IMproving Preparedness and Response of HEalth Services in major criseS

Ioannis Galatas, George Eftychidis, George Leventakis, Ilias GkotsisCenter for Security Studies (KEMEA), Athens, GreeceFP

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The Challenge

Current health emergency management systems consist of

disconnected command & control operationslacking of

appropriate coordination mechanismsfor the actions of their composing services

that will allow them to reform intoan effective, multi-faceted crisis response mechanism

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IMPRESS aims to advance the preparedness of emergency medical services

(health emergency operations centers, ambulance dispatch centers, hospitals

ED, first responders and volunteer communities etc) through:

planning for all-hazards;

increasing surge capacity;

tracking the availability of beds and other hospital resources using

electronic systems;

Monitoring health emergency operations and

developing systems that are interoperable between the involved

response actors

The general objective

is to provide preparedness and response capabilities through guidelines and

tools applicable in disaster scenarios

Aims & objective

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Re-balance the disproportion between response needs and health

system capacity, through proper mobilization of additional resources (material,

logistics and health personnel) and enhanced organization (e.g. e-triage,

interoperability of health services)

Remediate the information deficit with rapid collection of relevant

data and exchange of adequate information

Support decision making according to the impact of crisis and incident

type to the health status of the community

Improve the response and preparedness level of HS based

on efficient planning, integral organization and comprehensive training, using

interoperable tools and systems

Enhance interoperability within the same and among different EMS

organizations using common taxonomy and providing stakeholders in the emergency

response domain with a compatible operational framework

Objectives’ analysis

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Disasters’

Taxonomy

Response/

Ambulance

Injured Non-injuredED Specialized Units Other Sections

First Responders

EOC

EU

Customized response

according to disaster type

Stakeholders

CIV-MIL

Incident

Command Zone

Resources

Concept & Stakeholders

Dis.Med. @ Incident Scene

1

2

Hospital ED

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LOGEVO (LOGistics EVOlution)

a suite enabling the use of

models for the logistics of

health care resources

WARSYS (WARehouse SYStem)

a database with real time

medical & logistics information

from available repositories

SICKEVO (SICK patients

physiological EVOlution forecast)

addressing physiologic trajectory

assessment and forecast

SORLOC (SOuRce LOCalization)

module for localizing likely

exposure in Chemical and

Radiological incidents and

contaminants spread in case of

epidemics

High level architecture

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Nuclear weapons

Radiological dispersal devices (RDDs);

Radiological emitting devices (REDs);

Nuclear power plants’ accidents; R-waste depots

Biological warfare agents (BWAs);

Toxins;

Pandemics

Chemical warfare agents (CWAs);

Toxic industrial chemicals (TICs)

CBRNE threats

Low/high level explosives;

IEDs

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CBRNE targets

Population density

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CBRNE targets

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Moments after a CRE incident

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Medical disaster response

CZ HHZ

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Medical CRE response

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CBRNE stress factors

CHEMICAL BIOLOGICAL RADIOLOGICAL

Difficult, time-consuming

identification

BA not perceivable Cannot be noticed

Genetic effects Specialized LABs Hard to control

Carcinogenic Incubation period Children – pregnant

Limitation of personal

freedom

Delayed effects

Hereditary defects

Carcinogenic

Affecting both

Citizens & Responders

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Urban canyons

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CBRNE

FP7 - SEC-2013.4.1-4. GA. 608078

PARAMETERS DISASTER CRE DISASTER

IMPACT Local Massive

ZONES HZCZ HZWZCZ

AREA OF

OPERATIONS

Non-contaminated

Non-lethal

Contaminated

Lethal

VICTIMS Save ALL Save NOT ALL

HOSPITALS Dedicated ALL hospitals/clinics

WORRIED-WELL None 1:5

AFTERMATH Restoration Ghost city (R)

Long lasting (C)

Genetic/carcinogenic

Medical CRE response

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Contaminated plume

CBRNE

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Exercises/drills

Earthquake

Flooding

Tunnel explosion

Wildfire @

Palermo waste

dump

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CBRNEPalermo waste dump fire: July 29 – Aug 17, 2012

Day 1

Palermo District «Borgo»

160,000 inhabitants

504,000 m2

Day 2

Day 3

Day 4

Day 5

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- Bellolampo fire data will be used to validate IMPRESS emergency response modeling. Toxic cloud dispersion simulation will be also validated against Bellolampo fire data

- For the IMPRESS scenario will be simulated sudden release of high concentrations of toxic compounds from a tank fire developing on-board a ship moored in the Palermo harbor

- The test area, supposed to be affected, is the Palermo District “Kalsa” sized 0.8 km2 which includes several institutional buildings such as the Marine Institute, the Harbor Authority, and the Customs Office, the administrative offices of the University of Palermo, a private hospital and a church

- The areas in the Warm zone are suitable for triage, evacuation and landing of helicopters. The nearest hospital is 2 km away and is accessible directly through the seafront boulevard.

Field test of IMPRESS against Chem Acc

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According to the planned test

- the fire developing on-board the ship shall produce a toxic cloud

- The cloud due to the wind blowing from NE will be spread over the Kalsadistrict

- the IMPRESS modules will be activated

- at the Emergency Service,

- Emergency Department of local hospitals and

- at the National Health Service Operation center

for managing the public health aspects of the incident

- the Italian Civil protection Agency (PCI) shall coordinate the operations

System components

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The IMPRESS modules will be demonstrated/tested as follows:

SORLOC module is used to identify the distribution of potential patient flow, linked withthe distribution pattern of the toxic smoke cloud. Information will be shared with theNHS and the ED departments of the relative hospitals

WARSYS is accessed by authorized users of the involved authorities (NHS and EMS) toretrieve data concerning real time medical and logistics information.

SICKEVO shall provide physiological forecast of patients’ status evolution to the EMS andto the ED of relevant hospitals in order to support relevant decisions

LOGEVO module will support at the NHS and EMS level the monitoring and logistics ofhealth care resources

INCIMAG shall be used to exchange information regarding the incident/situation, receivedata and develop the situational picture (victim health status resource availability ) andreceive prediction of the scenario evolution based on the taken decision (calls toSICKEVO, LOGEVO,…,)

INCIMOB will provide field data collection and management support allowing theinsertion of patient data, exchanging and recording Triage data and displaying the actualsituational picture

IMPRESS components to be tested

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Thank you for your attention!

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