Planning for Health Emergency Management

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

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

Q & A

What is the difference between : Plans Procedures Guidelines Regulations Policies

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

Policy

a formal statement by a government, organisation or institution that expresses a set of goals, the priorities within those goals and the preferred strategies for achieving those goals; policy is based on the mandate of the institution (WHO)

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

The differences

Policy – what must be done

Guidelines – how to implement the policy – technical how

Procedures – how to implement the policy – administrative howInternal Regulations – special procedures which often incur a penalty if not followedPlan – who does what when to implement policy

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

Characteristics of Plans

The information is volatile:They lose relevance quickly because the information in them decays over a short timeThey need frequent revision

Are local and specific:They are made by the end-usersThey apply in specific circumstances

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

The relationship

Procedures, guidelines and authority are needed to make plans

Policies are needed to define guidelines and set procedures

Mandates are needed to set policies

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

Procedures

Procedures are about allocating responsibility for resources i.e.:

Acquisition of new resources Access to existing resources Accounting for the use of resources

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

Guidelines

Guidelines are about using resources:

Appropriate resources Application of those resources Evaluation of the effectiveness of resources

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

EmergencyOne characteristic of an emergency is that normal

procedures are inappropriate or inadequate to deal with the situation

In an emergency, special emergency procedures are needed to get the situation under control

In an emergency, institutions are given specific responsibilities which require extraordinary powers to be given to specific people for a limited time

Those specific people must have plans for how those extraordinary powers will be used and for defining the resources they will need to meet their responsibilities

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

Planning for emergenciesPlanning elementsPlanning is a LOCAL activity, undertaken within a national legal and policy framework:

Define the planning objectives Network with the stakeholders Analyse the community and its risks Plan for the priority risks Resource the plan Train and educate for the plan Advocate for changing attitudes to the risks Rehearse the plan Review and revise the plan

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

The importance of planning

lack of planning means that a failure comes as a complete surprise

a bad outcome is more often due to defective planning, rather than lack of resources

emergency response planning is about making the best use of available resources

Emergency preparedness planning is about getting new resources

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

Information is key to planning

bad or inadequate information

wrong planning parameters

bad plan

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

Participatory planning

all those who are involved in implementation need to be involved in the planning process

=the stakeholders

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 Conduct risk analysis - hazards and community vulnerabilities Set the planning objectives Define the management structure for the process Assign responsibilities Identify and analyse capacities and resources Develop emergency management systems and arrangements Document the plan Test the plan Review and update the plan on a regular basis

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

Outputs of the processA set of risk reduction plans – how can we prevent emergencies from occurring in our community

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

search and rescue plan evacuation/temporary shelter plan mass casualty management plan restoration of lifelines plan security plans

A set of disaster recovery plans (public health, education, agriculture, transport, public works etc.)

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

Outcomes of the processPlaning process is a sequence of steps whereby a community agrees on ways to enhance and protect it’s 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 and response greater awareness of risk reduction in the community higher levels of readiness to respond A set of 3 basic plan sets – a risk reduction plan, an emergency response plan a recovery plan (reconstruction plans can only be made after a disaster but should be based on existing policies and guidelines) increased public safety

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 period +

recovery period)

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

Common planning mistakes Making a “national plan”: emergency plans only work for institutions and communities – provinces and states need to develop policies, procedures and guidelines to direct planning process and support local response agencies in an emergency the plan is given more importance than planning process itself not all community members aware of the existence of a plan testing and revision is overlooked emergency planning is not integrated into normal activities different plans are developed for different hazards by different agencies – the all hazards approach should be preferred

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

Common planning mistakes

“National” plans have proven to be ineffective – planning is a local activity

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

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

“All Hazard Approach” plan: 80% of what we do in emergencies is

generic – we do it for every emergency – the all hazards approach No need to wait for field information to do

this

15% is specific to the hazard Much can be done before field data is

available but an assessment is needed to provide the quantitative data

5% is unique to the event – the people, the place and the time The assessment will provide all of this

data

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

1. Operational OrganisationEOC/command and control systems earthquake timecoordination mechanisms large numbers of trapped and injured placecommunications systems large numbers of homeless and displaced weathertransport and traffic management systems large numbers of dead and missinglogistics and supplies systems geographyassessment and reporting systems dead, injured and missing staff climateinformation systems and media management damaged critical infrastruture/resources (hospitals, vehicles)resource mobilisation/tracking systems loss of water, gas, electricity, phone, transport, fuel networksdonated supplies/foreign teams management systems loss of road, sea, air, rail infrastructure / access security

2. Response Operations politicssearch and rescue long period of Search/Rescue, victim extraction economyevacuation high demand for FA, stretchers, triage, medical transport governancemass casualty management high demand for beds, surgery, blood products, referralmanagement of dead and missing many wound infections, amputations, tetanus, dust inhalation emergency management capacitysecurity and traffic control high demand for orthotics, prosthetics, disability, dental logistics capacitytemporary shelter, clothing and utensils demand for specialised spinal and head injury care disposal of inappropriate donationsemergency water, sanitation and energy high demand for temporary shelter, food, utensils, stoves,emergency food / cooking supplies water, energy, clothing, tents, blankets leadershipemergency public and environmental health high demand for psychosocial support of victims and staff solidarityemergency engineering and public works severe disrupiton of public health services morale

3. Recovery Operations low risk outbreaks of communicable diseases corruptionlifelines variable demand for medicines and equipment crime / lootingcurative and public health care (acute/chronic injury care - high, infectious disease - low, lootingeducation potentially unstable chronic disease - medium)agriculture medium risk contamination of water and soil compensation claimstrade and commerce medium risk fertiliser, chemical, sewerage and gas leaks/spills insurance claims

4. Rehabilitation and Reconstruction urban fires, explosions ownership disputespeople contaminated, infested and unsafe foods property disputesproperty increased vector breedingservices high demand for debris clearance and disposal foreign assistancelivelihoods foreign teamsenvironment loss of livelihoods, markets, distribution networks

THIS IS WHAT WE PLAN FOR ….

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

A plan does not achieve results The goal of the planning process is not to make a plan – the goal is use it

Results come from the actions defined in the plan – if it’s not in the plan, no-one is responsible and it wont be done

The time to start planning is now

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

The role of governmentThe 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 contents of plans 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. bio terrorism, war

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

The role of national authorities

Emergency Planning is a local responsibility For most hazards, there should not be a “national plan” for responding to the common hazards – ideally, the national plan should simply be:

to support and resource local plans National authorities must provide the laws, policies, guidelines and procedures needed to make local plans for risk reduction, emergency response and disaster reconstruction

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

The planning hierarchy

The levels of the planning hierarchy should be modelled on the existing administrative structure of the country. It should include:

national polices, guidelines and procedures (for the planning process AND for the contents of plans) Provincial/state plans to support local plans local plans

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

Response planningElements of a response plan

A response plan will define :

a line of authority responsibilities of all the stakeholders the management of an Emergency Operations Centre the communications system alert and warning mechanisms public information arrangements resource management (human, financial and

material) reporting and accounting arrangements

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

Planning for the Phases

PEOPLE

PROPERTY

SERVICES

LIVELIHOODS

ENVIRONMENT

community

relief

recovery/ rehabilitation

reconstruction

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

Components of the planThe key components are:

the main plan which describes the goals, objectives and overall arrangements the functional plan which describes in detail how the main plan is to be implemented special plans e.g. airport, security standard operating procedures checklists maps hazard data community data staff data records of key decisions taken in meetings

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

Essential servicesThe following sectors are involved in the planning process:

communications police relief and rescue health social welfare transport public works also agriculture, media, education, fire, ambulance,

engineering, meteorology

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

Service planFor a hospital, the plan will describe:

activation mechanisms chain of command capacity assessment (casualty room, operating theatres,

beds, lab, blood bank, x-ray etc) medical and technical staff; resources

communications logistics administration procedures – admin. staff, engineers, porters etc. reception and triage surgery, morgue, decontamination, psychiatry, forensic services other support services - nutrition, physiotherapy, orthotics etc waiting area for families arrangements for the media arrangements for VIP visits

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

Capacity assessmentIn an emergency the following issues should be considered in assessing capacity to respond:

structural damage staff availability equipment failures energy supply water supply access routes additional workload

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

Elements of a good plan

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

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

Implement the plan

Plans will not be made or will lie unused unless the responsible authorities actively provide:

Education and information on how to plan Encouragement and incentives to plan Enforcement of regulations to plan Engineering and resource mobilisation solutions to problems identified by the planning process

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 good plan?

It meets the national planning criteria It conforms to the national planning format It is tested regularly All staff are familiar with the details of the

plan and know their responsibilities

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