How can we optimise emergency preparedness and response?

emergency preparedness
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Preparing for major medical emergencies is integral to protecting populations and optimising collaboration between response teams. Mariano Votta of the Cittadinanzattiva NGO discusses initiatives and tools aimed at supporting emergency preparedness and citizens’ engagement.

Earlier this year, a national exercise named ‘Vulcano 2022’ was carried out to evaluate the population’s response to major medical emergencies. The programme was organised by the Department of Civil Protection, in collaboration with local Sicilian institutions, and welcomed active participation from citizens living on Italy’s small volcanic island of Vulcano. Citizens received information on how to participate in the exercise and were joined by members of the National Service to test rescue activities and procedures in case of a major medical emergency. During the day, which was dedicated to volcanic risk, a public alarm (‘It-Alert’), created by the Civil Protection Department in collaboration with the CIMA Foundation, was sounded for the first time in Italy. The alert system warns citizens in real-time by disseminating information about upcoming or enduring emergencies and natural disasters.

Thanks to an H2020 EU-funded project, a new multi-tool called NIGHTINGALE (Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies) will support response efforts during major medical emergencies. The project is supported by the Italian NGO Cittadinanzattiva who are engaging citizens and volunteers so that they can feel more prepared in the event of a Mass Casualty Incident (MCI). NIGHTINGALE will bring together a network of emergency services and non-medical civil protection agencies that are involved in the emergency response. This includes firefighters, police, and search and rescue teams, but also volunteers and citizens, helping to enhance pre-hospital procedures and triage, as well as the collaboration between response teams.

These tests and exercises are yet another demonstration of how – in the aftermath of the COVID-19 pandemic – emergency preparedness is being prioritised, particularly in terms of supporting the active participation of the population in the response phase to emergencies. This is an extremely topical issue, both at the national and European level, particularly because in the past, the lack of common management and concrete involvement of citizens, who are often ill-informed, has complicated efforts to implement memory management strategies.

In terms of seismic risk, within the framework of another H2020 European project, ENGAGE (which started in July 2020 and whose mission is to provide novel knowledge, impactful solutions, and emergency response guidelines for exploiting Europe’s societal resilience), Cittadinanzattiva analysed a case study of the L’Aquila earthquake. The 6.3-magnitude earthquake struck the Italian city of L’Aquila on 6 April 2009, killing 309 people, leaving 70,000 homeless, and devastating more than 50 villages in the Abruzzo region. After conducting deep interviews with key stakeholders, the research team (Maya Battisti, Raniero Maggini, and Adriano Paolella) brought to light the changes that need to be implemented to ensure truly effective emergency preparedness and concrete citizen empowerment to enable an early response to MCIs, this included:

  • Developing a knowledge framework that fosters awareness of the risks associated with living in places exposed to potential high-impact natural disasters;
  • Clear communication to respond adequately to an emergency and ensure all affected residents are informed;
  • Training that can help to identify possible ‘response codes’ and the dissemination of operational procedures;
  • Simulation: a fundamental step to standardise and optimise behaviours, but must take into account the local context such as the urban planning of the territory – and the roads – which are subject to possible transformations over time;
  • Considering the complex structure of the community including the diversity between age groups and the need to identify linguistic codes suitable for different generations. Similarly, the ability of people to receive information, even if not consistent with their own culture and experience; and
  • Diffusion of a correct, basic technical culture on the anti-seismic design of buildings. The widespread technical culture is, in fact, a fundamental element for the participation of citizens in choices, risk reduction, and the widespread increase in the quality of building and setting.

In the European Union, from an executive and legislative point of view, two innovations must be highlighted and to which the utmost attention must be paid in the future. Firstly, the European Health Emergency Preparedness and Response Authority (HERA), and secondly the new legislative proposal for a European regulation of the European Parliament and of the Council concerning serious cross-border threats to health and repealing decision no. 1082/2013 / EU.

At the end of March 2022, HERA launched a call for applications for the constituency of the HERA Advisory Forum. This will be split into two subgroups including the Civil Society Forum (opened to a selection of 30 members including patients’ NGOs, consumers’ NGOs and healthcare professionals’ NGOs) which will help to ensure that the HERA will receive regular input, views, and opinions from civil society stakeholders. Then, the Joint Industrial Cooperation Forum is being set up to support collaboration with health-related industrial ecosystems in emergency preparedness and response to health crises. An encouraging opening which, among other things, meets an explicit request made by Cittadinanzattiva/Active Citizenship Network on the public consultation titled ‘Serious cross-border health threats – stronger, more comprehensive rules’ in which we reported the absence of involvement of civil society, and subsequently advanced an ad hoc proposal. In July 2021, Cittadinanzattiva had the opportunity to represent civil society as part of the Italian Ministry of Health’s new task force, ‘Permanent Nucleo for Health Risk Communication.’ As well as communicating important public health risks, the task force aims to protect citizens from fake health-related news.

The task force, HERA, and multi-stakeholder partnerships are a positive sign of engagement from European institutions and Member States regarding the involvement of civil society and intermediate bodies in the prevention and management of major emergencies. Much still needs to be done to guarantee a truly participatory process and support the formation of emergency management policies.

As well as engaging first response agencies (i.e., civil defence, etc.) and health personnel, civilians must be educated so they know how to respond in the event of natural disasters, attacks, shootings, and mass casualty incidents.

As stated by Amir Khorram-Manesh: ‘The use of immediate responders, before the arrival of first responders, is a life-saving approach in situations when every minute counts and every human resource is an invaluable asset. This highlights the need for engagement by the public at incident sites. Multiple measures, such as education, empowerment, and access, should be taken into consideration to enable bystanders to effectively help struggling survivors.’

Mariano Votta
Responsible for EU Affairs at Cittadinanzattiva NGO

Maria Maddalena D’Urso
Project Manager
Active Citizenship Network

This article is from issue 22 of Health Europa Quarterly. Click here to get your free subscription today.

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