The Public Safety Risk

Management Framework

The basis for designing EHA training

courses in WPRO
The Greek Temple Model of Society

art and culture

environment

governance
livelihoods
education
health

security
 Sustainable Human Development
health, education, governance, livelihoods, environment (security)

Public Safety individuals

populations

Emergency
Risk Management + Management

Hazard Prevention and

Vulnerability Reduction + Mitigation

+
Emergency Preparedness Emergency Relief
(readiness) + (response and recovery)

Reconstruction and
Disaster Emergencies Non Disaster Emergencies
Rehabilitation

for example

Earthquakes Epidemics
 Hazards

Risks

loss of control

Emergencies

national level of authority local

War / Complex Disaster Non-disaster

Personal Injury
Emergencies emergencies emergencies

Mass Casualty
Pollution Epidemics Refugees Local flooding
Events

Industrial Accidents Transport Accidents Civil strife Urban Fires

 Indicators for monitoring risk reduction

General impact of
Prevalence of disasters = Hazard specific mortality + Hazard specific morbidity
disasters

hazard prevalence injuries, disability, disease

events/province/year
affected/province/year
hazard conversion rate
disasters/total hazard events/year
flood disasters/total floods/year
mortality rate
fatality rate
lethality rate
deaths/100000 population/year
deaths/100000 affected/year
deaths/disaster event
flood mortality rate flood injury rate
flood fatality rate flood disability rate
flood lethality rate flood disease rate
flood deaths/100000 population/year flood cases/100000 population/year
flood deaths/100000 affected/year flood cases/100000 affected/year
deaths/flood event cases/flood event
report EXCESS cases

evaluate as 10 year rolling averages

Other indicators economic data

social data
agricultural data
education data

Emergency
Prevention and Vulnerability Reduction Community Risk
+ + Preparedness =
Mitigation Programme Programme Management
Programme

safer communities
 Risks are the potential outcomes from the exposure of communities to hazards
Public safety risk is:
How do we assess proportional to
Risk ? 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 risks
readiness determines post impact risks
Goal the goal of a community risk management programme is to
enhance 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 Management

Personal Injury Hazard Reduction
Non-disaster Emergencies + Vulnerability Reduction
Disaster Emergencies Emergency Preparedness
National Security

safer communities

Public Safety
Risk
Management
 Public Safety

Emergency Management Risk Management

Relief Emergency Hazard Reduction
Reconstruction Preparedness Vulnerability Reduction
Rehabilitation Readiness to Respond

safer communities

Public Safety
Risk
Management
 Public Safety

Risk Management + Emergency Management

Hazard Reduction
Vulnerability Reduction
Emergency Preparedness
Damage Assessment and Needs Analysis
Epidemiology and Reporting
Mass Casualty Management
Hospital Planning
Curative Care
Shelter and Security
Water and Sanitation
Control of Communicable Disease
Food and Nutrition
Reproductive Health
Psychosocial Needs
Medical Supplies and Logistics
Media and Public Information
Recovery and Rehabilitation

safer communities
 Disaster Management is:
80% generic 15% specific 5% unique
to all disasters to the hazard to the event
1. Organisation
EOC earthquake time
coordination large numbers of trapped and injured place
communications large numbers of homeless and displaced weather
transport large numbers of dead and missing
logistics and supplies geography
information and media dead, injured and missing staff climate
reporting and surveillance damaged critical infrastruture/resources (hospitals, vehicles)
loss of water, gas, electricity, phone, transport, fuel networks security
2. Response loss of road, sea, air, rail infrastructutre / access
search and rescue politics
evacuation long period of SAR, victim extraction economy
mass casualty management high demand for FA, stretchers, triage, medical transport governance
management of dead and missing high demand for beds, surgery, blood products, referral
security wound infections, amputations, tetanus, dust inhalation emergency management capacity
temporary shelter, clothing and utensils high demand for orthotics, prosthetics, disability, dental logistics capacity
emergency water, sanitation and energy demand for specialised spinal and head injury care disposal of inappropriate donations
emergency food supplies high demand for temporary shelter, food, utensils, stoves,
emergency public and environmental health water, energy, clothing, tents, blankets leadership
emergency engineering and public works high demand for psychosocial support of victims and staff solidarity
management of donated supplies/foreign teams morale

3. Recovery few outbreaks of communicable diseases corruption

lifelines variable demand for medicines and equipment crime
curative and public health care (acute/chronic injury care - high, infectious disease - low, looting
education potentially unstable chronic disease - medium)
agriculture compensation claims
trade and commerce contamination of water, air and soil insurance claims
toxic chemical, sewerage and gas leaks/spills
4. Rehabilitation and Reconstruction urban fires, explosions ownership disputes
people contaminated, infested and unsafe foods property disputes
property increased vector breeding
services
livelihoods loss of livelihoods, markets, distribution networks
environment
THIS IS WHAT WE PLAN FOR ….
 Definitions of Types of Emergencies
hazards + community risks (consequences) type of emergency
natural hazards
hydro metereological death mass casualty event
storms people injury (mental and physical) epidemic
floods disease (mental and physical)
extreme temperatures
drought + +
geological secondary hazards (fire, disease)
earthquakes displacement
slides services loss of property
volcano infrastructure loss of income disaster
other natural environment breakdown in security
forest fires livelihoods damage to infrastructure
technological hazards breakdown in essential services
industrial accidents
transport accidents + +
structural failures
urban fires
biological hazards
diseases of epidemic potential social environment breakdown in social, economic
infestations economic environment and political structures complex emergency
societal hazards political environment
famine
civil strife
war
terrorism
 community
hazard x vulnerability / readiness = Community Risks
risk quality risk quantity risk quantity
indicators: indicators: indicators: indicators:
natural hazards people: laws, policy, guidelines, procedures probability of:
biological hazards: access to health care authority, resources, plans death
technological 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 legislation
2. scale: magnitude, intensity access to clean water national and sectoral policy loss of lifelines ie
3. area, spread, duration access to sanitation administrative procedures (shelter, water, food, energy)
biological hazards: adequate housing response and recovery plans population displacements
season, infectivity, latency employment/income preparedness plans loss of property
transmission, 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/year
vector habitats cases and deaths/event/year
forestry, agriculture EXCESS injuries; disease; disability
Prevention and Emergency
Vulnerability Community Risk
Mitigation + + Preparedness =
Reduction Programme Management
Programme Programme
 Health Needs in an Emergency
Time-frame General Needs Health Sector Responsibilities
first search and rescue safe extraction, resuscitation and first aid
24 evacuation / shelter triage and transport system
hours food primary medical care
water detoxification /decontamination
public 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, PUCD
environmental 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/obstetrics
psychosocial services care of the disabled (mental and physical)
end of education reconstruction and rehabilitation
3 months agriculture specific training programmes
environmental protection health information campaigns/health education programmes
disability and psychosocial care
compensation/reconstruction evaluation of lessons learned
restitution/rehabilitation revision of policies, guidelines, procedures and plans
prevention and preparedness upgrade knowledge and skills, change attitudes and practices
 PHEMAP Course Logical Framework
1 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 information
4.4 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 Implications
Overall All persons whose health and safety is threatened by the impact or consequences of a hazard National Policy
Policy must be protected level Guidelines
Procedures
ImmediateAll persons who face an immediate threat to their life or health must be found, rescued and Local Authority
Needs moved to a safe place level Plans
Policy 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 Knowledge
disposal after appropriate forensic investigation (technical and Skills
administrative) Attitudes
Sectoral In order to protect their health and safety, all persons threatened by the impact or Guidelines define standards
Policy 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 resources
choices How to report
How to move people/goods
Sectoral 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 diagnose
education How to confirm
agriculture How to treat
social welfare How to report
What is prompt, competent etc
 Health Sector Role in Relief

Damage / Needs Assessment Surveillance Systems Organisation and Management

Structural damage and loss Community, hospital and laboratory Public Information
Equipment damage and loss Public and private Case Management
Staffing needs Injury (physical and mental) Referral systems
Access and communications Communicable diseases Reporting system
Programme needs: Disability (physical and mental) Supplies and equipment
Surveillance Nutrition Logistics, transport and communications
Clinical Care Water quality Human resources
Communicable Disease Control (Non communicable diseases) Professional information and education
Prerequisites for health (Vectors) Research

Clinical Care Communicable Disease Control Prerequisites for Health

Acute primary care Diseases of Epidemic Potential Shelter, water and sanitation
Care and treatment of injured Vaccine Preventable Diseases Environmental health
Care and treatment of disability Vector Borne Diseases Nutrition and food supply
Care 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

scaling up emergency services

Response using AVAILABLE surge capacity restoration of essential services (repair/replace)
reconstruction
 Communicable Disease Control in Emergencies

Diseases of Epidemic Vaccine Preventable Vector Born Diseases of Public

+ + +
Potential Diseases Diseases Health Significance
cholera measles malaria TB
typhoid tetanus dengue HIV/AIDS
meningitis polio encephalitis STI
influenza pertussis typhus helminths

Public Safety Risk Management

safer communities

Strategy Options

Diseases of Epidemic Vaccine Preventable Vector Born Diseases of Public

Potential Diseases Diseases Health Significance
environmental control vaccination coverage vector control behaviour change 1st
case 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 FACILITY

EMERGENCY hospital police BASED
PLANNING plan ambulance PLAN
internal

all fire
MASS health centres / police AREA
CASUALTY hospitals ambulance BASED
PLANNING joint civil defence PLAN
external plan search and rescue
public red cross
private blood banks / labs

DISASTER DISTRICT PROVINCE

PLANNING TOWN CITY MULTI-AREA
internal and DISTRICT PROVINCE BASED
external + PLAN
military community government
 Damage Analysis and Needs Assessment for the Health Sector
Assess 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 needs
2. curative, preventative, promotional and
rehabilitative services in place and meeting needs
3. specific preventative actions being taken –
Is there damage to vector control, measles vaccination, vitamin A,
public awareness, antenatal care etc
health sector
Is there a major health 4. guidelines issued and being followed
infrastructure AND NO
5. reporting and surveillance systems for injury,
problem?
Is there damage to disease, nutrition, water quality, disability in place
6. referral systems in place, including laboratories,
lifelines? psychosocial, chronic diseases and disability care
7. essential drugs and equipments available,
appropriate and sufficient
8. management, logistics and communications
systems in place and meeting needs
9. staff safety, information, training needs being
YES met
1. Seek expert advice
2. Organise temporary services NO Can services be delivered?
3. Organise epidemiological studies
YES Reinforce
What action is needed to address
both the causes and the
consequences?

1. Monitoring and reporting system YES Can the health system cope? NO
Bring in outside assistance
2. Rehabilitation and reconstruction Can the community/refugees cope?
 Damage and Needs Assessments

Reporting + Surveillance
Hospitals cough + fever
Clinics and Health Centres diarrhoea + fever
Laboratories headache + fever
PHC Programmes: rash + fever
nutrition myalgia + fever
IMCI - epi, ari, cdd etc other fever
water and sanitation malnutrition <5s
vector control trauma, disability
MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD
daily daily

? 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?

 Changing Behaviour Saves Lives
Impact on reduction Importance in 1998
of mortality in % US Health budget in %
3
Research 5
27

Public health and

behaviour
modification
Data are for total US
government national
health expenditures for
92 1998 (US$1.146 tn),
62 excluding amounts
invested by other
government departments.
Curative care -
infrastructure, Based on ‘An
treatment and Epidemiological Model for
administration Health Policy Analysis’,
Dever G.E.A., Soc. Ind.
11 Res., 1976, Vol. 2, p. 465.
 Changing Investment Priorities Saves Lives
Impact on reduction
Expenditure %
of mortality in %
3
Research 5
27

Risk management
and vulnerability
reduction

92
62

Relief
&
Preparedness

11
 The UN System
UNO WHO FAO UNESCO ILO
function political health agriculture education labour
headquarters New York Geneva Rome Paris Geneva
founded 1945 1948 1945 1945 1919
member states 191 192 184 177
staff 8700 3500 4300 2400 1900
budget (biennium) 2.5 billion 1.8 billion 3.7 billion
regular budget 800 million 650 million 544 million 481 million
head Secretary General Director General Director General Director General Director General
governing bodies Security Council Executive Board FAO Council Executive Board Executive Council
General Assembly World Health Assembly FAO Conference General Conference ILO Conference
additional/special International Court of Justice 6 regional offices 100 advisory bodies
functions Trusteeship Council 1200 collaborating centres
Economic and Social Council* specialised centres
Special Representatives
Special Operations - UNTAET The world spends
implementing bodies PKO $800 billion/year
UNDP on the military
UNFPA Also 15 other self-governing bodies including:
UNICEF The UN System has:
UNHCR World Bank/IMF finance/development loans 6,000 million clients
UNCHR ICAO civil aviation 52,000 staff
UN HABITAT UPU postal services $18 billion/year
OCHA WMO meteorology or $3 per client
WTO trade
Regional bodies ECA WIPO intellectual property New York City has:
ECE IMO maritime 8 million clients
ESCAP IFAD agricultural development 200,000 staff
ECLAC UNIDO industry $45 billion/year
ESCWA 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 Risk Management Framework

Thank you