ETHREAT PROJECT. EpiSouth Conference Rome, April 2010

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1 ETHREAT PROJECT EpiSouth Conference Rome, April 2010 The Project, Pilot Course and Results On Behalf of the ETHREAT TEAM: AGORITSA BAKA, MD Pediatric Emergency Medicine, Hellenic CDC, & Researcher, University of Athens, School of Medicine Agoritza Baka Medical Doctor is a pediatric emergency physician. Holds her degree from the Athens Medical School and was trained in USA. After returning to Greece she has worked in public health, mainly in the preparedness against new health threats such as bioterrorism, avian and pandemic influenza, as well as the preparedness of the health sector for disasters and emergencies. She has collaborated with the University of Athens, Dept of Epidemiology for a number of European projects. 1

2 Deliberate release Influenza pandemic Emerging or reemerging ID Environmental exposures PROJECT AIM Plan and develop an educational package containing the knowledge and training material necessary to empower European health professionals to rapidly recognise clinically and adequately respond to new public health threats, like attacks with biological, chemical and radiological agents. 2

3 PROJECT PARTNERS University of Athens, Dept of Hygiene and Epidemiology- Coordination, Greece PH Research Association Saxony, Dresden University of Technology, Germany Public and Environmental Health Unit, London School of Hygiene and Tropical Medicine, UK Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic Nofer Institute of Occupational Health, Lodz, Poland Public Health, Medical University, Sofia, Bulgaria OBJECTIVES 1. Set up a list of the educational objectives for front-line health professionals 2. Construct an inventory of all existing courses and training material relevant to the training of health professionals of new health threats thematic addressed to health professionals (including Armed Forces and front-line public health professionals) 3. Plan and develop a common European educational package and algorithm (guide) for action to enhance the understanding and response of health professionals to new health threats. 3

4 OBJECTIVES 4. Apply the educational package through a pilot course to a selected group of European health professionals on a pilot base, who in turn, can act as trainers, so as to receive feedback for improvements. 5. Prepare an evaluation report after having evaluated and assessed with the help of experts, trainers and trainees, the educational material and training methods. 6. Create a web site for discussion, evaluation and dissemination of the educational material. QUESTIONNAIRES explore the opinions of the target audience and of European experts in the area of PH and CBRN on the existence and appropriateness of currently available training programmes, the desired content of a basic educational package 4

5 Methods two questionnaires addressed to FLHPs and to CBRN experts in Europe administered in hard-copy form and via the project website from March to September 2006 FLHPs Results total valid questionnaires: 241 from 23 European countries > 50% of the responding FLHPs feel that they are currently poorly or very poorly prepared to deal with a chemical (53,3%), biological (47,2%) and radiological (57,6%) incident. 5

6 Radiological Chemical Biological do not know poor well Opinion of FLHPs on their ability to manage an RBC incident Tularaemia Plague Pulmonary poor well Smallpox Botulism Anthrax Toxins Viral haemorrhagic fevers Vesicants Nerve agents Opinion of FLHPs on their ability to manage patients affected by various high threat CBRN agents 6

7 Opinion of European FLHPs on their ability to access PPE at their workplace and if yes, to use it properly Properly use PPE low confidence high confidence no access Access in emergency ,6% of responding FLHPs not aware of an operational plan for responding to a CBRN incident nor their role in this plan 39% of FLHPs had received training on CBRN threats because they were selfmotivated >50% have trained in the last two years, probably reflecting the currently increased awareness regarding CBRN threats 7

8 Expert Results 63 questionnaires from 16 EU MS All responding experts report that they are aware of an operational plan to manage CBRN incidents 70% of experts state that >50% of FLHP in their country need training Radiological Chemical 0-24% 25-49% 50-74% % Do not know Biological 0% 25% 50% 75% 100% Opinion of European CBRN/ PH experts on the ability of FLHPs in their country to respond to a CBRN incident 8

9 Poison Poison Information Information Center Center rural and private rural and private physicians physicians Poison Poison Information Information Center Center CBRN INCIDENT RESPONSE ALGORITHM GREECE VICTIMS VICTIMS & & WORRIED-WELL WORRIED-WELL SEEK HELP SEEK HELP CBRN Incident Civilian Civilian EMS/Hospital EMS/Hospital Military Military EMS/Hospital EMS/Hospital Front Line Health Professionals ETHREAT Prefecture Prefecture Public Public Health Health Officer Officer HellenicCDC HellenicCDC Hospital National Hospital National Director Heath OpCetr Director Heath OpCetr Ministry Ministry of of Defense Defense GAEC GAEC General General Secretariat Secretariat of of Civil Civil Protection Protection [GSCP] [GSCP] Reporting Reporting to to Government Government Hierarchy Hierarchy GSCP GSCP Crisis Crisis Management Management Group Group Incident Incident Commander Commander Inform Report to HAEA = Hellenic Atomic Energy Committee * National Health Operations Center CBRN CBRN Incidence Incidence Response Response Groups Groups & & Resources Resources STATE CBRN RESPONSE IN EU COUNTRIES / ΚΡΑΤΙΚΗ ΑΝΤΙΔΡΑΣΗ ΣΕ ΧΒΠΡ ΕΠΙΘΕΣΗ LEVEL OF COMMAND ΕΠΙΠΕΔΟ ΔΙΟΙΚΗΣΕΩΣ GREECE/ΕΛΛΑΔΑ YOUR COUNTRY POLITICAL LEVEL ΠΟΛΙΤΙΚΟ ΕΠΙΠΕΔΟ Reporting to Government Hierarchy Υπουργικό Συμβούλιο υπό την αιγίδα του Πρωθυπουργού STRATEGIC LEVEL ΣΤΡΑΤΗΓΙΚΟ ΕΠΙΠΕΔΟ General Secretariat of Civil Protection [GSCP] Γενική Γραμματεία Πολιτικής Προστασίας [ΓΓΠΠ] INCIDENCE REPORT [all services] ΑΝΑΦΟΡΑ ΣΥΜΒΑΝΤΟΣ [από όλες τις υπηρεσίες] OPERATIONAL LEVEL ΕΠΙΧΕΙΡΗΣΙΑΚΟ ΕΠΙΠΕΔΟ GSCP Crisis Management Group Ομάδα Διαχείρισης Κρίσεων ΓΓΠΠ TACTICAL LEVEL ΤΑΚΤΙΚΟ ΕΠΙΠΕΔΟ INCIDENT COMMANDER ΔΙΟΙΚΗΤΗΣ CBRN Incidence ΠΕΡΙΣΤΑΤΙΚΟΥ Response Groups & Resources Πρώτοι Ανταποκριτές ΧΒΡΠ περιστατικού & Πηγές/Μέσα 9

10 PILOT COURSE 3 day awareness course in Athens, May participants (mix of FLHP and higher) 1 st day: Chemical threats 2 nd day: Biological, Risk communication, psych effects 3 rd day: Radiological, triage, decon and algorithms In general received well but Hands-on training Scenario discussion EDUCATIONAL MATERIAL Handbook: basic knowledge on Biological, chemical radiological threats Crisis management Infection control Psychological effects Principles of triage Memory cards CD-ROM: containing resources, pilot course material, algorithms 10

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12 Work packages 1, 2, 3 Coordination, Dissemination and Evaluation WP 4 Rural Life Characteristics relevant to AI WP5 Public Health Communication Campaigns on AI WP6 Development of Model Guidelines WP7 Pilot Test in EU rural communities Literature Review Expert Opinion Rural Life Characteristics relevant to AI Primary determinants Secondary determinants Keeping backyard poultry Farmers poultry related practices Open markets Children in contact w poultry Poor personal hygiene Disposal of dead birds Food handling and preparation Attendance of cockfights Defeathering Living in proximity to wetlands Socio-economic status Hunting practices Language barrier Care of sick persons Construction of villages that facilitates animal-human contact 12

13 Pilot Testing of Guidance 120% 80% 40% Hand Hygiene after poultry-related tasks No Yes Appropriate hand hygiene after poultryrelated tasks in the three EU regions 0% Greece Cyprus Italy Germany Poland Notify the Authorities for Dead Poultry 120% 80% 40% Other actions Yes 0% Greece Cyprus Italy Germany Poland Pilot testing of the model guidelines in 30 communities A total of 629 persons participated in the pilot testing in 5 EU MS: keeping backyard poultry is a common practice all over the EU it appears uncommon for children to be involved in tasks related to poultry in the three European regions education is still needed regarding the appropriate early involvement of the veterinary public health authorities for the potential threat of AI 13

14 EUROPEAN TRAINING FOR HEALTH PROFESSIONALS ON RAPID RESPONSES TO HEALTH THREATS Athena LINOS,MD: Agoritsa BAKA,MD: ( ) George Gouvras was head of Unit for Health Threats at the European Commission s Directorate for Public Health He was the person behind the EU Health Security programme, set up in December 2001 to improve preparedness, response and cooperation in the event of biological and/or chemical agent attacks. He also guided the preparedness for the response of the European Community against pandemic influenza. 14