Public Health Risk AssessmentPublic Health Risk Assessment

Bonnie Henry, MD, FRCPC

Doug Sider, MD, FRCPC

Public health CBRN course

Case 1Case 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)

Case 2Case 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

Case 3Case 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

Case 3Case 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)

Questions to ask: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?

Have you done your Have you done your risk assessment?risk assessment?

Goals of SessionGoals 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

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

1. Risk assessment2. Mitigation3. Preparedness4. Response5. Recovery

Public Health Emergency Preparedness and ResponsePublic 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 AssessmentImmediate 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.Requirement1. 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.

What’s your risk?What’s your risk?

Naturally occurring events Technological/infra-

structure eventsHuman related events

Natural events - examplesNatural events - examples

HurricaneTornadoExtreme heat/coldIce stormSnow stormFloodEpidemic/pandemic

Epidemic/pandemicEpidemic/pandemic

InfluenzaSARSE ColiSmallpox

Technological/ Technological/ Infrastructure eventsInfrastructure eventsElectricity system failureTransportation emergencyWater system emergencyStructural collapseHAZMAT eventsFireNuclear power station events

Human Related EventsHuman Related Events

Terrorism – biological, chemical, nuclear, radiological

Civil disturbanceLabour actionsArmed conflictLarge public gatherings

What is your risk for each?What is your risk for each?

Risk = Probability x Impactwww.ceep.ca

Risk = Probability x ImpactRisk = Probability x Impact

Components of RiskComponents of Risk

Probability?A. Highly likely?B. Likely?C. Possible?D. Unlikely?

Impact?4. Catastrophic3. Critical2. Serious1. Marginal

ProbabilityProbability

ProbabilityRating 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

Components of ImpactComponents of Impact

ImpactHumanPhysical infrastuctureBusiness

Impact4. Catastrophic3. Critical2. Serious1. Marginal

Impact - HumanImpact - Human

4. high probability of death 3. high probability of injury or illness; low

probability of death2. low probability of injury, illness or death1. unlikely to cause injury, illness or death in

community members/providers

Impact – Physical InfrastructureImpact – 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 damage1. unlikely to cause physical infrastructure

damage causing service disruption with resultant costs/recovery challenges

Impact - BusinessImpact - Business

4. 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

Overall Impact RatingOverall Impact Rating11-12 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

Risk Assessment - examplesRisk Assessment - examplesThreat Probability Impact

(H+P+B)Risk

Tornado B 3+3+2 B8

Dirty Bomb B/C/D 3+1+2 B/C/D6

Pandemic influenza

B 4+1+4 B9

Impact/Probability AHighlyLikely

BLikely

CPossible

DUnlikely

11-12:Catastrophic 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

Risk RatingRisk Rating

PrioritiesPriorities

1. Pandemic ‘flu’2. Tornado3. Dirty bomb

PrioritiesPriorities

Perform this exercise for all: Naturally occurring events Technological/infrastructure

events Human related events

SummarySummary

Assessment of risks is first step in planning

Helps focus efforts and ensures no possibilities are missed

Helps prioritize efforts in preparedness

““The only thing more difficult than The only thing more difficult than preparing for an emergency is preparing for an emergency is having to explain why you didn’t”having to explain why you didn’t”