2.3. Sharing information on roles and responsibilities among different organizations

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Stakeholders involved in resilience management need to have clear idea of roles and responsibilities who may be involved in the management of a potential crisis. Each organization should have an adequate knowledge not only of its own roles and responsibilities, but also of those of other organizations they may be required to collaborate with during a crisis. This is vital in order to identify gaps and cooperate before, during and after a crisis.


Implementation

Introduction

If an organization needs to collaborate with other organizations, it is essential that the latter are sufficiently informed on the following aspects:

  1. Who needs to be contacted during a crisis
  2. Which are the relevant roles for the management of both generic and specific types of crises
  3. Which are the high level responsibilities of these roles, so to have a correct expectation of how one should interact with them.

A prerequisite for the application of the actions described in this card is the existence of a network of organizations already collaborating among them. In addition, the actions are expected to be more effective if the organizations are already sharing some form of written policy or procedure, clarifying the way the organizations should collaborate. If the network is still under development or the organizations are only cooperating based on verbal agreements, it may be more productive to apply first other CCs related to the coordination and synchronization of distributed operations.

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Healthcare implementation - Introduction

N/A

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Air Traffic Management implementation - Introduction

Airport Emergency Plan should contain a description of the sequence of actions to be performed before, during and after the emergency situation. Standard Operating Procedures (SOPs) and checklists have to be established for all phases (before, during and after) the emergency.

Before a crisis

If a shared procedure among the different organizations already exists, the procedure should specify which are the involved organizations and which is the one expected to take initiative when a coordination with the other organizations is required. If a shared procedure does not exist yet, one or more organizations should take initiative to coordinate and decide together the group of relevant organizations to involve. For guidance on how to establish from scratch a new network of organizations, see the CC Establishing networks. Actions needed before a crisis:

  • Identify organizations with shared responsibilities in the management of a crisis.
  • Organize periodic coordination meetings among the organisations. The frequency of meetings may vary, depending on needs, time and budget constraints (e.g. from twice a year, until once every two years). The meetings should address the following questions:
  1. Which roles can be contacted within each organization to coordinate the management of both generic and specific types of crises
  2. Which are the high level responsibilities of these roles
  3. How these roles can be contacted
  4. What type of communication means should be preferred to coordinate with them (e.g. point-to-point communication tools, one-to-many communication tools, alarming systems, etc.).
  5. Which is the most updated terminology to indicate the roles and to describe their high level responsibilities
  • Ensure that at least one representative per organization participate to the coordination meetings and that each organization designates a point of contact (PoC) to take care of such coordination.
  • Make sure that the designated PoCs will arrange updating activities internally to their own organization, following each coordination meeting (the internal updating activities can range from simple notifications to the interested personnel, to real training activities designed on purpose).
  • Make sure that major changes affecting emergency procedures in each organizations are assessed for their potential impact on the interaction with other organizations and communicated to them.
  • If possible, inside each organization, design and develop a ‘quick reference guide’ format of the procedure, simplified and adapted to the specific needs of the concerned organization. The quick reference format should help the first responders to easily identify the roles they have to interact with during a crisis, as opposed to the full list of roles discussed during the coordination meetings that may not be relevant for all the organizations. To note that the effort to design a quick reference guide may be worth only in more structured domains, in which roles and responsibilities tend to remain more stable over time, as opposed to less structured domains where there is a risk for the guide to quickly become outdated

Triggering questions

Involvement of organizations
  • Does a shared procedure exist among different organizations required to manage jointly a specific type of crisis?
  • Is there a need to involve new organizations in the coordination activities about shared roles and responsibilities for the management of a crisis?
  • Is there a need to create a new network of organizations for the management of a specific type of crisis? (see CC Establishing networks)

Coordination mechanism

  • When a shared procedure among different organization exists, is there one organization clearly appointed to activate and arrange periodic coordination activities with other organizations?
  • Within our organization, is a calendar of periodic coordination activities already established, to check roles and responsibilities with other organizations?

Impact on other organizations

  • Did we recently experience within our organization changes of roles and responsibilities that could affect emergency procedures shared with other organizations?
  • Are these changes sufficiently significant to require a communications to other involved organizations?

Internal dissemination of changes

  • Are we providing adequate information and training on relevant changes of roles and responsibilities in other organizations to the personnel potentially involved in the management of crisis?
  • Can we develop a ‘quick reference guide’ to help the personnel of our organization to promptly identify shared roles and responsibilities with other organizations during a crisis?
  • If we already have a ‘quick reference guide’, do we need to update it to include recent changes of the procedure shared with other organizations?

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Healthcare implementation - Before

Example of situations of relevance to healthcare:

In case of serious cross-border threats to health, public health organizations with shared responsibilities in the management of specific crises are identified according to national, European and international regulations and legal frameworks that support a coordinated action on monitoring, early warning and combating threats.

  • At international level, each State Party appoints a National Focal Point and the authorities responsible within its respective jurisdiction for the implementation of health measures.
  • In order to improve the coordination of the shared actions at European level, an ad-hoc Committee would be established to support the Member States in their efforts to prepare, tackle and mitigate health crises.
  • Each Member State should regularly provide the Commission with an update on the status of their preparedness and response planning at national level, also including information that they are obliged to report according to the international regulation.
  • At all levels, the public health organizations involved provide contact details that need to be continuously updated and annually confirmed.
  • All the levels – international, European, national -need to be interwoven and work on coordination by collecting and sharing data and information.

See in addition Practice 1 in the Healthcare Practices, Methods and Tools section below.

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Air Traffic Management implementation - Before

In the context of Airport Emergency Plan, it is fundamental to:

  • organise training, drills and exercises to test if the people assigned to support the AEP are familiar with their roles and responsibilities

During a crisis

If the actions put in place before the crisis have been successful, during a crisis the personnel of each organization should be ready to react in an efficient and effective manner, reducing misunderstandings and misinterpretations about roles and responsibilities of other involved organizations.

Actions needed during a crisis:

  • Operate taking into consideration the information and/or the training received during internal updating activities concerning roles and responsibilities of other organizations involved in the management of the crisis.
  • If available, use the quick reference guide version of the procedure shared with other organizations to easily identify the relevant roles and responsibilities.

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Healthcare implementation - During

Example of situations of relevance to healthcare:

  • The involvement of the actors in the crisis management is regulated by the classification of the critical event, that is based on the magnitude of the event.
  • During the crisis, all the organizations involved at the regional, national, European, international levels operate according to the established legal frameworks and regulations in which roles and responsibilities are clearly described.
  • The coordination of the organizations involved may shift according to the crisis scale (e.g. whether the situation is classified or not as a national emergency) to guarantee an adequate level of access to the available resources and ensure an unified direction.

See in addition Practice 2 and Practice 4 in the Healthcare Practices, Methods and Tools section below.

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Air Traffic Management implementation - During

In the context of EACCC (European Aviation Crisis Coordination Cell), the steps that are taken in the event of a crisis are the following: [1]

  • the Network Manager contacts the relevant State Focal Points and those at risk at the beginning of any crisis, as well as relevant expert organisations, depending on the type of crisis (e.g. VAAC, ESA, etc.);
  • the EACCC is convened via meetings or teleconferences;
  • the remaining State Focal Points are contacted;
  • a crisis mitigation policy is discussed, agreed and approved by the EACCC;
  • the relevant State Focal Points provide a link with their internal structures nationally and, where appropriate, coordinate the response in line with their internal procedures;
  • the remaining State Focal Points are contacted;
  • a crisis-mitigation policy is discussed, agreed and approved by the EACCC.

When the crisis is resolved, the EACCC is deactivated.

After a crisis

The outcome of a crisis is obviously an opportunity to revise any kind of procedure shared among different organizations that were jointly involved in its management. Such review include the high-level definition of roles and responsibilities inside each organization. Actions needed after a crisis:

  • Organize extraordinary coordination activities (beyond the one normally planned) to revise the common procedure and update the high-level definition of roles and responsibilities in each organization, as needed.
  • Consider whether new organizations should be included in the shared procedure and periodic coordination mechanism (or if other organizations should be excluded from that, having lost their relevance in the shared procedure).

Triggering questions

Organizations involved
  • Did the shared procedure and coordination mechanism involved all the organizations relevant for the management of the crisis?
  • Considering what happened during the crisis: should new organizations be included in the shared procedure and coordination mechanism?

Coordination mechanism

  • Was the experienced crisis severe enough to justify extraordinary coordination activities (beyond the one normally planned) to revise the common procedure and the definition of high-level roles and responsibilities in each organization?
  • Is the frequency of periodic coordination activities sufficient at the light of the occurred crisis?

Impact on other organizations

  • Does our organization have ill-defined roles and responsibilities in the shared procedure, which negatively affected the response to a crisis managed in cooperation with other organizations?

Internal dissemination of changes

  • Did the information and training provided previously to the crisis result to be effective for what concern relevant changes of roles and responsibilities in other organizations?
  • If available, did the quick reference guide supported the identification of roles and responsibilities during the crisis?

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Healthcare implementation - After

After a crisis, the revision of common procedures is recommended at least after critical events with a large impact (for instance an earthquake crisis). This review aims both at confirming roles and responsibilities, and including new sub-clusters of actors and activities that have been set up for the first time in the field to manage the crisis. When useful, in order to ensure the timely new coordination actions over the time, specific legal measures could be provided.

See in addition Practice 3 in the Healthcare Practices, Methods and Tools section below.

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Air Traffic Management implementation - After

'In the context of EACCC (European Aviation Crisis Coordination Cell), the steps that are taken after the crisis are the following [2]:

  • A debriefing EACCC session is held after the crisis to address the lessons learned and to cover any remaining actions.
  • The EACCC gathers, prepares and shares any relevant information with the entire aviation community, ensuring that consistent messages are issued.
  • To achieve this, the EACCC prepares factual assessments of the situation for communications purposes. Using a nominated communications focal point, the EACCC ensures that consistent information, based on the factual assessment of the situation made by the EACCC, is transmitted to EC/EASA/EUROCONTROL as Network Manager, the civil and military authorities of affected States and corresponding NSAs/ANSPs, airlines and airports.



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Understanding the context

Detailed objectives

Major crises and emergencies that require the joint intervention of more organizations are luckily quite rare to occur. A negative consequence of this is that when the crisis occurs, managers and first responders may have lost familiarity with the best way to cooperate with other organizations and in case they have never experienced such coordination, establishing new links may be even harder. In addition, since the story of each organization develops independently, there might be cases in which roles identified in the past do not exist anymore or cases in which the way to get in touch with them has changed. More than that, the same roles may have modified their function within the organization to an extent that changes the way cooperate with it or the terminology to identify them may have evolved in way that makes them difficult to recognize. Therefore, if more organizations are expected to cooperate in case of crisis, there is a need to ensure that each of them has an adequate level of knowledge of aspects such as:

  • Which roles can be contacted within each organization to coordinate the management of both generic and specific types of crises
  • Which are the high level responsibilities of these roles
  • How these roles can be contacted
  • What type of communication means should be preferred to coordinate with them (e.g. point-to-point communication tools, one-to-many communication tools, alarming systems, etc.).
  • Which is the most updated terminology to indicate the roles and to describe their high level responsibilities

The actions proposed by this card focus around the idea that even in the case of well structured domains in which the relationships among different organizations are regulated by written procedures or polices, a stable coordination mechanism should be ensured. This mechanism consists of meetings among selected representatives of each organization, to be arranged at regular time intervals or after major events that have relevance for the way the cooperation should occur. Depending on budget and domain specific constraints, the meetings may also have a limited frequency (e.g. from twice a year, until once every two years), but it is very important that they are maintained over time and not triggered only by specific events or criticalities. It should be noted that this mechanism can be complementary to the ones suggested by other coordination CCs, i.e. CC 2.1 Promoting common ground and CC 2.2 Establishing networks. However, the three CCs should not be confused among them. Their mechanisms can be combined depending on specific needs and arrangements, but they are aiming at different goals.

Targeted actors

Policy, decision makers, resource managers, front-line operators in organizations, which have agreed to coordinate, exchange information and establish common procedures (even at a high level) with other organizations for the management of specific types of crisis.

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Healthcare actors

Several levels of actors need to be considered according to the healthcare system organization in each country. Especially policy and decision makers have to be identified with respect to the healthcare main macro area levels (i.e. international, European, national, regional/ local).

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Air Traffic Management actors

According to the provisions for Airport Emergency Plan of 'ICAO Annex 14 - Chapter 9. Emergency and other services' it is necessary to identify:

  • Agencies involved in the plan
  • Responsibility and role of each agency the director of the Emergency Operations Centre (EOC/COE) and Command Post (CP), for each type of emergency
  • coordinates of offices/people to be contacted in case of emergency

The plan coordinates the response or participation of all existing agencies which, in the opinion of the appropriate authority, could be of assistance in responding to an emergency.

Examples of agencies are provided in the document concerning emergencies:

  • ON-aerodrome : air traffic control unit, rescue and fire fighting services, aerodrome administration, medical and ambulance services, aircraft operators, security services, and police ;
  • OFF-aerodrome: fire departments, police, health authorities (including medical, ambulance, hospital and public health services), military, and harbour patrol or cost guard.

Expected benefits

Improved readiness to act in case of a crisis whose management requires joint and coordinated interventions of different organizations. Potential benefits associated to the improved readiness to act are:

  1. A more effective mitigation of the effects of the crisis, such as a reduction of the number of deaths and a reduction of the severity of injuries;
  2. A quicker return to a stable state, facilitating business continuity in the organizations affected by the crisis.

Relation to adaptive capacity

A stronger and more effective coordination among different organizations involved in the management of a crisis is expected to improve the overall capability of such organizations (as a group) to adapt to unexpected events and quickly identify the most effective responses to them. On the contrary, a loose and weak coordination between organization (e.g. lack of information on who should be contacted and wrong expectations on the roles of each actors) is likely to reduce adaptive capabilities and foster rigid and bureaucratic responses, which are inadequate to manage a crisis.

Relation to risk management

The existing risk assessment activities and the associated mitigation measures are made stronger by better knowledge of the safety issues concerning the interfacing between different organizations operating in the same domain.

Illustration

A potential illustrative case is the use of the “Manuale Rosso” (Red Manual) adopted by different entities with shared responsibilities for the management of emergencies at the Fiumicino Airport (Rome-Italy) following major aircraft accidents in the aerodrome area on in the vicinity of it.

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Healthcare illustration

An example of coordination and communication among actors - that is based on the mutual understanding of roles and responsibilities – concerns the Psittcacosis infection among the Fiumicino Airport staff and a cargo of live parrots.

Several years ago, two members of the Fiumicino (FCO) airport staff – in Rome (Italy) - were diagnosed with Psittacosis in a nearby hospital. The information was relayed to the local health unit (LHU) and from there to the Lazio Region and to the Ministry of Health (MoH) - Communicable Disease (CD) Office as per the national surveillance system. The Department of Prevention of the LHU investigated the working environment of the patients and found that both had worked at the airport in enclosures dedicated to the care and inspection of live animals and had handled a cargo of live parrots that had since left the airport. The MoH - CD office informed the USMAF (Port, Airport and Ground Crossing Health Offices) Central Coordination Office and the MoH Veterinary services. The USMAF Central Coordination Office communicated with the USMAF FCO (Port, Airport and Ground Crossing Health Office situated in the Fiumicino Airport). The Human contact tracing and surveillance were performed by the Lazio Region in collaboration with the Local Health Units of Rome. Information on the air carrier and exporter/country of origin was collected by the Veterinary Office, according to the rules on the controls of live animals and animal products. The FCO Border Control Post was able to identify the suspected cargo and its final destination thanks to its dedicated database on products received and inspection/control procedures. The USMAF FCO also consulted its dedicated NSIS (New Sanitary Information System) USMAF database on products received and inspection/control procedures. All findings were communicated to the USMAF Central Coordination Office. After internal communication among the relevant offices in the MoH (Central level), the Region of destination of the parrots was contacted. The Region then alerted the local health unit of the concerned area. The LHU coordinated the inspection of the pet shop that had received the parrots both for aspects concerning animal and human health [1].

The example shows the complexity of roles and responsibilities in multi-organizational crisis. Several actors were involved and operated according to their internal procedures and regulations. The fruitful collaboration among organizations were supported by a mutual awareness of their roles and responsibilities and by means of a central coordination – performed by the USMAF Central Coordination Office – that allowed the information collection and sharing among the actors involved.

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Air Traffic Management illustration

Illustrative cases concerning the Understanding of Roles and Responsibilities may be found online among the material concerning Airport Emergency Plans:

  • Some airport management companies publish online their AEP where all actors and their responsibilities are described in detail: e.g. Aeroporti di Roma [3] is one of them.
  • some examples of Lessons Learned from training, drills and exercises are available online: e.g. the largest full-scale emergency exercise in Florida history has been organised at Orlando International Airport (MCO) [4]. The Exercise Scenario was about "an Airbus A-320 carrying 93 passengers and 5 crewmembers crashes into a hotel one mile from the airport. In addition to including standard response elements such as patient triage & hazard identification, the off-site scenario also included the transfer of incident command to the jurisdiction of non-airport entity & area hospitals' surge capabilities."

Implementation considerations

Challenges

Different types of crisis are managed in different ways and may involve different organizations. The ideal cluster of organizations for the management of a certain crisis may not be applicable to or optimal for the management of another type of crisis. Therefore, the most challenging aspect is the identification of the right group of organizations for the establishment of a stable coordination. This may be particularly difficult in the case of very diverse and non-standardized domains in which the same activities (and therefore the potential crises affecting them) are managed in very different ways. In addition, the potential for effective cooperation among different organizations may be jeopardized by the lack of sufficient common ground for discussion on the most relevant aspects of crisis management. This may require specific actions to let the different organizations know better each other before establishing a stable coordination (see Card DR77 “Promoting common ground in cross-organizational collaboration in crisis management”).

Implementation cost

Costs may vary depending on different levels of implementation and different needs. They will be relatively limited when the intervention is mainly limited to the periodic coordination activities with the other involved organizations to update already existing shared procedures (minimum awareness level). They will considerably increase in complex organizations where a higher level of implementation will be required. E.g. large training programs as a consequence of updating common procedures with other organizations or major design/redesign of dedicated quick reference handbooks internal to specific organizations.

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Healthcare implementation considerations

Associated challenges

Some contextual conditions affect the implementation of the resilience principle described in this card:

  • Type of emergency. The card is adequate to contexts characterised by repeatable, bounded emergency situations, where scenarios typologies are reasonably predictable, and where consequently it is possible to have stable emergency procedures, and identifiable actors. On the other hand, the approach may not work in non-structured situations, in which the intervention has to be prepared on ad-hoc basis.
  • Confidentiality. Confidentiality may prevent some organisations to disclose internal information about roles, responsibilities’ and contact numbers.
  • Safety culture level. Different actors from different organisations may have different levels of safety culture; therefore, not all of them may consider periodic meetings valuable to increase mutual awareness of relevant roles, responsibilities and contacts.
  • Competition among the actors. The competition among the actors – rather than the collaboration - fostered by policies and strengthened by cultural, social and economic factors - do not enhance the resilience perspective.

Furthermore, in some countries healthcare actors’ roles and responsibilities could not be easy identifiable because there is not always a direct correspondence between roles and responsibilities. During the emergencies, for instance, the lower hierarchical roles happen to endorse higher responsibilities but in an informal way and without an institutional acknowledgements due to power issues that are strictly related to the hierarchical structure of the healthcare system. This is a critical issue that severely compromise the possibility to recognize which are the effective and crucial healthcare roles.

Minimum viable solution

Implementation costs are scalable: they depend on the involved levels of the healthcare system (regional, national, European, international). The minimum viable solution to assure a common understanding of roles and responsibilities at regional and national levels, consists in clearly identifying, within each organization, contact persons, for shared procedures, who are in charge of arranging updating activities. One minimum activity should concern the regular information sharing by each organization regarding organizational aspects that could impact on the coordination activities for the crisis management (e.g. resources availability, changes in internal procedures and regulations). A mailing list or communication platform (see Tools in: Healthcare Practices, Methods and Tools section below) could be used for this purpose.

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Air Traffic Management implementation considerations

According to ICAO Annex 14 - Chapter 9. Emergency and other services "An aerodrome emergency plan shall be established at an aerodrome, commensurate with the aircraft operations and other activities conducted at the aerodrome." "The aerodrome emergency plan sets forth the procedures for coordinating the response of different aerodrome agencies (or services) and of those agencies in the surrounding community that could be of assistance in responding to the emergency."

At European level [5]: "In May 2010, the European Commission (EC) and EUROCONTROL jointly established the European Aviation Crisis Coordination Cell (EACCC) to coordinate the management of crisis responses in the European ATM network. In addition, the EC included crisis management aspects in the NM implementing rule (NM IR), which lays down detailed rules for the implementation of ATM network functions." The main role of the EACCC is to coordinate the response to those network crisis situations which impact adversely on aviation, in close cooperation with corresponding structures in States. This includes proposing measures and taking initiatives and, in particular, acquiring and sharing information with the aviation community (decision makers, airspace users and service providers) in a timely manner. In accordance with the Network Manager Implementing Rule, the EACCC consists of a single representative of:

  • the EU Member State holding the Presidency of the European Council;
  • the European Commission;
  • EASA;
  • EUROCONTROL;
  • the Network Manager;
  • the military;
  • the Air Navigation Service Providers;
  • airports;
  • airspace users.

The representatives of the Network Manager and the Commission co-chair the meetings of the EACCC. Experts may be seconded to the EACCC on a case-by-case basis, depending on the specific nature of the crisis. The EACCC coordinates with relevant State Focal Points from the early stages of the crisis onwards.

IATA in the "EMERGENCY RESPONSE PLAN - A template for Air Carriers - PUBLIC HEALTH EMERGENCY" proposes (for information purposes only) an outline of the roles and responsibilities of each member of the Emergency Response Team (ERT) and a checklist of actions to be taken in the event of a public health Emergency. [6]


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Relevant material

Relevant Practices, Methods and Tools

Practices

Complex entities, composed of many interdependent subsystems, can improve their ability to recover from incidents through the better management of key interfaces (from the paper “Managing incidents in a complex system: a railway case study”, Collis at al. 2016).

“Planning for incident response should include ensuring that interdependencies between organizations and the contact details for each are maintained up to date, via agreed interface protocols, and that there are credible, robust, coordinated and practiced emergency plans" (ID 287-p183) (TRL9).

Organizations can become wiser by looking at incidents outside their own sector (from the Paper “Resilience Through Emergency Planning: Learnings from Cross-Sectoral Lessons”, Chrichton et al, 2009).

“(…) a responding organization must retrieve control of the situation, and should have in place an effective emergency preparedness response plan and procedures. It is vital that the people involved in the response have received sufficient opportunity beforehand, in the planning stage, to form effective relationships with those people that the emergency will thrust together both intra- and inter-organizationally. These relationships also need to recognize the competencies, responsibilities, and constraints under which each organization and its people are working. People need to understand not just WHAT they must do, but HOW they can work most effectively together” (ID 1317-p13).

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Healthcare Practices, Methods and Tools

Practices

Practice 1. In Italy, in case of epidemic threats identified by a national surveillance system with impact at international level: Public Health organizations with shared responsibilities are identified according to national ministerial decree/ pandemic plan/ standard operating procedures, the European Decision No 1082/ 2013/ EU [3], and the International Health Regulation (IHR) [4].

  • At international level, according to the IHR, each State Party establishes a National IHR Focal Point and the authorities responsible for the implementation of health measures. In the IHR, roles and responsibilities of the National IHR Focal Points are clearly described. States Parties provide WHO with contact details of their National IHR Focal Point and WHO provides States Parties with contact details of WHO IHR Contact Points.
  • At European level, the Decision supports a coordinated Union action on monitoring, early warning and combating serious cross-border threats to health. An important role in the coordination of these actions is played by the Health Security Committee composed of high-level representatives from Member States. In case of communicable diseases, the surveillance at Union level is carried out by the European Centre For Disease Prevention and Control (ECDC). In order to strengthen the preparedness and the response planning, Member States should regularly provide the Commission with an update on the status of their preparedness and response planning at national level, also including information that Member States are obliged to report to the WHO in the context of the IHR.
  • At national and regional levels, in Italy, roles and responsibilities of organizations involved in the management of the epidemic disease are regulated by the Pandemic preparedness plan [5] provided by the Ministry of Health (MoH). Standard operational procedures (POS) are also released by the USMAF Central Coordination Office in charge for healthcare facilities and services at the Points of Entry (PoE) such as airports and ports (MoH).

Practice 2. In the Italian National healthcare system, numerous actors are involved in communicable disease detection and early warning and in outbreak/health emergency response. Their involvement differs whether the situation is classified or not as a national emergency [1]. All the organizations involved at the regional, national, European, international levels operate according to the legal frameworks mentioned in the before phase.

In case of a national emergency, as foreseen in the Pandemic Preparedness Plan [4], the Council of Ministers activates the Department of Civil Protection that in turn activates governmental and non-governmental actors such as the Italian Red Cross, the operational network of the emergency health response (118) and the Police forces.

Coordination shifts from the Ministry of Health to the Civil Protection Department. If the emergency is health related, the Minister of Health will be called to provide technical advice.

As National IHR Focal Point (NFP), the MoH – Directorate General of Prevention is responsible for communicating timely both to WHO at international level, and to ECDC at Union level by means of the Early Warning and Response System (EWRS). This notification of alerts is required only where the scale and severity of the threat are significant and they affect more than one Member State and require a coordinated response at the Union level. Deadline and procedures are regulated by the legal frameworks [3], [4].


Practice 3. An example of revision of common procedures after a crisis is provided by the case of the Abruzzo earthquake emergency occurred in Italy, in 2009. In order to strengthen the local capability to assure an adequate level of health rescue and assistance at local/ regional level in coordination with the National Civil Protection Department – Sanitary Unit, Regional Health Modules (RHM) were established during the emergency, and legal measures to include them in a common procedure were released in 2011, after the crisis. Legal measures take into account what happened in the field, among the already identified actors, during the crisis management. The aim is to describe and specify the general process to activate and manage RHMs that have to operate in the first 72 hours of the crisis, to minimize victims and the avoidable health consequences among the severely injured persons. The procedure details have to be specifically established between the Civil Protection Department and each Region [More information, in Italian, are available at: http://www.protezionecivile.gov.it/jcms/en/view_prov.wp?contentId=LEG28816]

Practice 4. An example of coordination mechanism among the Health Emergency Operations Facility (HEOF) established by the Directorate-General for Health and Food Safety (DG SANTE) of the European Commission. The HEOF is a Link/Contact structure for health crises established in Luxembourg. Its activity has been agreed at European Community level and formally endorsed, taking account of subsidiary principles. If required, the Health Event Managers will cooperate with competent authorities and services other than human public health, as specified in their national plans. The Health Emergency Operations Facility operates as the public health hub for linkage with the centralised national / European Community Crisis Management structures. All stakeholders are supposed to provide information to each other. In this way they can feed into their decisional process the information displayed on a secure website monitored by the Link/Contact Structure. The HEOF is a tool that can provide decision makers with:

  • (i) fast and comprehensive international situation

awareness and analysis;

  • (ii) transmission of information about measures implemented in other Member States
  • (iii) effective coordination of responses.


Methods

The Cluster Approach, is generally applied to improve the effectiveness of response capability of the humanitarian response in terms of sufficient global capacity, predictable leadership in the main sectors of response, partnership among actors involved, accountability of partners, strategic coordination and prioritization [5].

Tools

Communication platforms, are useful tools to share information, practices, and to support the coordination among actors with same objectives.

Examples are provided by:

  • EU SHIPSAN ACT Information System (SIS) [7]. The EU SHIPSAN ACT is a European Joint Action dealing with the impact on maritime transport of health threats due to biological, chemical and radiological agents, including communicable diseases and supports the implementation of IHR [3]. The SIS is a Communication Network platform, an information system and a database.

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Air Traffic Management Practices, Methods and Tools

According to ICAO ANNEX 14, VOL I Provisions fo Airport Emergency Plan, the AEP has to be subject to periodic testing & review results. "The AEP shall be tested by conducting:

  • a full-scale aerodrome emergency exercise at intervals not exceeding two years. The purpose of a full-scale exercise is to ensure the adequacy of the plan to cope with different types of emergencies.
  • partial emergency exercises in the intervening year to ensure that any deficiencies found during the fullscale aerodrome emergency exercise have been corrected. The purpose of a partial exercise is to ensure the adequacy of the response to individual participating agencies and components of the plan, such as the communications system.

The AEP shall be reviewed thereafter, or after an actual emergency, so as to correct any deficiency found during such exercises or actual emergency."

Moreover there are different types of exercises, from a lower level to a higher level exercise, with each one building on the concepts of the previous exercise. FAA in its AC 150/5200-31, Airport Emergency Plan [7] refers to and provides details about:

  1. Orientation Seminars to discuss the AEP and initial plans for upcoming drills and exercises, as well as to become familiar with the roles, procedures, responsibilities, and personalities of all those involved.
  2. Drills to test, develop or maintain skills in a single emergency response procedure.
  3. Tabletop Exercise to provide training and evaluate plans and procedures and to resolve questions

of coordination and assignment of responsibilities in an informal, non-threatening format without concern for time constraints, stress levels, or actual simulations.

  1. Functional Exercise to test or evaluate the specific capabilities of the participants for several functions under a stress-induced environment with time constraints and actual simulation of specified events. In other words, it can test within specified limits the internal airport and the external responses of off-airport emergency response agencies.
  2. Full-Scale Exercise to evaluate the operational capability of the emergency management system in a

stress environment with actual mobilization and deployment to demonstrate coordination and response capability. It uses all resources and requires reaction from equipment and personnel that would normally be available if the exercise were an actual emergency.

References

  • Collis, L., Schmid F., Tobias A., (2013). Managing incidents in a complex system: a railway case study. Cogn Tech Work (2014) 16:171–185 Cambridge, MA: MIT Press.
  • Reissman, B.D., Howard J., Responder Safety and Health: Preparing for Future Disasters, Mount Sinai Journal of Medicine 75:135–141, 2008

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