IMPRESS conducted an analysis of major threat scenarios and lessons learnt

The intention of the report is to identify and analyze major threat scenarios for infectious diseases, releases of hazardous material and major trauma events, where possible linking to real events with lessons learned. Such events might be considered “Events of Public Health Concern” (EoPHC) and the scenarios that exemplify them assist with the definition of the scope of the IMPRESS toolbox. The risks posed by these threats on a nation’s public health are explored.

Two key features are required of the scenarios developed below: international aspects of a response (for example, cross-border communication or countermeasure sharing) and events with a disproportion between demand for and supply of health care (due to multiple hazards or complex care requirements).

Different types of incident and emergency vary considerably in the short and longer term public health impacts on the affected community, with different demands being placed on different elements of the potential health response. Any given event/scenario  determines which actors within the responder community need to be involved; the types, detail and amount of information or data that need to be shared and acted upon; and how quickly. Whilst capability gaps may exist for certain health responses, for a given scenario, the capacity related issues that need to be considered (amongst others) include:

• Ambulance (and potentially Police and Fire) service capacity
• Mass decontamination facilities
• Availability and type of countermeasures and related delivery system
• Diagnostics and tests to confirm agent
• Hospitals (bed space in ER/ICU/specialist treatment, medical (clinician and nurses) staff)
• Morgues
• Environmental clean-up (cordons, making safe, vector control)
• Psychosocial impacts and interventions

The pathogenic mechanism of adverse health determinants as well as the lack of health promoters can be described as biological, chemical, physical and/or psychosocial processes. Health hazards or stressors include hazardous materials (HZM), mechanical pressure and vibrations (e.g. sharps, noise, repetitive stress), electromagnetic radiation (e.g. thermal, ionizing radiation) as well as disruptors and disturbances of basic physiological processes (e.g. sleep deprivation, biorithm disturbance, nutrient disequilibrium) and psychosocial stress (e.g. emotional pressure, psychotrauma).

Incidents involving hazardous materials include Biological, Nuclear, Incendiary, Chemical, Explosive (NBICE) or Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) agents. Scenarios with Explosive and Incendiary agents result in trauma (e.g. mechanical injury such as crushing and fragmentation, but also burns). Scenarios with living organisms or biological agents and with nuclear materials or radiological hazards have a particular pathogenesis, which differs from (bio)chemical mechanisms of harm.