The Role of Military Public Health and Healthcare Providers in National Bioterrorism Event Consequence Management

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1 The Role of Military Public Health and Healthcare Providers in National Bioterrorism Event Consequence Management COL (Ret) Zygmunt F. Dembek, PhD, MS, MPH, LHD EpiMilitaris Conference Hotel Zamek Ryn Mazury, Poland October 2014 The views expressed in this lecture are those of the author and do not reflect the official policy, or position of the Department of Defense, or the U.S. Government.

2 Objectives Describe Poland s unique capacity to respond to a CBRN crisis List Poland s CBRN response team members Assess capacity for CBRN consequence management List and assess gaps and suggest methods of coordinating response for CBRN consequence management

3 Emergency Preparedness Activities Preparedness Mitigation Response Recovery

4 Poland s Critical Stakeholders National Emergency Management Ministry of Health Chief Sanitary Inspectorate and regional State Sanitary Epidemiological Services Ministry of National Defense Ministry of Interior and Administration National Institute of Public Health/National Institute of Hygiene Health facility (hospital) managers

5 Governance Components to Poland s Crisis Preparedness National health sector crisis management Health education Communication Resource generation Health crisis planning Pharmaceutical & medical supplies Health financing Budget and contingency funds Service delivery Surge capacity Crisis management Health services for displaced persons

6 History of Natural Crises in Poland Over 30 natural and man made disasters in the past 20 years ~250,000 persons affected 1500 deaths ~$4.5M (US) loss Floods 1934 largest flood in the 2 nd Polish republic 55 deaths, $12M (US) damages 1997 central European flood ~110 deaths, 3.8B damages in Czech Republic and Poland 2002, 2009, 2010, 2013 floods Extreme weather conditions 2011 Cyclone Kwasery (Xavier) 400,000 homes without power Industrial and transportation accidents March 3, 2012 Warsaw Kracow rail line, worst rail disaster in 20 years. 16 dead, 58 injured.

7 Incident Command (ICS) Management System Command Operations Planning Logistics Administration/Finance

8 Poland s State Fire Service National Rescue and Firefighting System Firefighting/Natural disaster response Technical rescue Chemical rescue Ecological rescue Medical rescue Cooperation with State Medical Rescue System

9 Poland s Military Capacity CBRN mass casualty decontamination is traditional responsibility of Polish Army Has specialized equipment and training Military police assistance Potential extensive Army response to a mass casualty disaster 2 mobile hospitals First aid and transport capacity Can increase national bed capacity Blood transfusion stations and clinical laboratory capacity in military hospitals 3 permanent military hospitals within Poland PPE readily available in military units and healthcare facilities National mobilization possible in 6 hours

10 Civil Military Collaboration Civil military cooperation during a disaster is based upon written disaster plans What is the status of the CBRN plan where you live? Unique contributions of Polish military to civilian consequence management include: Expertise Information Security Infrastructure Capacity building Civil defense model for civilian military cooperation

11 NATO model, includes: Civil Military Collaboration Emergency response planning Training Exercises Resource capacity augmented by Minister of Defense, at request of provincial (Voivodes) governor Initiates military units to assist civilian crisis and consequence management

12 Emergency Management System in Poland Administrative level Emergency management authority Consultative and advisory body Emergency management center National Council of Ministers Government Team for Government Security (Prime Minister) Emergency Management Center Provincial (Vojewodztwo) Governor Provincial emergency management team Provincial emergency management center District (Powiat) District Head (District staroste) District emergency management team District emergency management center Communal (Gmina) Head of commune Mayor President of acity Communal emergency management team Communal emergency management centers may be established but there is no obligation to do so.

13 The State Sanitary Inspectorate s Early Warning and Response System Ensures a Rapid Effective Information Exchange With: EU member states European Commission (EC) European Center for Disease Prevention and Control (ECDC) World Health Organization (WHO) International Health Regulations (IHR) national focal point in Poland

14 Natural Disasters in Poland, Number of events: 37 Number of people killed: 1,693 Average killed per year: 55 Number of people affected: 370,666 Average affected per year: 11,957 Economic Damage (US$): 8,266,150,000 Economic Damage per year (US$): 266,650,000

15 SERC/LEPC Model (US) LEPC Membership: Elected state and local officials Police, fire, civil defense, and public health officials Environment, transportation, and hospital officials Facility representatives Representatives from community groups and media

16 SERC/LEPC Model (US): A community hazardous chemical monitoring system Established in 1986 A 2008 survey determined: 9 of 10 SLPCs meet annually, ¾ meet quarterly ~60% reviewed and updated their emergency response plan in the previous year >75% exercised their emergency response plan in the past year, ~70% conducted full scale exercises

17 Critical Resources for Consequence Management Human resources Pharmaceutical & medical supplies Equipment and infrastructure Health information management

18 Poland s Response Planning Process All emergency response plans are submitted to the MoH s Department of Defense, Crisis Management and Medical Rescue MoD s Military Medical Services prepare response plans for different crisis scenarios Threat analyses are developed by the Government Protection Agency and the State Fire Service

19 Emergency Medicine/EMS in Poland Each province has a designated physician rescue coordinator and rescue information center staffed with medical dispatchers Emergency response exercises are organized annually at the Provincial level Emergency medicine is a recognized medical specialty in Poland, and Poland hosts the Central European Emergency Medicine Congress every 4 years Emergency medical services (Ratownictwo Medyczne) are provided by public hospitals Emergency medical services are physician led and supported by paramedics and nurses, and integrated with public health Ambulances Helicopters

20 Recommendations External review of hospital emergency plans Accreditation may stimulate Hospital emergency preparedness program to include contingency aspects for extended large scale disaster Pandemic preparedness Displaced persons Mortuary Psychological Establish national public health laboratory network

21 Recommendations Increase interactions between civilian and military first responders, particularly regarding CBRN response Complete legislation and mechanisms necessary for emergency pharmaceutical delivery Execute the Emergency Management Center in the Department of Defense, Crisis Management and Medical Rescue Pre hospital and hospital emergency medical services to be fully coordinated

22 Recommendations The Department of Defense, Crisis Management and Medical Rescue could take the national lead role in a number of necessary CBRN preparedness coordinating functions, including the need to: Create a network of health coordinators Draft and implement health policy Design exercises Support hospital emergency preparedness programs with: Regulations Patient procedures Vulnerability assessments Mass casualty response plans Contingency plans Ensure the validity of emergency plans

23 Conclusions Poland has all the critical stakeholders and necessary partners for bioterrorism and CBRN consequence management Poland has the experience of successful response and recovery from recent natural disasters Civil military cooperation is essential to the successful consequence management of bioterrorism or CBRN event Consider the LEPC/SERC model (US) Emergency medicine and emergency response capacity are key Strengthen hospital, local, regional, national disaster preparedness plans, procedures, and exercises