21 Avenue du Stade de France 93218 Saint Denis La Plaine Cedex · (France: heat wave – 2003,...

France's Health Emergency Preparedness and Response Force

21 Avenue du Stade de France

93218 Saint Denis La Plaine Cedex

September 2015


EPRUS: A public agency to tackle crises and exceptional situations in public health

Background to its establishment (2007):

Feedback on national and international crises

(France: heat wave – 2003, Pakistan: earthquake – 2005, La Réunion island:

Chikungunya outbreak– 2006)

Need for planning: SARS 2003, H5N1 influenza pandemic 2004

Securing public procurement and management of strategic stocks of health

products

Specific and progressive regulatory framework:

Laws dated 5 March 2007 and 10 August 2011, decree of 7 January 2013

(instituted the State's preparedness to face major threats to public health and

adapted the State's response to tackle exceptional public health situations)

Governance:

• Administrative supervision by the Ministry for Health

• A board whose membership is equally balanced between State/Health

Insurance

• Dual appointment of DG: Health – Interior ministry

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Three Main Missions

Acquire health products for national strategic stocks and

manage their flow, transportation and distribution to prevent and/or

be prepared for major risks

Set up and mobilise a health reserve corps (practising or former

healthcare professionals and medical students), managing its

administration and finances, + facilitate CUMPs (emergency

psycho-medical units)

Provide logistical expertise to national and territorial actors:

consistency of defence plans and rescue plans that can be

deployed across the territories

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3 Complementary Units

Pharmaceutical Unit

Health Reserve Unit

Support Services

Two specialised committee of experts (and a

psychiatrist nominated as national adviser to EPRUS's DG for the psycho-medical emergencies)

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In charge of securing national strategic stocks for the Ministry of Health, through:

• Acquisition and renewal of the annual national strategic stock programme

• Storage on national and zonal pharmaceutical platforms

• Distribution based on a master plan

Distribution of rare health products (often in an emergency) – For example

» Antitoxins (Diphteria, Botulism…)

» Favipiravir (Ebola)

Sending health products abroad at the Ministry for Foreign Affairs' request (often in an emergency)

ROLE

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Allocation and handling of strategic and tactical stocks

National Strategic Stocks

(65,000 pallets)

- Enable the State to maintain a

back-up emergency response

capacity in case of a threat to public

health caused by an epidemic, a

natural or industrial disaster, or

terrorist attack

- Health products and equipment

held and managed under the sole

responsibility of EPRUS

Tactical Equipment

- Medical equipment and products

needed by health facilities providing

emergency services (SAMU or SMUR in

France) in the event of exceptional

health situations

- Ensure an early response pending

mobilisation (where necessary) of

strategic stocks, or management of any

exceptional events not covered by the

plan for use of strategic stocks [PSM 1

and PSM 2, with additional allocations of

antidotes and antibiotics]


Including:

Mobile health units: 109 x "PSM* 1" (treatment of 25 patients) and 22 x "PSM

2" (treatment for 500 patients): tents, emergency generators, heating, lighting, stretchers,

communication networks, etc.

Personal protective equipment (suits, masks, gloves, hoods, etc.)

Means of detection, protection and decontamination in case of CRBN risk

Mobilisation of health facilities, with the remit of PSM 2 extending across their

entire zone, in addition to 1st line means deployed

Acquisition and maintenance: national funding

Ongoing: procedures for acquisition and renewal with a view to acquisition + a

management application + renewal of the PSMs' composition

TACTICAL MEASURES WITHIN HEALTH FACILITIES

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*PSM = « mobile medical unit »



Have skilled human resources available to respond to

exceptional public health emergencies in France and

abroad:

To provide back-up to medical and/or socio-medical facilities

To support the public health response within the framework of the various contingency plans

Have equipment and materials available to achieve these

missions: protective clothing, medical equipment

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A potential pool of 6,000 volunteer health professionals,

including 2,200 reservists who can be mobilised at a

moment's notice: • Active workforce (employed and freelance): 63%

• Retired (< 5 years) 26%

• Students + « not active » : 11%

Breakdown: • 35% medical professionals

• 58% paramedical professionals

• 7% administrators and technicians

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Volunteers sign a 3-year contract with EPRUS

Volunteers in employment sign a three-party agreement:

Volunteer - Employer - EPRUS

Reservists benefit from: Protected status (social protection, insurance, responsibilities)

A continued salary

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An appropriate recruitment policy to fulfil our criteria

Missions: • 45 days a year (90 days, with special dispensation)

• Requiring numerous specific skills sets

• Internationally and in overseas territories:

– Working healthcare professionals

• Mobilisation on the mainland:

– Retired healthcare professionals, students, the unemployed

Additional training requirements:

• Theoretical: humanitarian issues, etc.

• Practical: field exercises, etc.

• e-learning: lessons in "Organisation of treatment abroad"

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Slow-paced public health crises: • Epidemics, pandemics (dengue, flu, chikungunya, etc.)

• One-off vaccination campaigns

• One-off climate-related public health measures (roaming)

Rapidly evolving public health crises: When territorial and zonal resources need backup, in the context of security

or defence plans:

• Industrial/technological disasters (like Toulouse-AZF)

• Natural disasters (flooding, earthquake)

• CBRN (multiple attacks "red alpha" plan)

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One-off precautionary measures:

• Beyond the capacity of the defence zone, or of national

scale (Olympics, G8, G20, D-Day Commemorations, 11

January 2015 Paris rally, COP21, Euro 2016, etc)

Back-up for treatment provision in départements and overseas territories (Mayotte)

Key experts and short term experts

International public health operations (WHO, EU…): • Haiti, Libya, Japan, Ivory Coast, Congo, Guinea, etc.

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Whatever the nature of the crisis, the Health Reserve Corps can be mobilised: On demand

• by the relevant Prefect or State representative (homeland)

• by the RHA or zonal RHA (regional health agency)

• by the MFEA's Crisis Centre (ministry of foreign affairs)

By a mobilisation order issued by the Health Minister

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EPRUS now counts about 50 missions carried out by the health reservists since the creation of the corps in 2007

For instance : La Dominique (2015)

Népal (2015)

Ebola in West Africa (mainly in Guinea but also Mali, and Equatorial Guinea) and France (2014-2015)

Providing expertise in Polynesia (Dec. 2013): 4 experts mobilised (intensive care doctor, epidemiologist, hospital director, LAV technician)

Support mission to French Guyana (March-June 2013): 35 professionals mobilised (paediatricians, emergency doctors, paediatric nurses)

Mission to Congo (March 2012): 19 professionals mobilised

Support mission in Benghazi, Libya (Oct-Dec 2011): 33 healthcare professionals involved including emergency doctors, anaesthetists, surgeons, epidemiologists and hospital directors

Mission to Haiti (January-December 2010): a hundred healthcare professionals mobilised (50% medical, 50% paramedical)

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To find out more

Web

www.eprus.fr

Facebook

https://fr-fr.facebook.com/EPRUS.ReserveSanitaire

Twitter

https://twitter.com/EPRUS

Blog by reservists

https://reservesanitaire.wordpress.com/

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http://www.eprus.fr/




https://twitter.com/EPRUS

https://reservesanitaire.wordpress.com/


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EPRUS Action: in France (1)

Material Resources • Building up a supply of PPE personnal protective equipment (over

20,000)

• Acquiring transport containers – plane/helicopter (= 2) – and protective covers for transportation (= 22)

• Provision of PPE supplies to SAMU healthcare facilities and referral centres

• Importation, storage and distribution of experimental treatments for France (but also Germany, Norway, Switzerland, Spain, Italy and the WHO)

• Making educational films

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EPRUS Action: in France (2)

Human Resources • Teams of 25 reservists for transporting people with a 'confirmed

case' or a 'possible case' of the disease (on the mainland or for Medevac from West Africa)

• Team of 30 reservists that could be mobilised to healthcare facilities treating a 'confirmed case' (backup for direct treatment of the patient)

• Currently: 200 people with direct experience of Ebola

• Backup for regional and national agencies (RHAs and InVS), eg. monitoring contact cases

• Health surveillance of borders (Roissy Charles De Gaulle)

• Involvement in the Nogent le Rotrou training centre

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EPRUS Action: in West Africa Material Resources

• Delivering PPE and equipment, etc.

Human Resources • Experts advising the Guinean government in Conakry since April

2014, in Mali since November 2014 and in Equatorial Guinea (Africa Cup of Nations, January 2015)

• Medical teams for the Ebola treatment centre in Macenta (in the Forest Region of Guinea)

• Teams to supervise health surveillance at airports: Conakry (since September 2014 until now), Bamako and Malabo

• Experts advising the Chief of Staff to the French Ambassador in Guinea (Conakry and Equatorial)

• Backup for the Institut Pasteur, the EFS (French blood service) and INSERM (French Institute of Health and Medical Research)

• Experts advising the WHO 22


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THANK YOU FOR YOUR ATTENTION

www.eprus.fr

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