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