The Public Safety Risk Management Framework

The basis for designing EHA training courses in WPRO

security

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art and culture

The Greek Temple Model of Society

Sustainable Human Development

health, education, governance, livelihoods, environment (security)

Public Safety

Risk Management + Emergency Management

Vulnerability Reduction + Hazard Prevention and Mitigation

+Emergency Preparedness

(readiness) + Emergency Relief (response and recovery)

Reconstruction and Rehabilitation Disaster Emergencies Non Disaster Emergencies

for example

Earthquakes Epidemics

individuals

populations

Hazards

Risks

Emergencies

national local

War / Complex Emergencies

Disaster emergencies

Non-disaster emergencies Personal Injury

Pollution Mass Casualty Events Epidemics Refugees Local flooding

Industrial Accidents Transport Accidents Civil strife Urban Fires

level of authority

loss of control

Indicators for monitoring risk reduction

Prevalence of disasters General impact of disasters = Hazard specific mortality + Hazard specific morbidity

hazard prevalence injuries, disability, diseaseevents/province/year mortality rate flood mortality rate flood injury rateaffected/province/year fatality rate flood fatality rate flood disability rate

lethality rate flood lethality rate flood disease ratehazard conversion rate deaths/100000 population/year flood deaths/100000 population/year flood cases/100000 population/year

disasters/total hazard events/year deaths/100000 affected/year flood deaths/100000 affected/year flood cases/100000 affected/yearflood disasters/total floods/year deaths/disaster event deaths/flood event cases/flood event

report EXCESS cases

evaluate as 10 year rolling averages

Other indicators economic datasocial dataagricultural dataeducation data

Prevention and Mitigation Programme + Vulnerability Reduction

Programme +Emergency

Preparedness Programme

= Community Risk Management

safer communities

Risks are the potential outcomes from the exposure of communities to hazardsPublic safety risk is:

How do we assess proportional toRisk ? hazard X vulnerabilities

readiness

Determinants:quality hazard is a determinant of the TYPES of risks (death, disease etc)

quantity vulnerabilities/readiness are determinants of HOW MUCH risk (risk modifiers)vulnerability determines pre-impact risksreadiness determines post impact risks

Goal the goal of a community risk management programme is toenhance public safety in communities

Outcome Public safety risks are reduced by:

reducing exposure to hazards (hazard mitigation/prevention)

AND

reducing vulnerabilities in communities (of people, property, services, livelihoods, environment)

AND

increasing readiness of responders

Public Safety

Emergency Management Risk ManagementPersonal Injury Hazard Reduction

Non-disaster Emergencies + Vulnerability ReductionDisaster Emergencies Emergency Preparedness

National Security

safer communities

Public Safety Risk

Management

Public Safety

Emergency Management Risk ManagementRelief Emergency Hazard ReductionReconstruction Preparedness Vulnerability ReductionRehabilitation Readiness to Respond

safer communities

Public Safety Risk

Management

Public Safety

Risk Management + Emergency ManagementHazard Reduction Damage Assessment and Needs Analysis

Vulnerability Reduction Epidemiology and ReportingEmergency Preparedness Mass Casualty Management

Hospital PlanningCurative Care

Shelter and SecurityWater and Sanitation

Control of Communicable DiseaseFood and Nutrition

Reproductive HealthPsychosocial Needs

Medical Supplies and LogisticsMedia and Public Information

Recovery and Rehabilitation

safer communities

Disaster Management is:80% generic 15% specific 5% uniqueto all disasters to the hazard to the event

1. OrganisationEOC 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 infrastruture/resources (hospitals, vehicles)

loss of water, gas, electricity, phone, transport, fuel networks security2. Response loss of road, sea, air, rail infrastructutre / accesssearch and rescue politicsevacuation 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, referralsecurity 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 specialised spinal and head injury care disposal of inappropriate donationsemergency 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 corruptionlifelines variable demand for medicines and equipment crimecurative 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 disputespeople contaminated, infested and unsafe foods property disputesproperty increased vector breedingserviceslivelihoods loss of livelihoods, markets, distribution networksenvironment

THIS IS WHAT WE PLAN FOR ….

Definitions of Types of Emergencieshazards + community risks (consequences) type of emergency

natural hazards hydro metereological death mass casualty event

storms people injury (mental and physical) epidemicfloods disease (mental and physical)

extreme temperaturesdrought + +

geological secondary hazards (fire, disease)earthquakes displacement

slides services loss of propertyvolcano infrastructure loss of income disaster

other natural environment breakdown in securityforest fires livelihoods damage to infrastructure

technological hazards breakdown in essential servicesindustrial accidentstransport accidents + +

structural failuresurban fires

biological hazardsdiseases of epidemic potential social environment breakdown in social, economic

infestations economic environment and political structures complex emergencysocietal hazards political environment

faminecivil strife

warterrorism

communityhazard x vulnerability / readiness = Community Risks

risk quality risk quantity risk quantityindicators: indicators: indicators: indicators:

natural hazards people: laws, policy, guidelines, procedures probability of:biological hazards: access to health care authority, resources, plans deathtechnological hazards measles vaccination knowledge, skills, attitudes injury (mental and physical)societal hazards under 5 nutrition multisectoral, all hazards disease (mental and physical)1. probability of occurrence under 5 mortality legislation2. scale: magnitude, intensity access to clean water national and sectoral policy loss of lifelines ie3. area, spread, duration access to sanitation administrative procedures (shelter, water, food, energy)

biological hazards: adequate housing response and recovery plans population displacementsseason, infectivity, latency employment/income preparedness plans loss of propertytransmission, resistance, etc female literacy technical guidelines loss of income earthquakes property: management structure floods/storms health infrastructure institutional arrangements secondary hazards famine vehicles information systems breakdown in security diseases of epidemic potential medical equipment/supplies warning systems damage to infrastructure events/crowds services: human resources breakdown in services intoxification curative care services material resources environmental contamination infestations ambulance services financial resources etc transport accidents public health services simulations and training structural failures health information system education industrial accidents livelihoods: public information pollution formal community participation Monitor and evaluate by following refugees informal research hazard specific rates and trends: war environment: publications events/year terrorism natural/built/urban/rural private sector role cases and deaths/100000/year

water/soil/air quality cases and deaths/1000 affected/yearvector habitats cases and deaths/event/year

forestry, agriculture EXCESS injuries; disease; disabilityPrevention and

Mitigation Programme

+ Vulnerability Reduction Programme +

Emergency Preparedness Programme

= Community Risk Management

Health Needs in an EmergencyTime-frame General Needs Health Sector Responsibilitiesfirst search and rescue safe extraction, resuscitation and first aid

24 evacuation / shelter triage and transport system

hours food primary medical carewater detoxification /decontaminationpublic information system acute medical and surgical care (first line and referral)

ency coordination, communication, logistics and reporting systems (including injury and disability registers)

end of security emergency epidemiological surveillance for VBD, VPD, DEP, DPHS

first week energy (fuel, heating, light etc.) treatment and control of cases of VBD, VPD, DEP, DPHS, PUCDenvironmental health services: strengthen blood banks and laboratories (diagnosis, confirmation, referral) * vector control strengthen burns, spinal/head injury, orthotics/prosthetics, dental services * personal hygiene strengthen referral system - curative and obstetric services

* sanitation, waste disposal etc. nutrition surveillance and support (including micronutrient supplementation)

dead and missing (emergency measles vaccination and Vitamin A)

end of protection (legal and physical) (re) establishment of the health information system

first month employment restoration of preventative health care services such as EPI, MCH, etc.public transport restoration of priority disease control programmes such as TB, malaria etc.public communications restoration for services of non-communicable diseases/obstetricspsychosocial services care of the disabled (mental and physical)

end of education reconstruction and rehabilitation

3 months agriculture specific training programmesenvironmental protection health information campaigns/health education programmes

disability and psychosocial carecompensation/reconstruction evaluation of lessons learnedrestitution/rehabilitation revision of policies, guidelines, procedures and plansprevention and preparedness upgrade knowledge and skills, change attitudes and practices

PHEMAP Course Logical Framework1 Impact of hazards in Asia and the Pacific

2 Risk Management Policy 3 Emergency Management Policy

3.1 Health effects of hazards

3.2 Health sector priorities

6 Emergency Preparedness 4 Emergency Response 5 Recovery

4.1 Damage and needs assessment

4.2 Epidemiology and reporting

4.3 Public information4.4 Medical supplies and logistics

4.5 hospital planning

4.6 mass casualty management

4.7 control of communicable diseases

4.8 environmental health

4.9 nutritional aspects of food aid

4.10 reproductive health

4.11 psychosocial health

Applications of the Risk Framework

Disaster Relief Imperatives Preparedness ImplicationsOverall All persons whose health and safety is threatened by the impact or consequences of a hazard National PolicyPolicy must be protected level Guidelines

ProceduresImmediateAll persons who face an immediate threat to their life or health must be found, rescued and Local AuthorityNeeds moved to a safe place level PlansPolicy All persons who are injured must be treated promptly, appropriately and competently Resources

The dead must be recovered, identified and returned to their families for culturally appropriate Personnel Knowledgedisposal after appropriate forensic investigation (technical and Skills

administrative) AttitudesSectoral In order to protect their health and safety, all persons threatened by the impact or Guidelines define standardsPolicy consequences of a hazard must have: for any given circumstance-General adequate access to safe and appropriate shelter What is adequate?

adequate access to sufficient numbers of appropriate facilities for personal/public hygiene What is safe?adequate access to a sufficient quantities of safe water What is sufficient?

adequate access to sufficient quantities of safe and appropriate foods What is appropriate?decision If the minimum standards are met there will be no excess morbidity and mortality Procedures define:makers If less than the standard is provided, there will be additional cases of disease and death. How to get resourceschoices How to report

How to move people/goodsSectoral All cases of diseases of public health significance must be detected, diagnosed, confirmed Guidelines define "appropriate"Policy and treated promptly, competently and appropriately for any given circumstance-Specific etc How to detect (surveillance)

other sectors: How to diagnoseeducation How to confirmagriculture How to treatsocial welfare How to report

What is prompt, competent etc

Health Sector Role in Relief

Damage / Needs Assessment Surveillance Systems Organisation and ManagementStructural damage and loss Community, hospital and laboratory Public InformationEquipment damage and loss Public and private Case ManagementStaffing needs Injury (physical and mental) Referral systemsAccess and communications Communicable diseases Reporting systemProgramme needs: Disability (physical and mental) Supplies and equipment

Surveillance Nutrition Logistics, transport and communicationsClinical Care Water quality Human resources

Communicable Disease Control (Non communicable diseases) Professional information and educationPrerequisites for health (Vectors) Research

Clinical Care Communicable Disease Control Prerequisites for HealthAcute primary care Diseases of Epidemic Potential Shelter, water and sanitationCare and treatment of injured Vaccine Preventable Diseases Environmental healthCare and treatment of disability Vector Borne Diseases Nutrition and food supplyCare and treatment of chronic disease Diseases of Public Health Significance Health information

Reporting System

Preparedness building the capacity to do ALL of the above Surge Capacity

Response using AVAILABLE surge capacityscaling up emergency services restoration of essential services (repair/replace) reconstruction

Communicable Disease Control in Emergencies

Diseases of Epidemic Potential + Vaccine Preventable

Diseases + Vector Born Diseases + Diseases of Public

Health Significancecholera measles malaria TBtyphoid tetanus dengue HIV/AIDS

meningitis polio encephalitis STIinfluenza pertussis typhus helminths

Public Safety Risk Management

safer communities

Strategy Options

Diseases of Epidemic Potential

Vaccine Preventable Diseases

Vector Born Diseases

Diseases of Public Health Significance

environmental control vaccination coverage vector control behaviour change 1stcase detection + case confirmation + case management + information/education 2nd

outbreak containment and control 3rd

Public Safety Risk Management

safer communities

HOSPITAL PLANNING FOR EMERGENCIES

HOSPITAL single fire FACILITYEMERGENCY hospital police BASED

PLANNING plan ambulance PLANinternal

all fireMASS health centres / police AREA

CASUALTY hospitals ambulance BASEDPLANNING joint civil defence PLAN

external plan search and rescuepublic red crossprivate blood banks / labs

DISASTER DISTRICT PROVINCEPLANNING TOWN CITY MULTI-AREAinternal and DISTRICT PROVINCE BASED

external + PLANmilitary community government

Damage Analysis and Needs Assessment for the Health SectorAssess resources and Assess the health status

infrastructure (morbidity, mortality, nutrition)

Monitor and evaluate:1. water, sanitation, shelter, food supply and nutrition services in place and meeting needs2. curative, preventative, promotional and rehabilitative services in place and meeting needs3. specific preventative actions being taken – vector control, measles vaccination, vitamin A, public awareness, antenatal care etc4. guidelines issued and being followed5. reporting and surveillance systems for injury, disease, nutrition, water quality, disability in place6. referral systems in place, including laboratories, psychosocial, chronic diseases and disability care7. essential drugs and equipments available, appropriate and sufficient8. management, logistics and communications systems in place and meeting needs

YES 9. staff safety, information, training needs being met

1. Seek expert advice2. Organise temporary services3. Organise epidemiological studies

YES ReinforceWhat action is needed to address

both the causes and the consequences?

1. Monitoring and reporting system Can the health system cope?2. Rehabilitation and reconstruction Can the community/refugees cope?

YES NO Bring in outside assistance

NO Can services be delivered?

Is there damage to health sector infrastructure

Is there damage to lifelines?

AND Is there a major health problem?

NO

Damage and Needs Assessments

Reporting + SurveillanceHospitals cough + feverClinics and Health Centres diarrhoea + feverLaboratories headache + feverPHC Programmes: rash + fever

nutrition myalgia + feverIMCI - epi, ari, cdd etc other fever

water and sanitation malnutrition <5svector control trauma, disability

MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD

? workload ? investigation

expected needs unexpected needs? enough supplies ? new supplies

? enough staff ? new staff? referral system working ? new referral system

institution focus disease focus

are we meeting the needs?

dailydaily

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Curative care -infrastructure,treatment andadministration

Public health andbehaviour

modification

Research

Impact on reductionof mortality in %

Importance in 1998US Health budget in %

Data are for total US government national health expenditures for 1998 (US$1.146 tn), excluding amounts invested by other government departments.

Based on ‘An Epidemiological Model for Health Policy Analysis’, Dever G.E.A., Soc. Ind. Res., 1976, Vol. 2, p. 465.

Changing Behaviour Saves Lives

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Relief&

Preparedness

Risk managementand vulnerability

reduction

Research

Impact on reductionof mortality in %

Expenditure %

Changing Investment Priorities Saves Lives

UNO WHO FAO UNESCO ILOfunction political health agriculture education labourheadquarters New York Geneva Rome Paris Genevafounded 1945 1948 1945 1945 1919member states 191 192 184 177staff 8700 3500 4300 2400 1900budget (biennium) 2.5 billion 1.8 billion 3.7 billionregular budget 800 million 650 million 544 million 481 millionhead Secretary General Director General Director General Director General Director Generalgoverning bodies Security Council Executive Board FAO Council Executive Board Executive Council

General Assembly World Health Assembly FAO Conference General Conference ILO Conferenceadditional/special International Court of Justice 6 regional offices 100 advisory bodiesfunctions Trusteeship Council 1200 collaborating centres

Economic and Social Council* specialised centresSpecial RepresentativesSpecial Operations - UNTAET The world spends

implementing bodies PKO $800 billion/yearUNDP on the militaryUNFPA Also 15 other self-governing bodies including:UNICEF The UN System has:UNHCR World Bank/IMF finance/development loans 6,000 million clientsUNCHR ICAO civil aviation 52,000 staffUN HABITAT UPU postal services $18 billion/yearOCHA WMO meteorology or $3 per client

WTO tradeRegional bodies ECA WIPO intellectual property New York City has:

ECE IMO maritime 8 million clientsESCAP IFAD agricultural development 200,000 staffECLAC UNIDO industry $45 billion/yearESCWA IAEA atomic energy or $5,625 per client

(2000 data)

UN system consists of 82 elements, 19 are self-governing and the rest governed by the General Assembly in New York* ECOSOC is responsible for the overall coordination of the UN system

The UN System

The Risk Management Framework

Thank you