12. Future of REMPAN Session

Purpose

· Discuss mandate and terms of reference
· Modes of action
· Responsibilities of network members
· Workplan for the next 2 years

Mandate and Responsibilities

WHO has the following statutory general responsibilities related to emergency response:

· Act as the directing and co-ordinating authority on international health

· Furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of member states

· Establish and maintain effective collaboration with UN, specialised agencies, government health administrations, NGO's etc

· Assist member states to strengthen health services

· Promote, in co-operation with other international agencies where necessary, the improvement of nutrition, housing, sanitation, recreation, economic and working conditions, and other aspects of environmental hygiene

· Study and report on administrative and social techniques affecting public health and medical care from a preventative and curative viewpoint, including hospital and social security

· Provide information, counsel and assistance in the field of health

· Assist in developing an informed public opinion among all people on matters of health.

REMPAN was established by WHO to address part of its responsibility under the WHO constitution, WHA resolutions and acceding to two legally binding International Conventions covering:

· Early Notification of a Nuclear Accident (1986) and
· Assistance in the Case of Nuclear Accidents or Radiological Emergency (1986).

These Conventions came into effect in 1986. WHO along with FAO and WMO acceded to the Conventions in 1988. Interpretation and collaborative responsibilities of each signature agency have been drafted by the Inter-Agency Committee on Response of Nuclear Accidents (IACRNA). These are summarised in a draft document entitled "Joint Radiation Emergency Management Plan of the International Organizations, to be released July 2000. Practical arrangements for implementation of WHO'S responsibilities under these Conventions come under REMPAN.

Participating International Organizations in IACRNA

· International Atomic Energy Agency (IAEA)
· World Health Organization (WHO)
· World Meteorological Organization (WMO)
· United Nations Office of Co-ordination of Humanitarian Affairs (OCHA)
· Food and Agricultural Organization (FAO)
· Commission of the European Communities (CEC)
· Nuclear Energy Agency of the Organization for Economic Co-operation and Development (NEA/OECD)

Responsibilities under the Conventions

If asked for advice or assistance, IAEA uses its own resources to carry out an initial assessment of need and may mobilise its Emergency Response Network (ERNET) and other partner organizations, as appropriate, to provide assistance. This network will include agency medical field teams, whose membership of ERNET will be cleared by WHO/HQ in advance.

IAEA has the prime responsibility to:

· Receive official notification of the accident from the accident state
· Establishes primary functional links with the accident and affected states
· Acts as the focal organization for responses
· Triggers actions under the Conventions
· Establishes functional links with international convention partners
· Co-ordinate international assistance, on request of the member state
· Establish standards of safety for protection for health and environmental effects (from ionizing radiation) and provide for application of these standards

WHO receives notification from IAEA of accidents requiring response and alerts its regional offices and REMPAN collaborating centres in order to:

· Provide assistance in radiological and public health assessment

· Provide assistance in emergency medical diagnosis and treatment radiation accident victims

· Provide advice and assistance on longer-term medical treatment

· Assist in the assessment of long-term impact and advice on relocation, food control and decontamination

· Assist in the mitigation of mental health impacts

· Provide advice on longer-term protective actions

WHO also co-ordinates the release of information to the media with its international partners.

Types of accidents

· Nuclear reactor or activities involving release of radioactive materials
· Lost or stolen sources
· Re-entry of nuclear powered satellites
· Overexposures from medical or industrial sources
· Terrorist situations

Terms of Reference

To carry out the obligations under these Conventions, REMPAN was established to:

· Enhance medical preparedness in the case of radiation accidents within WHO member states

· Provide medical advice and assistance to alleviate health consequences to individuals and populations involved in radiation accidents

· Provide public health advice to member states aimed at preventing or reducing long-term effects from low and prolonged exposure of populations living in areas with high levels of radioactive contamination

· Assist in follow-up studies of persons exposed to radiation.

How REMPAN operates

Through its network of specialised agencies, and in collaboration with IAEA, REMPAN:

· Contributes medical assistance and treatment to exposed patients

· Collects information on patient treatment and makes this available to network members

· Develops and maintains updated patient treatment protocols

· Provides public health advice for use prior to, during and following an accident to keep population exposures as low as can be achieved

· Maintains regular communication with network members

· When WHO receives official notification from IAEA concerning a radiation accident it immediately disseminates this information to network members for action as appropriate

· In collaboration with IAEA, WHO identifies a network member (or members) to deal with the medical treatment of accident victims

· WHO maintains close liaison with network members before, during and after accidents and maintains a record of information that can be shared by network members

· Hold biennial meetings to discuss progress on workplan of the network and identify future directions and activities

· Holds focused workshops for physicians to discuss best available patient treatments

· Maintains a database of information on experiences gained about patient injuries and treatments, as well as their successes or failures

Responsibilities of Network Members

· WHO/HQ is responsible for co-ordinating the activities of the network and ensuring the publication of network documents, newsletters and training manuals. Work closely with IAEA to achieve the aims and objectives of REMPAN

· Regional offices are responsible for liasing with WHO/HQ and network members in their region

· Collaborating centres are responsible for network activities related to their terms of reference as a WHO CC. This includes training as requested

· NGOs are responsible for contributing to network activities related to their area of expertise.

· Provide specialists for training workshops

· Promote harmonisation of medical treatments and public health responses in cases of radiation accidents

· Provide a clearinghouse of information for network members and national authorities

· Provide a forum of lesson learned and feed them back to network members. Network members need to be in close contact or integrated with the relevant national response system and contact points under the Conventions

Workplan for next 2 years

· Package REMPAN into activities that can be properly budgeted and obtain funds

· Assess composition of collaborating centre network to fulfil REMPAN objectives and responsibilities and the workplan

· Establish an e-mail and fax listing of network members and distribute

· Publish a general brochure on REMPAN and distribute

· Publish proceedings of 8^th REMPAN meeting

· Establish a newsletter and distribute to REMPAN members on regular basis

· Publish the results collected from a database of patient treatments with recommendations on currently best available treatment protocols for various radiation exposure situations

· Hold regional and subregional training workshops in radiation protection and radiation medicine in collaboration with IAEA

· Publish a guide on public health measures to be followed in case of radiation accidents and distribute to national authorities

· Publish training manuals (in all major WHO languages) on medical management, radiation protection and public health prevention measures to be followed in case of radiation accidents

· Update response guide on the medical management and treatment of patients acutely exposed to radiation

· Review and update the procedures for response to various accident scenarios jointly with IAEA and make available to all network members and conduct exercises on this

· Publish a document on the network of available medical treatment services within REMPAN

· Establish a mechanism for sharing experience and lessons to be learned from treatment results of radiation exposed patients

· Conduct at least one exercise per year to test the responsiveness of the network in case of an accident

· Update WHO web site that contains all key information, copies of documents and links to network member web sites

Recommendations with immediate effect

· Discuss future of GERMON at IACRNA; EU may collect information from countries outside EU and provide synthesis of information

· WHO to prepare a press release and fact sheet on REMPAN activities and future programmes

· Budget: to get funds for REMPAN, including an emergency fund

· Others.

Further information

Dr Mike Repacholi, Coordinator RAD and
Dr Istvan Turai, Medical Officer, REMPAN-Coordinator
World Health Organization
1211 Geneva 27, Switzerland

E-mail: repacholim@who.int and turaii@who.int
Fax: +41 22791 4123