Preparedness in the Southwest

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1 Preparedness in the Southwest Risk Assessment and Hazard Vulnerability Developed by The Arizona Center for Public Health Preparedness Cover Art

2 Chapter 1 Importance of Conducting a Hazard Risk Assessment Chapter 2 Components of a Risk Assessment Chapter 3 During the Response- Conducting a Rapid Risk Assessment Appendix A Supporting Documents Appendix B References 1

3 Module Overview Reducing disaster vulnerability requires increasing knowledge about the likelihood and consequences of natural and technological hazards. This can empower individuals, communities, and public agencies with the knowledge to mitigate risk and respond effectively to hazard events. This module will outline the components of risk assessment: hazard identification, hazard analysis, and hazard vulnerabilities. Learning Objectives After completing the module, the student will be able to: 1. Understand the importance of conducting a risk assessment. 2. Understand the public health role in conducting a risk assessment. 3. Describe the three main steps involved in a risk assessment. 4. Identify resources and tools to conduct a risk assessment. 5. Describe the necessary data to collect and objectives of a rapid risk assessment. Core Competencies and Target Capabilities Addressed Competencies Competency 1: Describe the public heath role in emergency response in a range of emergencies that might arise. Competency 4: Describe his/her functional role(s) in emergency response and demonstrate his/her roles in regular drills. Target Capabilities Critical Infrastructure Protection Food and Agriculture Safety and Defense Responder Safety and Health 2

4 Chapter 1 Importance of Conducting a Hazard Risk Assessment Introduction As you will recall from the first AzCPHP course, Introduction to Public Health Preparedness, a hazard is any source of danger or adverse condition that may have harmful effects. Hazards can be natural or manmade, including biological, chemical, or radiological terrorism. A risk assessment is a comprehensive tool used to both identify hazards that a community may be susceptible to and to mitigate the impact of the identified hazard. Risk Assessment and the All Hazards Plan Therefore, risk assessment is an essential step that lays the foundation for the All Hazards Plan and incident specific emergency response plans. (For more information on creating a plan for your agency, please review the All Hazards Plan module). Conducting this risk analysis allows emergency managers to identify threats, vulnerabilities and consequences that need to be addressed for their specific jurisdiction. This information obtained is varied and may provide details on: Loss of life Harm to public health and safety Structural damage Environmental damage Risk Assessment as a Federal Priority In addition, the risk assessment will ensure that resources are prioritized and targeted to events that are most likely to occur and/or have the potential for the greatest destructive outcome. In order to plan for and respond to a variety of hazardous events, it is important to develop a comprehensive hazard risk assessment in advance. Who is responsible for conducting a risk assessment? It should be noted that in general, the agency most responsible for conducting a hazard risk assessment is the Arizona Division of Emergency Management (ADEM) and other county offices of Emergency Management. However, as with the All Hazards Plan, it is important that many partnering agencies are involved in the process. Creating partnerships with other agencies will help to increase the understanding of what other agencies are responsible for and allow agencies to work together more effectively during all phases of an emergency response. Arizona Hazard Mitigation Planning System (AzHMPS) The Arizona Department of Emergency Management has created an online risk assessment tool called the Arizona Hazard Mitigation Planning System (AzHMPS). This system provides agencies conducting a risk assessment an online system to enter data and analyze risks. It also acts as an electronic repository of hazard data for the state to be available for creating and updating local and state hazard mitigation plans. Public Health Role Like other agencies involved in preparedness and response, the local and state level 3

5 public health department has a role in conducting a risk assessment of their respective jurisdictions. The four major functions public health plays are: Identify disaster related hazards and associated vulnerability in a community. Determine risk of public health needs likely to be created should such disasters occur. Prioritize health needs based on information from community needs assessment. Provide decision makers with objective information to guide prevention, mitigation, and response to disease. Source: Public Health Management of Disasters, The Practice Guide Public Health and Emergency Management Some of the steps taken by public health during a risk assessment are the same as other agencies. However, while other agencies may be considering issues such as structural integrity of a critical infrastructure, public health would need to consider how a disaster related to a particular infrastructure would affect the health of the population. The opposite link gives examples of some of the possible considerations made during a risk assessment by hazard for both public health and emergency management. You will notice that some considerations must be taken into account by both agencies (and ideally all considerations would be addressed by every agency conducting a risk assessment). See Appendix A1 for a comparison of public health and emergency management considerations. Disaster Prevention Measures The ultimate goal in conducting a risk assessment is to eventually deter the disaster itself or at least reduce the impact a disaster has on a community. Six categories of disaster prevention measures can be implemented following the analysis of hazards, vulnerability, and risk: Prevention or removal of the hazard (i.e., closing down an aging industrial facility that cannot implement safety regulations). Moving those at risk away from the hazard (i.e., evacuating populations prior to the impact of a hurricane, resettling communities away from flood prone areas). Providing public information and education (i.e., providing information concerning measures that the public can take to protect themselves during a tornado). Establishing early warning systems (i.e., using satellite data about an approaching hurricane for public service announcements). Reducing the impact of the disaster (i.e., enforcing strict building regulations in an earthquake prone zone). Increasing local capacity to respond (i.e., coordinating a plan utilizing the resources of the entire health community, including health departments, hospitals, and home care agencies). 4

6 Disaster Prevention Measures The ultimate goal in conducting a risk assessment is to eventually deter the disaster itself or at least reduce the impact a disaster has on a community. Six categories of disaster prevention measures can be implemented following the analysis of hazards, vulnerability, and risk: Prevention or removal of the hazard (i.e., closing down an aging industrial facility that cannot implement safety regulations). Moving those at risk away from the hazard (i.e., evacuating populations prior to the impact of a hurricane, resettling communities away from flood prone areas). Providing public information and education (i.e., providing information concerning measures that the public can take to protect themselves during a tornado). Establishing early warning systems (i.e., using satellite data about an approaching hurricane for public service announcements). Reducing the impact of the disaster (i.e., enforcing strict building regulations in an earthquake prone zone). Increasing local capacity to respond (i.e., coordinating a plan utilizing the resources of the entire health community, including health departments, hospitals, and home care agencies). Components of a Hazard Risk Assessment Now that you understand why it is important to conduct a risk assessment, we can begin to discuss the composition of a risk assessment. There are three components of a hazard risk assessment: I. Hazard Identification II. Hazard Profile III. Vulnerability Assessment The remainder of the module will give an overview of each of the main components of a risk assessment, provide information on conducting a rapid needs assessment, and direct the reader to tools to assist in the completion of a hazard risk assessment. 5

7 Chapter 2 Components of a Risk Assessment Hazard Identification The first step in a risk assessment is identifying the hazards that could affect your community. These can be either naturally occurring or man-made hazards. Hazard identification takes into account both historical events and events that have not yet occurred. Initially, any and all hazards should be considered. However, knowledge of the community will help to determine the probability that an event will occur. Step 1: Hazard Identification Hazard Identification involves both the collection of data from various sources and compiling the findings in an orderly list. Data Collection Resources In order to try and determine what incidents may occur in the future, it is good to know what incidents have happened in the past. Data on past incidents can be found through American Red Cross, local fire and police departments, and local newspapers. Other sources of hazard information include: Centers for Disease Control and Prevention (CDC) Federal Emergency Management Association (FEMA) National Response Center U.S. Department of Transportation Other Health Departments Poison Centers Don t forget about information contained within your own agency. For example, surveillance data or simply past communicable disease reports can provide a useful resource on previous infectious disease outbreaks. Creating the List Once the research is complete, a list of potential hazards in your community can be compiled. Keep in mind that hazard lists pose two problems. The first is the possibility of exclusion or omission; there is always a potential for new and unexpected hazards (which is part of why maintaining an all-hazard capability is important). The second is that such lists involve groupings, which can affect subsequent analysis. A list may give the impression that hazards are independent of on another, when in fact the are often related (e.g., an earthquake might give risk to dam failure). Lists may group under one category very different causes or sequences of events that require different types of response. - Guide for All-Hazard Emergency Operations Planning Step II: Hazard Profile The second step in conducting a risk assessment is to profile the identified hazards and analyze their potential consequences. A hazard profile involves determining the impact of the hazard event, or how bad the disaster could get in your community or jurisdiction. Once historic and other data have been collected and analyzed, hazard profile maps can be developed including locations of historical and potential events and areas of critical infrastructure and key resources within your community. 6

8 Researching and mapping historic events While researching historical hazardous events in a community, it is important to collect specific information on the incident. The greater detail that can be gathered on previous events, the better prepared the agency can be in the future. Part of public health s responsibility is to review its surveillance data. For example, if after review a department notes that outbreaks of a specific disease occur every three years in the summer. Using this information, health departments can work to mitigate the number of people affected by encouraging community vaccinations or begin health education campaigns to make people aware of prevention strategies. Reviewing Current Studies, Plans and Analyses In addition to researching historical events, it is a good idea to review existing studies and plans that describe or quantify potential community hazards. Some examples of plans or studies include: Area drainage master plans Emergency action plans Geological surveys Floodplain studies Annual weather reports Furthermore, basic community data is also important to have on hand (such as population size and distribution from census data). For public health departments, it is important to compile data and information on resources such as location of health care facilities and bed capacity to help create response plans for incidents involving mass casualties. See Appendix A2 for a listing of additional resources that can be used. Calculated Priority Risk Index (CPRI) Developing a single indicator of possible threats helps to prioritize resources and determine which hazards need special attention during the planning process. To aid in the ranking of hazards, the AzHMPS contains a tool by which individual hazards can be evaluated and even ranked according to an indexing system. The Calculated Priority Risk Index (CPRI) value is determined by assigning a degree of risk to one of four categories (see Appendix A3) and then an index value is calculated based on a weighing scheme. Map Development Once the historic hazards and other study data have been collected and analyzed, hazard profile maps are developed to provide a geographic depiction of each identified hazard s potential threat to the community or jurisdiction. Critical Infrastructure sites to consider for a Hazard Map include: Historic sites of hazardous events Potential sites for future hazardous events Transportation routes Main utility lines and stations Locations of health facilities Locations of vulnerable populations Water sources Concentrations of residential offices, shopping, industrial areas, schools Government buildings 7

9 Public Health Considerations While Mapping Like other agencies conducting a hazard risk assessment, public health agencies should map areas that contain critical infrastructures (such as health care facilities). In addition, public health has the responsibility of identifying vulnerable populations within the community (such as nursing homes). Knowing the location of these populations can help determine if other resources are needed (such as ambulances during an evacuation) during an emergency response. (For more information on working with vulnerable populations in your community, please review the Special Populations module in this course.) Step III. Vulnerability Assessment Vulnerability is defined as the degree of loss resulting from the hazard or hazardous event. A vulnerability assessment involves assessing each identified hazard s impact on the community and includes the following tasks: Assets Inventory Potential Loss Estimations Development Trends Analysis The overall goal is to determine how susceptible individuals, property and the environment are to the adverse affects of a hazardous event. For public health, this involves estimating the health impact of potential incidents and the requirements for health care facilities and public health intervention Assets Inventory Goal: identify all critical and non-critical facilities and infrastructures in the community or jurisdiction. In order to complete this process, it is important to know what constitutes a critical and non-critical facilities and infrastructures. What are critical and non-critical facilities and infrastructure: --Telecommunication Infrastructure, Electrical Power Systems, Gas and Oil Facilities, and more (See Appendix A4) Note: For public health it is most important to consider how the disruption of any of these facilities or infrastructures would affect the health and welfare of individuals. For example, disruption in the water supply could lead to the consumption of unfiltered water and potentially an increase in associated diseases. Potential Loss Estimations Goal: Assess the potential loss that may occur for each identified hazard in terms of human and economic values. (See Appendix A5) Human Losses: An estimate of the human losses includes at a minimum the numbers of human fatalities, injuries, and displaces that may occur. Economic losses: are dollar calculations for building/structure replacement, annual revenue, and building contents. Development Trends Analysis Goal: Conduct a general assessment of land uses and development trends within the 8

10 community or jurisdiction. This involves looking again at hazards that have occurred in the past and determining if the land use played a role in the event itself or lead to increased losses. For example: do zoning regulations allow for building in a floodplain or is there only one transportation route into and out of a major community hospital? In order to mitigate against additional losses in the future, hazard maps previously created in the risk assessment process can be used in conjunction with development maps to try and make the best planning decisions possible. Categories of Vulnerability Once a vulnerability analysis has been conducted for the community as a whole, a separate vulnerability analysis should take place for each of the identified hazards. In doing so, there are five basic categories of vulnerability that should be taken into account: Proximity and Exposure Physical Social Economic Capacity To learn about measures that can be taken to reduce these vulnerabilities within your community, view the given Categories of Vulnerability Table in Appendix A6. Applying the Risk Assessment Once the hazard risk assessment has been completed, credible scenarios based on the hazards most likely to occur in the area can be created. Beginning with the defined hazard, emergency planners can begin to consider how the hazard could develop, the potential consequences of the event, and what staff and resources will be deployed to respond adequately. Developing and exercising these scenarios may help determine what capacities exist to cope with effects of disaster and planning can begin to help reduce the effects of the defined event. Furthermore, participating in such exercises prior to an incident will help agency members learn more about the response to a specific incident and further enhance their ability to conduct rapid risk assessments. 9

11 Chapter 3 During the Response- Conducting a Rapid Risk Assessment Rapid Health Assessments Rapid health assessments are risk assessments used during the response phase of an emergency to characterize the health impact of a disaster on the affected community. The primary task of rapid health assessments are to collect, analyze, and disseminate timely, accurate health data. Conducted by a multidisciplinary team that may include experts such as an epidemiologist, clinician, environmental engineer and statistician, they provide an estimate of the risks and facilitate the rational allocation of available resources according to the true needs of the emergency. The risk assessment can help guide officials recognize areas of the community that may be most vulnerable immediately following the event and prioritize response activities based on need. Hence, the health assessment will identify the health needs, prioritize response activities, initiate an appropriate emergency response, and evaluate the effectiveness of the response. Objective of a Rapid Health Assessment The public health objectives in conducting a rapid health assessment are to assess: The presence of ongoing hazards (i.e., a persistent toxic plume following a major chemical release). The nature and magnitude of the disaster (i.e., number of people affected or geographic area involved). Major medical and public health problems of the community (including risk of further morbidity and mortality; observed patterns of injury, illness, and deaths; need for food, water, shelter, and sanitation). Availability of resources within the local community and the impact of the disaster on those resources. Community need for external assistance. Augmentation of existing public health surveillance to monitor the ongoing health impact of the disaster. Prioritizing Data Collection Data needed for this rapid health assessment may be collected as the incident unfolds. Thus, the nature of the incident will determine the type of data that will be collected and the amount of time available to collect the information necessary for officials to make decisions. However, assessment teams may prepare for this assessment by compiling a library of key forms and checklists that may be used. For disaster assessment protocols and forms, view the WHO Tools for Emergency Field Response from the World Health Organization. Sudden Impact Disaster: As the disaster unfolds, the assessment team will have to consider the immediate priorities and data needs based on the situation. The following are some data needs that will need to be considered for a sudden impact disaster: 10

12 Sudden Impact Disaster: Days 1-2 Public heath assessment teams must consider both the immediate priorities and data that should be collected as soon as possible. Priority: Emergency medical response (care and treatment of those affected), search and rescue operations, and safety of first responders. Actions: - Survey the response site to ensure first responders are not at continued risk from the hazard - Work with the Safety Officer to ensure responders are monitoring their exposure levels and are using appropriate personal protective equipment (PPE). - Report data collected (see box) to the Incident Commander or the Emergency Operations Center to help make decisions and evaluate the incident. - Use data to help create an incident action plan; addressing the operations, hazards, and exposures that pose the greatest potential risks to responders. Sudden Impact Disaster: Days 3-6 At this point in time, the need for emergency medical services should have begun to reduce and new issues will begin to arise. Priority: Ensuring availability and access to primary health care Key Data to Collect: - Persistent hazards related to on-going deaths or injuries - Injuries due to clean-up activities - Environmental health assessment - Status of community infrastructure (water, sewer, power, etc.) - Availability of supplies Sudden Impact Disaster: Days 6+ After this period of time, the phase of the operation should have moved from response to recovery. At this point in time, all response and recovery plans should have been fully executed. Priority: Ensuring continuation of services Actions: - Increased surveillance activities that focus on illnesses and injuries reported from health care facilities and the incident site following the disaster. - If the disaster resulted in displaced persons placed into shelters, public health should consider increasing surveillance activities for both diarrheal and respiratory diseases within the shelters. - Status and capacity of health care facilities (e.g. staff, medical, and pharmaceutical supplies. Conclusion As you have read, a hazard risk assessment is an integral part of any public health preparedness plan. In order to adequately prepare for any emergency situation, you must know where those situations are likely to occur, the potential affects on the community, and ways to prioritize resources for a response. 11

13 This module was designed to provide information on the overall goals and steps of a risk assessment. Using the tools and resources given, your agency can now work on their own risk assessment and begin utilizing the information in the planning process for your community. 12

14 Appendix A1 Public Health vs. Emergency Management Considerations Hazard Public Health Considerations Emergency Management Considerations Wildfire Smoke and particulate inhalation Structural damage to businesses and homes Extreme Heat Loss of power leading to overheating and death of elderly individuals Overheating of utilities leading to blackouts Hazardous Materials Incidents Biological Terrorism (Anthrax) Hurricane Earthquake Exposure to people in the area and health effects of environmental contamination Hospital capacity for those affected and ability to mass prophylaxis those exposed Contamination of local water supplies and monitoring the health of evacuees in shelters Hospital capacity for the injured and environmental impact of damaged utilities (ie broken sewer lines affecting water supplies) Health effects of environmental contamination and possible disruption of transportation routes Available resources to conduct decontamination of affected site. Structural damage to critical infrastructure and economic impact to local area Structural building damage and collapse and maintaining the integrity of hazardous material storage. 13

15 Appendix A2 Summary of Potential Data Resources 14

16 Appendix A3 CPRI Categories and Risk Levels 15

17 Appendix A4 Categories to Define Critical Facilities and Infrastructure Categories to Define Critical Facilities and Infrastructure Telecommunications Infrastructure: o Telephone, data services, and Internet communications, which have become essential to continuity of business, industry, government, and military operations. Electrical Power Systems: o Generation stations and transmission and distribution networks that create and supply electricity to end users. Gas and Oil Facilities: o Production and holding facilities for natural gas, crude and refined petroleum, and petroleum derived fuels, as well as the refining and processing facilities for these fuels. Banking and Finance Institutions: o Banks, financial service companies, payment systems, investment companies, and securities/commodities exchanges. Transportation Networks: o Highways, railroads, ports and inland waterways, pipelines, and airports and airways that facilitate the efficient movement of goods and people. Water Supply Systems: o Sources of water; reservoirs and holding facilities; aqueducts and other transport systems; filtration, cleaning, and treatment systems; pipelines; cooling systems; and other delivery mechanisms that provide for domestic and industrial applications, including systems for dealing with water runoff, wastewater, and firefighting. Government Services: o Capabilities at the federal, state, and local levels of government required to meet the needs for essential services to the public. Emergency Services: o Medical, police, fire, and rescue systems. Other noncritical facilities: o Public libraries, schools, museums, parks, recreational facilities, historic buildings or sites, churches, residential and/or commercial subdivisions, and apartment complexes. Source: ADEM Model Local Hazard Mitigation Plan 16

18 Appendix A5 Estimate of Losses Source: ADEM Model Local Hazard Mitigation Plan 17

19 Appendix A6 Categories of Vulnerability Table 18

20 Appendix B References Hazard Risk Assessment Instrument from the UCLA Center for Public Health and Disasters (HRAI) Young Landesman, Linda. Public Health Management of Disasters, The Practice Guide 2nd Edition. American Public Health Association Publishing. Chapter 5. Target Capabilities List Critical Infrastructure Protection (CIP). The Public Health Response to Biological and Chemical Terrorism Interim Planning Guidance for Ste Public Health Officials - Appendix 1: Basic Emergency Preparedness Planning. U.S. Department of Health and Human Services and the Centers for Disease Control. July Model Local Hazard Mitigation Plan. Arizona Division of Emergency Management. November 1, SLG 101: Guide for All-Hazard Emergency Operations Planning. Chapter 2: The Planning Process. WHO Tools for Emergency Field Response 19

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