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Public Health Risk AssessmentPublic Health Risk Assessment
Bonnie Henry, MD, FRCPC
Doug Sider, MD, FRCPC
Public health CBRN course
Case 1Case 1
A tornado has just hit your community; dozens of walking wounded are appearing at the local hospital, as well as individuals looking for loved ones
Ambulance communications notifies the local hospital to expect at least 30 patients of varying severity in the next hour
Municipal officials have called you to the EOC and asked you to prepare some public safety messages (re food, water, shelter)
Case 2Case 2
An explosion has occurred at the Bloor station in the Toronto subway system
CBRN team is responding due to a phone call to a local TV station from a terrorist group chanting “Death to Canada” and claiming that a radioactive substance has been released
Case 3Case 3
A mysterious influenza-like illness beginning in Southeast Asia has been found to “jump” from birds to people
Over 400 people of all ages have been affected; mortality is 50%
Recent reports indicate some human to human transmission
Case 3Case 3
The disease is making its way west; cases are turning up in Europe
The WHO announced that the world may be entering Phase IV of the Pandemic phases (human cases found with subtype; established human spread)
Questions to ask:Questions to ask:
1. Is my organization/community prepared to respond to these events?
2. Does my organization/community need to be prepared anyway?
3. What are our priorities?
Goals of SessionGoals of Session
Describe the need for and context of risk assessment in emergency health planning
Describe and prioritize the risks faced by of your organization/community to better prepare for public health emergencies
Phases of an Emergency Phases of an Emergency ((F/P/T National Framework)F/P/T National Framework)
1. Risk assessment
2. Mitigation
3. Preparedness
4. Response
5. Recovery
Public Health Emergency Preparedness and ResponsePublic Health Emergency Preparedness and Response
GOAL: To enable and ensure a consistent response to public health emergencies and emergencies with public health impacts.
Hazard Identification and Assessment
Immediate Outcomes Awareness of the hazards which are relevant to the catchment area of the
board of health. Risk-based emergency planning and programming to guide ongoing board
of health preparedness efforts.
Requirement
1. The board of health shall, in accordance with the Provincial Protocol on Public Health Emergency Preparedness, 2007, identify and assess the relevant hazards and risks to public health within the health unit area.
What’s your risk?What’s your risk?
Naturally occurring events Technological/infra-
structure eventsHuman related events
Natural events - examplesNatural events - examples
HurricaneTornadoExtreme heat/coldIce stormSnow stormFloodEpidemic/pandemic
Technological/ Technological/ Infrastructure eventsInfrastructure eventsElectricity system failureTransportation emergencyWater system emergencyStructural collapseHAZMAT eventsFireNuclear power station events
Human Related EventsHuman Related Events
Terrorism – biological, chemical, nuclear, radiological
Civil disturbanceLabour actionsArmed conflictLarge public gatherings
Components of RiskComponents of Risk
Probability?A. Highly likely?
B. Likely?
C. Possible?
D. Unlikely?
Impact?4. Catastrophic
3. Critical
2. Serious
1. Marginal
ProbabilityProbability
ProbabilityRating
Description Detail
A Highly Likely nearly 100% probability in next year
B Likelybetween 10 and 100% probability in next year,
or at least one event in next 10 years
C Possiblebetween 1 and 10% probability in next year, or
at least one event in next 100 years
D Unlikely less than 1% probability in next 100 years
Components of ImpactComponents of Impact
ImpactHumanPhysical
infrastuctureBusiness
Impact4. Catastrophic
3. Critical
2. Serious
1. Marginal
Impact - HumanImpact - Human
4. high probability of death 3. high probability of injury or illness; low
probability of death2. low probability of injury, illness or death1. unlikely to cause injury, illness or death in
community members/providers
Impact – Physical InfrastructureImpact – Physical Infrastructure
4. extensive physical infrastructure damage with substantial service disruptions, high costs and extended recovery time
3. moderate physical infrastructure damage
2. minor physical infrastructure damage
1. unlikely to cause physical infrastructure damage causing service disruption with resultant costs/recovery challenges
Impact - BusinessImpact - Business
4. numerous public/private sector entities unable to provide services
3. significant/widespread or long term service interruptions
2. minor or limited or short term service interruptions
1. unlikely to cause public/private sector service interruptions
Overall Impact RatingOverall Impact Rating11-12 Catastrophic Community cannot assure core
public/private services without extensive assistance from provincial or federal resources
8-10 Critical Community can only assure a normal level of services with assistance from outside the region or the community is reduced to providing a minimal level of service with normal resources existing within the community
5-7 Serious Community can assure a normal level of services with assistance from within region or reduced levels of service with resources existing within the community
3-4 Marginal Normal level of functioning or increased level of public/private services required within the community
Risk Assessment - examplesRisk Assessment - examples
Threat Probability Impact (H+P+B)
Risk
Tornado B 3+3+2 B8
Dirty Bomb B/C/D 3+1+2 B/C/D6
Pandemic influenza
B 4+1+4 B9
Impact/ProbabilityA
HighlyLikely
BLikely
CPossible
DUnlikely
11-12:Catastrophic A11-A12 B11-B12 C11-C12 D11-D12
8 -10: Critical A8-A10 B8-B10 C8-C10 D8-D10
5 - 7: Serious A5-A7 B5-B7 C5-C7 D5-D7
3 - 4: Marginal A3-A4 B3-B4 C3-C4 D3-D4
Risk RatingRisk Rating
PrioritiesPriorities
Perform this exercise for all: Naturally occurring events Technological/infrastructure
events Human related events
SummarySummary
Assessment of risks is first step in planning
Helps focus efforts and ensures no possibilities are missed
Helps prioritize efforts in preparedness