Planning for Health Emergency Management

Planning for Health Emergency

Management

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


The differences:

Policy – what must be done

Guidelines – how to implement the policy – technical how

Procedures – how to implement the policy – administrative how

Protocols - step-by-step instructions to perform a given activity

Plan – who does what when to implement policy


The relationship:

Mandates are needed to set policies

Policies are needed to define guidelines and set procedures

Guidelines and procedures are needed to make plans

“Policy for health emergency management is set at thenational or sub-national level, it is executed at the locallevel”


Policy - All victims of all sorts of emergencies or disasters shall be searched, rescued, and managed timely and appropriately

Guidelines – Case Definition of victims; Guidelines on search, rescue, and case managementProcedures – Procedures of patient referral; emergency procurement of drugs and medicines

Plans - Emergency Manager responsible for triaging; Details on who does what, responsible persons; plan changes from one facility to another;

Example:


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THE CONTEXT OF COMMUNITY RISK MANAGEMENT

Public Safety

Risk ManagementHazard Prevention

Vulnerability ReductionEmergency Preparedness

Emergency ManagementDamage Assessment & Needs Analysis

Hospital Planning

Shelter & Security

Food & Nutrition

Epidemiology & Reporting

Media & Public Information

Control of Communicable Disease

Reproductive HealthPsychosocial Needs

Medical Supplies & Logistics

Water & Sanitation

Mass Casualty Management

Curative Care

Recovery and Rehabilitation

safer communities

+


Policy, guidelines, proceduresNational

level

Community level

Develop and implement

Preparedness programs

Vulnerability reduction plans

Emergency response plans

National & provincial levels = support communities in their work

Mobilise extra-resources

International org & assistance

Provinciallevel

Special plans

From Policy, Guidelines and Procedures to Community Plans


What are the Emergency Management Plans?

Emergency Preparedness Program/Plano Hazard Reduction Programo Vulnerability Reduction Programo Emergency Preparedness (Capacity Building Program)

Emergency Response Plan Contingency Plan Business Continuity Plan Recovery/Rehabilitation Plan


Defining the various plans:

National Plan –

multi-sectoral plan developed for the situations that are not under the direct responsibility of regional and local authorities coordination, resource mobilization, information management includes contingency plan includes all the regional plans



Regional Plan –

multi-sectoral plan developed for the situations that are not under the direct responsibility of local authorities coordination, resource mobilization, information management, service delivery includes contingency plan includes all the local plans



Local Plan –

multi-sectoral and multi-disciplinary plan developed for local situations operationalize the national policy and guidelines coordination, resource mobilization, information management, service delivery, etc. includes contingency plan includes business continuity plan


National Plan

Regional Plan

Regional Plan

Regional Plan

Local Plan

Local Plan

Local Plan

Local Plan

Local Plan

Local Plan


Community Risk Management Plan

Provincial EmergencyDisaster Plans

National Emergency Disaster Plan

HazardSpecific

Plans AgenciesSpecific Plans

(hospitals)

SectoralPlans

Intersectoral in nature

Context of emergency plans for a community


Disaster Management is:80% generic 15% specific 5% unique

to all disasters to the hazard to the event1. OrganizationEOC earthquake timecoordination large numbers of trapped and injured placecommunications large numbers of homeless and displaced weathertransport large numbers of dead and missinglogistics and supplies geographyinformation and media dead, injured and missing staff climatereporting and surveillance damaged critical infrastructure / resources (hospitals, vehicles)

loss of water, gas, electricity, phone, transport, fuel networks security2. Response loss of road, sea, air, rail infrastructure / accesssearch and rescue politics

evacuation long period of SAR, victim extraction economymass casualty management high demand for FA, stretchers, triage, medical transport governancemanagement of dead and missing high demand for beds, surgery, blood products, referral

security wound infections, amputations, tetanus, dust inhalation emergency management capacitytemporary shelter, clothing and utensils high demand for orthotics, prosthetics, disability, dental logistics capacityemergency 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 leadershipemergency engineering and public works high demand for psychosocial support of victims and staff solidaritymanagement of donated supplies / foreign teams morale

3. Recovery few outbreaks of communicable diseases corruptionvariable demand for medicines and equipment crime

curative and public health care (acute / chronic injury care - high, infectious disease - low, lootingeducation potentially unstable chronic disease - medium)agriculture compensation claimstrade and commerce contamination of water, air and soil insurance claims

toxic chemical, sewerage and gas leaks / spills4. Rehabilitation and Reconstruction urban fires, explosions ownership disputes

people contaminated, infested and unsafe foods property disputesproperty increased vector breedingserviceslivelihoods loss of livelihoods, markets, distribution networksenvironment

THIS IS WHAT WE PLAN FOR ….


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


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 responsibilitiescommunity members / groupsInstitutions 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


The following sectors are involved in the emergency planning process:

Essential Services

• communications• police• relief and rescue• health• social welfare

• transport• public works• also agriculture, media,

education, fire, ambulance, engineering, meteorology


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 patientsManagement of the dead and missing

Management of information (public information; support activities; health info system)

Mental healthEnvironmental healthReproductive healthPublic health programs (continuity of essential programs)


THE EMERGENCY PLANNING PROCESS


Elements of Hospital Preparedness, Response and Recovery Plan

I. BackgroundII. Plan descriptionIII. Goals and objectivesIV. Planning GroupV. Emergency Preparedness Plan

Hazards prevention Vulnerabilities reduction Risk reduction (capacity development)

VI. Management StructuresVII. Roles and responsibilities


Elements of Hospital Preparedness, Response and Recovery Plan

VIII. Response Plan Policies, guidelines, procedures, protocols for the

developed systems Response, Contingency, Business Continuity plan

IX. Recovery and Reconstruction Plan Damage Assessment and Needs Analysis Post-incident evaluation Recovery and rehabilitation Plan based on lessons

learnedX. Annexes

GlossaryAbbreviationsDirectory of contact personsInventory of resources of hospital and partner agenciesHospital policies, guidelines, protocols, and other issuances

relevant to emergency or disaster management


Form Planning Group

Hazard Analysis

Develop Strategies andSystems

Describe ManagementStructure

Describe Roles andResponsibilities

Emergency Planning

Process

Define the plan

Analyze resources

“Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

Vulnerability Analysis

Risk Analysis

Problems/Gaps Analysis


The Planning Process Determine the authority responsible for the process Establish a planning committee and objectives; management structure of the processAssign responsibilities Conduct a risk assessment - hazards and community vulnerabilities (core elements) Identify and analyse capacities and resources Stakeholders analysis Develop strategies, emergency management systems and arrangements Document the plan Test the plan; Disseminate the plan Review and update the plan on a regular basis


Background

1. Name of the agency and address

2. Geographic description (location: Low lying area? Etc.)

3. Demographic profile of catchments communities

4. Community Profile

5. Health statistics (IMR, MMR, etc.)

6. Health facilities found in the municipality/city

7. Available health services

8. Manpower complementation

9. Disasters responded/managed

10. Legal issuances establishing authority in HEM


Significance:

a. Picture of the site and location of the hospital

b. Catchments areas provided with hospital services

c. Health resources in and around the hospital

d. Existing capacity and capability of the hospital

e. Partner agencies around the hospital

f. Anticipated hazards as basis for hospitals’ capacity and capability building


Define Plan

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.


Plan Definition

Brief description of the content of the plan Specific intentions relevant to set goals and objectives. Include the coverage, scope and limitations. Include the legal basis whereby the hospital is authorized to act in disaster situations Legal issuances detailing the roles and functions of hospitals in managing all phases of emergencies or disasters


Scope of the Plan

Significance:Who will implement the planExtent of implementation including limitations

Goals and Objectives

Give the purpose of the plan from a broader to more specific perspectives.


Review Planning Group/Committee

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


Planning Group/Committee Planning Committee include major stakeholders Permanent or “AD HOC Group” which convenes only for

emergency planning purposes. This group shall be created through an order. Roles and functions of the planning group/committee

Develops, reviews and updates the HEPRRP Gathers required information and gain commitment of

key people and organizations Initiates testing of the plan for its functionality and

adaptability to current situation

i.


Example of Planning Committee Structure

Director/Designate

Representativefrom areas of

operation

Representative from

Administrative Division

Representative from Planning

Division

Representative from the

Finance Division


Risk 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/risk assessment / developing response and recovery strategies / mitigation


An integrated set of long-term, multi-sectoral development activities

Emergency Preparedness Program –

Reminder


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


ANATOMY OF COMMUNITY RISK MANAGEMENT

hazard

communityvulnerability

readiness

multisectoral, all hazards

Community risk

indicators: indicators:indicators:indicators:probabilityscale/magnitude/ strength/intensityspreadduration

biological hazards: season, infectivity, latency, transmission resistance, etc.natural phenomenafaminediseases of epidemic potentialevents/crowdsintoxificationinfestationstransport accidentsstructural failuresindustrial accidentschemical accidentspollutionrefugeeswarterrorism

Prevention & MitigationProgramme

=

=

People:access to health

caremeasles

vaccinationunder 5 nutritionunder 5 mortality

access to clean water

access to sanitation

adequate housingemployment/

incomefemale literacy

Property:health

infrastructurevehicles

medical supplies

Services:curative care

servicesambulance

servicespublic health

serviceshealth info system

Environment:water/soil/air

quality

Vulnerability Reduction Programme

policy, plans, proceduresknowledge, skills, attitudesresources

legislationnational & sectoral policyadministrative proceduresresponse & recovery planspreparedness planstechnical guidelinesmanagement structureinstitutional managementsinformation systemswarning systemshuman resourcesmaterial resourcesfinancial resourcessimulations & trainingeducationpublic informationcommunity participationresearchpublications

Emergency PreparednessProgramme

risk of:death

injury (mental/ physical)

disease (mental/physical)

loss of lifedisplacement

loss of propertyloss of income

secondary hazardsbreakdown in

securitydamage to

infrastructurebreakdown in

servicesContamination

Community Risk Management


Emergency Preparedness ProgramPlan to build response capacity:

1. Policies, Protocols, Guidelines and Procedures2. Plans3. People (Human Resource development)4. Promotion and Advocacy5. Partnership Building6. Physical (Facility Enhancement)7. Program Development8. Practices documentation9. Peso (Finance) and Logistics10. Package of Services


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


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


Assessment of Response Capacity of the Health Sectormandate 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


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 managemento resource managemento evacuationo specific situation such as hazardous material…


Emergency Response Plan

It is important to have Emergency Response Plan:

to have an orchestrated, timely, and appropriate response actions

to save lives and reduce sufferings of the affected population


Emergency Response Plan

A plan containing description of:

Responsibilities Command & coordination mechanism Management structures Resource management Information management and communication Training and exercises


Difference between Emergency Response Planning and Routine PlanningERP focuses on:

Coordination and management systems of resources from several sectorsemergency management and incident management systemsManagement 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?


Key characteristics of an ERP

Emergency Response Plan and Recovery Plan

an agreed set of arrangements forresponding to, andrecovering from emergencies

plans involve the description ofresponsibilitiesmanagement structuresresource and information managementLogistics managementTraining and exercises

plans focus on protecting life, property and environmentoutcomes


Core Elements of an Emergency Response Plan

Management Structures

Incident Commander

Public Info. Officer

Liaison Officer

Safety Officer

Operations Logistics PlanningAdministrative/Finance

“Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”


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

Emergency Response Plan Development



Emergency Response Policies, Guidelines, Procedures and Protocols

a.Activation of Code Alert Systemb.Activation of the Planc.Incident Command Systemd.Activation of the EOCe.Information Management Systemf.MHPSSg. Security systemh.Public Information Systemi. Coordination, networking and referral systemj. Provision of public health services



Emergency Management Policies, Guidelines, Procedures and Protocols

k. Infection Controll. System to upscale services in case of surge of patientsm. System on drills/simulation exercisesn. Stockpiling of emergency medicines and supplieso. Logistics management systemp. Decontamination proceduresq. Management of the dead and missing persons during disasters



Emergency Management Policies, Guidelines, Procedures and Protocols

p. restoration of critical servicesa.Electrical supply and back-up generatorsb.Drinking water supply and alternate sourcesc.Fuel reservesd.Back-up communication systeme.Wastewater and solid waste water treatmentf.Fire suppression

q. SOP on managing volunteers and donations


Recovery and Reconstruction Plan

Damage Assessment and Needs Analysis Post-incident Management Medium-term and long term recovery, reconstruction, and development plan Multi-sectoral initiative (education, agriculture, public works etc.)


Next Actions1. Write the Plan and have it approved by the head of the

agency. The Plan is not a plan until written and approved by the head of agency

2. Disseminate the plan to all the stakeholders and staff. Everyone needs to know the plan so that in emergency no one would ever say, “he does nothing cause he knows nothing”.

3. Test the plan. The plan is believed to be effective only when it is tested, be able to know its functionality, acceptability, and doability in the hands of the implementers.

4. Update the plan4. Implement the plan. 5. Monitor and evaluate the implementation of the plan6. Review and update the plan regularly.


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


Evaluate the PlanHow 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?


Other areas of enquiry:1. Timeliness (as well as appropriateness)

2. Connectedness (and coordination)

3. Coherence (fits into the medium and long term plans of the government)

4. Preparedness ( preparedness activities and the effectiveness of the activities undertaken)

5. Evaluating the effectiveness of emergency preparedness programmes in normal times


Outputs of the intersectoral emergency planning process

A set of emergency response plans – who does what when using existing capacity:

search and rescue planevacuation / temporary shelter planmass casualty plan / hospital planssectoral relief plans (food, water, health, lifelines etc.)security plansMitigation; EWS (MCM: all hazards)

A disaster recovery and reconstruction plan (education, agriculture, public works etc.)

INPUT PROCESS OUTPUTResource

RequirementStrategies/Activities

PerformanceIndicators

EVALUATION(Intervention)

EffectivenessEfficiency

RelevanceImpact

ConnectednessCoherence

Preparedness

CoverageTimeliness

OUT-COMEImpact

Indicators

MONITORING

Evaluation Process

INPUT PROCESS OUTPUTResource

Requirement

Strategies/Activities

PerformanceIndicators

EVALUATION(Intervention)

Effectiveness

Efficiency

RelevanceImpact

ConnectednessCoherence

Preparedness

CoverageTimeliness

OUT-COMEImpact

Indicators


Effectiveness achieving objectives doing the right thing right includes cost- effectiveness

Efficiency doing it right with as few resources as

possible (effort, time, money, people, material)


Relevance/Appropriateness doing the right thing in the right way at

the right time

Impact doing the right thing changing the situation more profoundly and in longer term

Coverage the extent to which interventions reach

the intended target population linked to effectiveness


Outcomes of the emergency planning processThe 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.)


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?


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


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


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….


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


Group Work Activity

Develop a Health Emergency Preparedness Program, Response Plan, and Recovery Plan for your respective area of responsibility:

1.Local Plan2.Regional Plan3.National Plan

For academic purposes, choose a hazard to work on (All- hazard Approach)


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


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Early warning information...links with Response Plans

The emergency response plans are useful only:when they are activated they are relevant and functionalThey 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)


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


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 ?


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)


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


THANK YOU

Planning for Health Emergency Management

Documents

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