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6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Counterterrorism Hospitals
Preparedness and Response.
An Italian Pilot Project.
A.Rossodivita1, M.R Gismondo1, C. Picco2, A. Zoli2, G.
Rizzardini1
1Luigi Sacco Academic Hospital, Milan Italy
2 AREU – Regional Emergency Medical Service Company of
Lombardia , Italy
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6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
GTI report 2016
32685 DEATHS
IN 2014
80% INCREASE
>11 COUNTRIES
IRAQ
NIGERIA
AFGANISTAN
PAKISTAN
SYRIA
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Percentages of People in Western Countries-
Domestic Islamic Extremism 2005-2015
GTI Report 2016
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
TE-SAT 2016 TERRORISM REPORT
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Attacks in Western countries accounted for a small percentage incidents,
representing 4.4 per cent of terrorist incidents and 2.6 per cent of deaths over
the last 15 years , until 2015. In 2015 – 2016 years we assisted in a progressive
escalation on terrorist attacks in Europe due to ISIS/ISIL attacks , starting from
France , and Belgium of particular concern. The four large attacks listed above
make up 91 per cent of deaths from terrorism in the West during this period
FRANCE 2015
148 DEATHS
350 CASUALTIES
TE SAT 2016 REPORT
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
CBRNE
To date terrorists and criminals seem to remain interested in using weapons that are
easily available, not too complex to operate, and which have direct and lethal effects.
These three factors – availability, uncomplicated knowledge and effectiveness -
encourage terrorists to use conventional firearms and explosives.
Although CBRN materials remain highly attractive to terrorists, they are difficult to
acquire, transport, handle and deploy without particular scientific knowledge and
technology.
Nevertheless, several incidents in 2015 involved the actual or attempted malevolent
use of CBRN materials with criminal or unknown intentions. In recent years, jihadist
terrorists and their sympathisers have regularly expressed threats involving CBRN
materials in their propaganda.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
TERRORISM
Non Conventional Terrorism
International terrorism has
crossed many boundaries , both
geographic and ethical, since the
attack on World Trade Center in
2001, the dispersion to antrax
through the American mail
system, the terrorist attack on
Tokyo’s underground
transportation system in 1995,
had provided an important lesson
regarding the use of non
conventional and specifically
chemical and biological terrorism.
CBRNE
Chemical , biological, radiological
, nuclear and explosive (CBRNE)
incidents are low frequency ,
high impacts events, and are
encountered rarely in clinical
practice until now, but the new
terrorist attacks in Europe ,
increasingly frequent, aggressive,
unpredictable impose to first
responders and receivers of
victims to must be competent to
manage these scenarios.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
HOSPITAL PREPAREDNESS AND RESPONSE
• TREATMENT LARGE NUMBER OF CASUALTIES
• RECOGNITION OF NON CONVENTIONAL ATTACKS
• EARLY DETECTION
• RAPID RESPONSE
• DECONTAMINATION
• IMPLEMENT HOSPITAL PLANS
• BED SURGE CAPACITY
• ……
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
HOSPITAL SENTINEL PROJECT
Actually in Italy few hospitals are really ready to response
in case of terrorist attacks to population, especially in the
field of non conventional agents, such as Biological,
Chemical, Radiological, Nuclear and Explosives
(CBRNE).The aim is to prepare a specific terrorism task-
force inside all Emergency Departments able to prepare
and train physicians and nurses in case of terrorism
attacks to the population, and to prepare hospitals to be
ready in 30 minutes after a declaration of a terroristic
attack from EMS.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Lombardia District- EMS Service
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
BIO –Haza HOSPITAL SENTINEL PROJECT
AREU and Luigi Sacco Academic Hospital as National Referral Center for Bioterrorism
and Infectious Diseases Emergencies
to prepare a strong hospital preparedness and response to counter possible maxi-
emergencies, arising from non-conventional terrorist attacks, in particularly from
biological and chemical risk (biological, chemical and Radiological BCR)
to respond to possible" Infectious EMERGENCIES or BIO-TERRORISM attacks", and or
possible chemical attacks or "TOXIC TRAUMA".
to respond in an innovative and dynamic manner to such emergencies
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Hospital’s Network
The idea is to create a
"network of hospitals and
people”
To create an integrated
inter-hospitals Task Force
on counterterrorism , that
should also interact with all
institutions involved in the
fight against terrorism
Real time information,
effectiveness on specific
response and preparedness
and simplicity should be
the keys of this project.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Prepare more resilient and safe hospitals is the aim of this
project to better protect population
Children safety
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
BIOHAZA HOSPITAL SENTINEL PROJECT 1
• Hospital safety practices, procedures and proper use of containment
equipment and isolation in biosafety; high containment infectious risk;
• Guidelines on Trauma TOXIC (conventional & non -conventional from
chemical trauma, toxins, or biological risk);
• Civil and military cooperation models
• Principles of MILITARY tactical medicine used on the battlefield
• Applications of new tools on Information Technology (IT), using specific
App created to communications during emergencies, and disasters to
support EMS and population,
• Telemedicine system to assist in remote , specialists operating within the
Emergency Department, to guarantee communication with other hospitals
in real time, to collect and share more informations on victims, medical
treatments, resources, bed surge capacity in very short time
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
BIOHAZA HOSPITAL SENTINEL PROJECT 2
• Creating specialized medical centers of Lombardia, particularly in the
metropolitan area of Milan to fight against bioterrorism and chemical
risks, which can operate in conjunction with all the institutions
involved in the fight against terrorism
• Referral Center for the Lombardia Region for early warning and
detection ALERT / Detection
• Specific Hospital training courses
• Field Hospitals deployment for CBRN.
• Maintaining ongoing relationships with international institutions
involved in this area (World Health Organization WHO, ECDC, CDC,
etc).
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
CONCLUSIONS
Terrorism acts because his actions happen when and where they are not
expecting. Often occurs and acts as an "epidemic", due to a disease caused
by natural causes; no one can predict when and how it will happen, who
will strike and manner of expression and transmission, severity and impact
on the surrounding environment.
The experience of living in this constant uncertainty has been and will be a
stimulus and challenge to seek new ways to protect population, to better
treat victims, to identify new form of civilian and military cooperation in
order to obtain a more coordinated and integrated response in combating
terrorism, to boost research, by defining more and new law enforcement
strategies to protect the more vulnerable population.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
“Those who cannot remember the past are condemned to repeat it”
George Santayana
THANK YOU

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Counterterrorism Hospitals Preparedness and Response, An Italian Pilot Project, Alessandra ROSSODIVITA

  • 1. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Counterterrorism Hospitals Preparedness and Response. An Italian Pilot Project. A.Rossodivita1, M.R Gismondo1, C. Picco2, A. Zoli2, G. Rizzardini1 1Luigi Sacco Academic Hospital, Milan Italy 2 AREU – Regional Emergency Medical Service Company of Lombardia , Italy Please add your logo here
  • 2. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org GTI report 2016 32685 DEATHS IN 2014 80% INCREASE >11 COUNTRIES IRAQ NIGERIA AFGANISTAN PAKISTAN SYRIA
  • 3. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Percentages of People in Western Countries- Domestic Islamic Extremism 2005-2015 GTI Report 2016
  • 4. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org TE-SAT 2016 TERRORISM REPORT
  • 5. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Attacks in Western countries accounted for a small percentage incidents, representing 4.4 per cent of terrorist incidents and 2.6 per cent of deaths over the last 15 years , until 2015. In 2015 – 2016 years we assisted in a progressive escalation on terrorist attacks in Europe due to ISIS/ISIL attacks , starting from France , and Belgium of particular concern. The four large attacks listed above make up 91 per cent of deaths from terrorism in the West during this period FRANCE 2015 148 DEATHS 350 CASUALTIES TE SAT 2016 REPORT
  • 6. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org CBRNE To date terrorists and criminals seem to remain interested in using weapons that are easily available, not too complex to operate, and which have direct and lethal effects. These three factors – availability, uncomplicated knowledge and effectiveness - encourage terrorists to use conventional firearms and explosives. Although CBRN materials remain highly attractive to terrorists, they are difficult to acquire, transport, handle and deploy without particular scientific knowledge and technology. Nevertheless, several incidents in 2015 involved the actual or attempted malevolent use of CBRN materials with criminal or unknown intentions. In recent years, jihadist terrorists and their sympathisers have regularly expressed threats involving CBRN materials in their propaganda.
  • 7. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org TERRORISM Non Conventional Terrorism International terrorism has crossed many boundaries , both geographic and ethical, since the attack on World Trade Center in 2001, the dispersion to antrax through the American mail system, the terrorist attack on Tokyo’s underground transportation system in 1995, had provided an important lesson regarding the use of non conventional and specifically chemical and biological terrorism. CBRNE Chemical , biological, radiological , nuclear and explosive (CBRNE) incidents are low frequency , high impacts events, and are encountered rarely in clinical practice until now, but the new terrorist attacks in Europe , increasingly frequent, aggressive, unpredictable impose to first responders and receivers of victims to must be competent to manage these scenarios.
  • 8. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org HOSPITAL PREPAREDNESS AND RESPONSE • TREATMENT LARGE NUMBER OF CASUALTIES • RECOGNITION OF NON CONVENTIONAL ATTACKS • EARLY DETECTION • RAPID RESPONSE • DECONTAMINATION • IMPLEMENT HOSPITAL PLANS • BED SURGE CAPACITY • ……
  • 9. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org HOSPITAL SENTINEL PROJECT Actually in Italy few hospitals are really ready to response in case of terrorist attacks to population, especially in the field of non conventional agents, such as Biological, Chemical, Radiological, Nuclear and Explosives (CBRNE).The aim is to prepare a specific terrorism task- force inside all Emergency Departments able to prepare and train physicians and nurses in case of terrorism attacks to the population, and to prepare hospitals to be ready in 30 minutes after a declaration of a terroristic attack from EMS.
  • 10. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Lombardia District- EMS Service
  • 11. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org BIO –Haza HOSPITAL SENTINEL PROJECT AREU and Luigi Sacco Academic Hospital as National Referral Center for Bioterrorism and Infectious Diseases Emergencies to prepare a strong hospital preparedness and response to counter possible maxi- emergencies, arising from non-conventional terrorist attacks, in particularly from biological and chemical risk (biological, chemical and Radiological BCR) to respond to possible" Infectious EMERGENCIES or BIO-TERRORISM attacks", and or possible chemical attacks or "TOXIC TRAUMA". to respond in an innovative and dynamic manner to such emergencies
  • 12. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Hospital’s Network The idea is to create a "network of hospitals and people” To create an integrated inter-hospitals Task Force on counterterrorism , that should also interact with all institutions involved in the fight against terrorism Real time information, effectiveness on specific response and preparedness and simplicity should be the keys of this project.
  • 13. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Prepare more resilient and safe hospitals is the aim of this project to better protect population Children safety
  • 14. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org BIOHAZA HOSPITAL SENTINEL PROJECT 1 • Hospital safety practices, procedures and proper use of containment equipment and isolation in biosafety; high containment infectious risk; • Guidelines on Trauma TOXIC (conventional & non -conventional from chemical trauma, toxins, or biological risk); • Civil and military cooperation models • Principles of MILITARY tactical medicine used on the battlefield • Applications of new tools on Information Technology (IT), using specific App created to communications during emergencies, and disasters to support EMS and population, • Telemedicine system to assist in remote , specialists operating within the Emergency Department, to guarantee communication with other hospitals in real time, to collect and share more informations on victims, medical treatments, resources, bed surge capacity in very short time
  • 15. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org BIOHAZA HOSPITAL SENTINEL PROJECT 2 • Creating specialized medical centers of Lombardia, particularly in the metropolitan area of Milan to fight against bioterrorism and chemical risks, which can operate in conjunction with all the institutions involved in the fight against terrorism • Referral Center for the Lombardia Region for early warning and detection ALERT / Detection • Specific Hospital training courses • Field Hospitals deployment for CBRN. • Maintaining ongoing relationships with international institutions involved in this area (World Health Organization WHO, ECDC, CDC, etc).
  • 16. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org CONCLUSIONS Terrorism acts because his actions happen when and where they are not expecting. Often occurs and acts as an "epidemic", due to a disease caused by natural causes; no one can predict when and how it will happen, who will strike and manner of expression and transmission, severity and impact on the surrounding environment. The experience of living in this constant uncertainty has been and will be a stimulus and challenge to seek new ways to protect population, to better treat victims, to identify new form of civilian and military cooperation in order to obtain a more coordinated and integrated response in combating terrorism, to boost research, by defining more and new law enforcement strategies to protect the more vulnerable population.
  • 17. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org “Those who cannot remember the past are condemned to repeat it” George Santayana THANK YOU

Editor's Notes

  1. 3329 DEATHS FOR TERRORISM IN 2000 VERSUS 32685 IN 2014
  2. the overall threat is reinforced by the substantial numbers of returned foreign terrorist fighters that many Member States now have on their soil, and the significant rise in nationalist (xenophobic), racist and anti-Semitic sentiments across the EU, each resulting in acts of right-wing extremism.
  3. BLACK MARKET IN FORMER SOVIET UNION COUNTRIES, NUCLEAR AND RADIOCATIVE MATERIALS HAVE CONTINUED TO APPEAR IN BLACK MARKET SYRIA AND IRAQ BOTH HADE CHEMICAL WEAPONS AND CHEMICAL STOCPILESM THE USE OOF CHLORO GAS IN ALEPPO WAS REPORTED IN THE LAST MONTHS