Public Health Risk Assessment

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Public Health Risk Assessment
Public health CBRN course

• Bonnie Henry, MD, FRCPC
• Doug Sider, MD, FRCPC

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Case 1

• A tornado has just hit your community dozens of
  walking wounded are appearing at the local
  hospital, as well as individuals looking for
  loved ones
• Ambulance communications notifies the local
  hospital to expect at least 30 patients of
  varying severity in the next hour
• Municipal officials have called you to the EOC
  and asked you to prepare some public safety
  messages (re food, water, shelter)

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Case 2

• An explosion has occurred at the Bloor station in
  the Toronto subway system
• CBRN team is responding due to a phone call to a
  local TV station from a terrorist group chanting
  Death to Canada and claiming that a radioactive
  substance has been released

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Case 3

• A mysterious influenza-like illness beginning in
  Southeast Asia has been found to jump from
  birds to people
• Over 400 people of all ages have been affected
  mortality is 50
• Recent reports indicate some human to human
  transmission

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Case 3

• The disease is making its way west cases are
  turning up in Europe
• The WHO announced that the world may be entering
  Phase IV of the Pandemic phases (human cases
  found with subtype established human spread)

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Questions to ask

1. Is my organization/community prepared to respond
   to these events?
2. Does my organization/community need to be
   prepared anyway?
3. What are our priorities?

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Have you done your risk assessment?
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Goals of Session

• Describe the need for and context of risk
  assessment in emergency health planning
• Describe and prioritize the risks faced by of
  your organization/community to better prepare for
  public health emergencies

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Phases of an Emergency
(F/P/T National Framework)

• Risk assessment
• Mitigation
• Preparedness
• Response
• Recovery

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Public Health Emergency Preparedness and Response

• GOAL To enable and ensure a consistent response
  to public health emergencies and emergencies with
  public health impacts.
• Hazard Identification and Assessment
• Immediate Outcomes
• Awareness of the hazards which are relevant to
  the catchment area of the board of health.
• Risk-based emergency planning and programming to
  guide ongoing board of health preparedness
  efforts.
• Requirement
• The board of health shall, in accordance with the
  Provincial Protocol on Public Health Emergency
  Preparedness, 2007, identify and assess the
  relevant hazards and risks to public health
  within the health unit area.

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Whats your risk?

• Naturally occurring events
• Technological/infra-structure events
• Human related events

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Natural events - examples

• Hurricane
• Tornado
• Extreme heat/cold
• Ice storm
• Snow storm
• Flood
• Epidemic/pandemic

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Epidemic/pandemic

• Influenza
• SARS
• E Coli
• Smallpox

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Technological/ Infrastructure events

• Electricity system failure
• Transportation emergency
• Water system emergency
• Structural collapse
• HAZMAT events
• Fire
• Nuclear power station events

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Human Related Events

• Terrorism biological, chemical, nuclear,
  radiological
• Civil disturbance
• Labour actions
• Armed conflict
• Large public gatherings

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What is your risk for each?

• Risk Probability x Impact
• www.ceep.ca

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Risk Probability x Impact
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Components of Risk

• Probability?
• Highly likely?
• Likely?
• Possible?
• Unlikely?

• Impact?
• 4. Catastrophic
• 3. Critical
• 2. Serious
• 1. Marginal

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Probability
Probability Rating Description Detail
A Highly Likely nearly 100 probability in next year
B Likely between 10 and 100 probability in next year, or at least one event in next 10 years
C Possible between 1 and 10 probability in next year, or at least one event in next 100 years
D Unlikely less than 1 probability in next 100 years
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Components of Impact

• Impact
• Human
• Physical
• infrastucture
• Business

• Impact
• 4. Catastrophic
• 3. Critical
• 2. Serious
• 1. Marginal

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Impact - Human

• 4. high probability of death
• 3. high probability of injury or illness low
  probability of death
• 2. low probability of injury, illness or death
• 1. unlikely to cause injury, illness or death
  in community members/providers

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Impact Physical Infrastructure

• 4. extensive physical infrastructure damage with
  substantial service disruptions, high costs and
  extended recovery time
• 3. moderate physical infrastructure damage
• 2. minor physical infrastructure damage
• 1. unlikely to cause physical infrastructure
  damage causing service disruption with resultant
  costs/recovery challenges

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Impact - Business

• numerous public/private sector entities unable to
  provide services
• 3. significant/widespread or long term service
  interruptions
• 2. minor or limited or short term service
  interruptions
• 1. unlikely to cause public/private sector
  service interruptions

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Overall Impact Rating
11-12 Catastrophic Community cannot assure core public/private services without extensive assistance from provincial or federal resources
8-10 Critical Community can only assure a normal level of services with assistance from outside the region or the community is reduced to providing a minimal level of service with normal resources existing within the community
5-7 Serious Community can assure a normal level of services with assistance from within region or reduced levels of service with resources existing within the community
3-4 Marginal Normal level of functioning or increased level of public/private services required within the community
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Risk Assessment - examples
Threat Probability Impact (HPB) Risk
Tornado B 332 B8
Dirty Bomb B/C/D 312 B/C/D6
Pandemic influenza B 414 B9
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Risk Rating
Impact/Probability A Highly Likely B Likely C Possible D Unlikely
11-12Catastrophic A11-A12 B11-B12 C11-C12 D11-D12
8 -10 Critical A8-A10 B8-B10 C8-C10 D8-D10
5 - 7 Serious A5-A7 B5-B7 C5-C7 D5-D7
3 - 4 Marginal A3-A4 B3-B4 C3-C4 D3-D4
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Priorities

• Pandemic flu
• Tornado
• Dirty bomb

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Priorities

• Perform this exercise for all
• Naturally occurring events
• Technological/infrastructure events
• Human related events

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Summary

• Assessment of risks is first step in planning
• Helps focus efforts and ensures no possibilities
  are missed
• Helps prioritize efforts in preparedness

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The only thing more difficult than preparing for
an emergency is having to explain why you didnt