system

38. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Assessment of Response Capacity of the Health Sector  mandate and authority to deliver relief (scope of responsibility)  management and command structure (coordination among stakeholders)  competencies of staff (knowledge and skills and ability)  the availability and accessibility of information  the existence and relevance of plans  the existence and relevance of procedures  the networking of the plans of the Health Sector with the plans of the other sectors

39. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 38 Early warning information...links with Response Plans The emergency response plans are useful only :  when they are activated  they are relevant and functional  They are efficiently used So the early activation of the response plans is essential. In many emergencies there is a time frame which allows for early activation (floods; displacement of populations; anticipated cold wave, start of an outbreak, etc.) and for developing further mitigation measures (early warning is critical)

40. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman THE STEPS ONE BY ONE

41. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Step 1: Define Project  Determine the aim, objectives and scope of the planning process  Identify the tasks to be performed, and the resources needed  Identification of the framework in which emergencies will be managed  legislation policy and guidelines must be considered  and the resources that will be required:  stakeholders / agencies, etc.

42. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Step 2: Review Planning Group  Key Stake-holders to be represented  multi-disciplinary teams are essential to ensure sufficient expertise  must have appropriate authority  political and economic circumstances may influence choice of members  social and cultural issues must be considered  there must be an efficient reporting system

43. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Step 3: Potential Problem Analysis  planning group should know result of vulnerability analysis (at least core elements)  technique for identifying preventive and mitigation strategies; response and recovery strategies for identified problems  systematic breakdown of the problem into its components  techniques involves: o hazard analysis / vulnerability assessment / developing response and recovery strategies / mitigation

44. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Step 4: Resource Analysis why?  to ensure that PRR strategies can be supported  to ensure that preparedness is coordinated  to ensure cooperation between agencies  to know who is responsible for supplying

45. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Step 5: Roles and Responsibilities  should be defined & described to ensure that each organization knows precisely what is expected of it and that everyone is aware of the general roles of all relevant organizations  multi-sectoral approach for national disaster plan  key issues: o Information management o resource management o evacuation o specific situation such as hazardous material…

46. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman THANK YOU