Strategies and systems

Developing strategies and systems

Strategies and systems that are commonly required for response and recovery include those for the six sectors in the model illustrated in Fig. 22, that is:

- communications;
- search and rescue;
- health and medical;
- social welfare;
- transport and lifelines
- police and security;

as well as:

- alerting;
- command, control, and coordination;
- information management;
- resource management;
- evacuation;
- hazardous materials.

Fig. 23. The six sectors

Communications	Police and security
· Head Chief of provincial communications · Role Maintain radio and telephone contacts between organizations, including within the area of operations · Organizations Post and telecommunications, interior ministry, armed forces, radio amateurs, etc.	· Head Chief of police or national guard · Role Gather information and maintain public order and traffic flow, identify bodies · Organizations Police, national guard, customs, armed forces
Health and medical	Search and rescue
· Head Provincial director of health · Role Organize emergency care at emergency site, medical transport to hospitals, hospital treatment and health care for evacuees and the community · Organizations Health staff and resources (civilian, military, public, or private), certified first-aid workers, other services	· Head Chief of fire department or civil protection · Role Fire-fighting, rescue work, clearing rubble, protection of individuals and property · Organizations Fire department and other rescue services, public or private companies, railway companies, utilities (water, electricity)
Social welfare	Transport and lifelines
· Head Provincial director of social services · Role In cooperation with local authority (mayor, district chief, etc.) organize reception and accommodation of, and catering for, emergency victims · Organizations Local community services	· Head Provincial director of equipment and public works · Role Mobilize and coordinate necessary means of transport, meet special needs of other services, restore communication routes to ensure general traffic flow, restore electrical power and drinking-water supply networks · Organizations Public roads, road transport companies, breakdown services, repair workshops, armed forces

Aspects of each of these areas are described in this section. Reference should also be made to the checklists in Annex 3.

Communications

Communications concern the means of relaying information between organizations, individuals with particular responsibilities, and the community. Adequate communications facilities are essential to all aspects of response and recovery operations. As regards electronic communications (radio, facsimile, e-mail, etc.), the system should allow (6):

- coverage from community to provincial and national levels, both within and between organizations;

- primary reliance on existing systems and compatibility between organizations’ systems;

- dedicated frequencies for command, control, and coordination;

- backup systems and backup power supplies;

- simplicity of activation and operation.

Search and rescue

The aim of search and rescue planning is to save lives and minimize further injury to people and damage to property in times of emergency. Search and rescue services, supported as necessary by specialist groups such as marine and air rescue units and mountain rescue teams, will:

- provide life-saving support to trapped people during the course of rescue operations;

- save lives by the rapid and safe extrication of trapped people;

- save lives by the rescue and recovery of people who may be at risk in difficult terrain or through abnormal weather conditions;

- recover the dead;

- provide temporary support, repair, or demolition of damaged and dangerous structures to minimize further injury to people, damage to property, or disruption to services;

- provide support, on request, to other services or specialist units.

Search and rescue planning should ensure that all people and resources engaged in search and rescue are efficiently utilized before, during, and after an emergency. It should consider three categories of rescue workers:

- survivors who are able to start immediate work at the emergency site;

- untrained personnel who usually arrive from outside the immediate area to assist the casualties;

- trained personnel who arrive in organized rescue teams and can utilize the available resources, material, and untrained personnel in carrying out life-saving tasks.

Health and medical

Health and medical planning includes:

- the broad health sector;
- public health;
- mental health;
- nutrition;
- hospital emergencies;
- the integration of rescue and medical services;
- triage and first aid.

Social welfare

Social welfare involves the care of people and the community during and after emergencies. Any emergency threatens the physical and emotional well-being of large numbers of people. Individuals may experience bereavement, physical injury, and separation from families, as well as personal losses of clothing, housing, food, household goods, employment, and income. Communities may be affected by severe damage to lifeline services (power, water, gas, electricity, and sewerage) and transport. Hence, providing for the welfare of the victims of an emergency is a fundamental task of emergency preparedness at all levels of government. Various factors such as weather, health hazards, or disruption of supplies may make it necessary to evacuate all or part of the emergency area, and planning and organization for the care of the homeless are essential to emergency preparedness.

The tasks that may be required include the provision of:

- temporary accommodation, including emergency camps;
- care of children and the elderly;
- clothing and household items;
- counselling;
- emergency feeding;
- financial assistance;
- insurance and legal advice;
- public information;
- referral service;
- registration and enquiry services.

Communities should be encouraged to manage these tasks. The natural leaders of the community should form the backbone of the emergency organization since excessive external assistance can damage a community and destroy self-reliance.

Social welfare planning should describe how people’s immediate welfare needs should be met during and after an emergency and prescribe procedures to meet those needs during an evacuation and subsequent recovery. It should emphasize that social welfare is the responsibility not only of specialized government organizations, but also of all other government organizations and NGOs. Social welfare planning should set out the tasks and responsibilities of these organizations.

Past emergencies have shown that no coherent action in social welfare can be undertaken unless plans for receiving and accommodating the population are already in place. These plans should provide for human and material resources, reception areas, and intervention procedures. Ideally, plans will have been prepared well in advance and regularly updated.

As with emergency medical response, the management of emergency-stricken populations should be based on reception in two stages:

- forward reception, for immediate management, counting, and assessment of needs;

- backup reception, for temporary accommodation, family regrouping, and providing information to families.

A site outside the immediate emergency area should be selected, if possible, as the forward reception point, to avoid exposure to further accidents and to ensure that rescue operations are unhampered. The purpose is to provide immediate comfort and basic facilities for victims. There should be adequate signs and direction arrows at the reception point showing where specific resources and assistance can be found. The tasks of forward reception are thus:

- recording information on people by means of individual record cards, gathering data for reuniting families, and searching for children;

- comforting the victims, with all workers doing their part to restore psychological balance as quickly as possible and prevent further harm.

The more structured backup reception facility should be used to reunite families, with the help of the information gathered at the forward reception point. It should serve as an information coordination centre and for reorganizing the life of the community, finding and adapting accommodation, and ensuring that it is functional. This will require an inventory of the human resources and materials available, and the distribution of tasks.

Human resources

The personnel working for the backup reception should have certain technical and human skills:

· Skills in reception and recovery. Familiarity with the procedures and facilities for information management is essential, plus the ability to:

- listen to people’s problems, record, and classify them;

- analyse the situation, determine the best forms of response and recovery in terms of the resources available, and rank them in order of urgency;

- ensure that resources are used once they are distributed.

· Technical knowledge of logistic support. This covers areas such as energy (electricity, gas, heating, fuel), services (water, telephone), shelter, premises and their use, and catering.

· Safety consciousness. Personnel should be attentive to their own safety and the safety of the people in their care. They should not intervene in areas at risk.

· Language. Knowledge of the local language and dialects is nearly always essential for organizing response and recovery. People who speak the language should be included among the supervisory personnel.

· Training. Ideally, personnel should receive prior training in emergency response and recovery arrangements at the sites where they may work. It will often be necessary to rely on volunteers, who will require information and leadership from people with prior training.

· First aid and health. Some personnel should be capable of giving first aid. They should assist casualties who are ill or unconscious, pending the arrival of a doctor. They should carry out all necessary measures to ensure general hygiene (considering factors like presence of animals, the control of parasites, the prevention of faecal infection, etc.). In all these activities, continuous liaison with a doctor is desirable.

Material resources

Material resources may be classed as either fixed or mobile:

· Fixed resources - pre-arranged premises and facilities for receiving people.
· Mobile resources may include:

- vehicles for transporting people and materials;
- blankets, camp-beds;
- sources of electric power and lighting facilities;
- drinking-water or facilities for producing it;
- food supplies appropriate for the population, particularly for children;
- sheeting to cover broken windows and walls, and the means to fix it in place.

Transport and lifelines

Transport is an important factor in managing an emergency. It includes identifying and mobilizing transport resources and controlling movement. The aim of transport preparedness is to prescribe arrangements for identifying resources (road vehicles, rail, shipping, aircraft, and access routes) to ensure their best use. Planning aspects include:

- making arrangements for identifying, acquiring, or organizing public and private transport resources at every level of government;

- identifying, regulating, restoring, and maintaining access routes during an emergency;

- coordinating transport;

- ensuring compatibility with provincial and national transport planning.

An emergency is likely to disrupt lifeline services (electricity, gas, water, petroleum fuels, and communications) essential to the community’s survival. Apart from its impact on the stricken area, it may affect other parts of the province or country, particularly if electricity generation, gas production capacity, or water supply systems are reduced by the emergency, or if transmission through the affected area is interrupted. Supply of other energy sources such as vehicle, aviation, and heating and cooking fuels may become irregular, or existing stocks may be destroyed.

Restoring lifeline services is an important part of re-establishing normal conditions. Those energy forms that can be supplied by road, rail, or sea transportation methods (including liquefied petroleum gas (LPG), gasoline (petrol), diesel fuel, and coal) must be dealt with in transport planning. Lifeline services planning entails strategies to restore supplies of electricity, gas, and water, etc., which are generally provided through a central supply system. In some areas, liquid gasoline (petrol) products are piped, and provincial and community emergency plans must provide for restoration of supplies in the event of disruption.

Protecting and restoring lifeline services, particularly electricity, are crucial measures in any emergency. Medical facilities, public health systems, and many other essential services depend on electricity for their continued operation, as does the commercial storage of food under refrigeration. Electricity is required for many communications systems, e.g. radio transmitters, radio-telephone systems, facsimile machines, and computer systems. Most industrial and commercial enterprises use electricity in their processes and many other buildings use it for lighting, heating, cooking, water heating, refrigeration, and air conditioning.

Gas is piped to some urban areas, and may be important for electricity generation. Failure of gas pipelines supplying power stations may reduce available electrical resources. Local power schemes, in-house and standby generators, in turn, are likely to depend on accessible stocks of LPG or diesel fuel.

The aim of lifeline services planning is to organize for the restoration, operation, and maintenance of all lifeline services under emergency conditions. It should also ensure the best use of available systems and resources in the event of an emergency, including:

- identifying electricity, gas, and water supply systems at national, provincial, and community level;

- determining what resources would be needed for restoring damaged systems and how they might be obtained during an emergency;

- ensuring that regular supplies of all services are restored as soon as possible and in order of importance;

- establishing guidelines for operational emergency plans for provincial and community organizations.

In general, the following principles should be followed in an emergency:

· Electricity supply systems should be accorded a high priority for restoration and maintenance because of their life-preserving and communications purposes.

· Piped gas supply systems should be accorded priority where they are used for fuelling power stations or where they form a major energy source for the community.

· Water supply systems should be given priority where there is possible contamination of existing supplies and where the sewerage systems are damaged and causing a risk to public health.

Police and security

An emergency creates complex problems for maintaining law and order and performing day-to-day police functions. Law and order must be maintained even during emergencies. This may prove difficult since police may be heavily committed to emergency operations. Police organizations will need to develop operational plans that ensure sufficient resources for normal policing and security.

Alerting

Alerting consists of a number of response phases, including:

· Alert - the period when it is believed that resources may be required, which prompts an increased level of preparedness.

· Standby - the period normally following an alert, when the controlling organization believes that deployment of resources is imminent and personnel are placed on standby to respond immediately.

· Call-out - the command to deploy resources.

· Stand-down - when the controlling organization declares that the emergency is controlled and that resources may be recalled.

To implement these phases, there should be:

- a protocol that stipulates which organizations to alert for which emergencies and what tasks;

- a contact list for all organizations;

- a description of the type of information that should be supplied in the various phases of alerting.

Command, control, and coordination

Command, control, and coordination concern managing people, resources, and information during response and recovery operations, and consist of the following elements:

- information management;
- resource management;
- decision-making;
- problem-solving;
- reporting to higher levels of authority.

These activities often take place in emergency coordination centres (ECCs). It is preferable to have ECCs established at national, provincial, and community levels. A model for establishing them at the provincial level is outlined below:

· The provincial ECC is established in the chief town of the province and staffed by the director of response and recovery operations (appointed by the provincial governor or prefect), representatives of the heads of the six sectors, and communications and administrative personnel.

· The operational ECC is located as close as possible to the area of operations and run by a deputy of the director of response and recovery operations and representatives of the heads of the six sectors.

The role of the provincial ECC is to:

- communicate with the operational ECC and the relevant provincial or national services;

- process information and make certain instructions are carried out;

- coordinate deployment of reinforcements or additional supplies and dispatch them to the emergency site.

The operational ECC should be located close enough to the emergency site to allow speedy and permanent liaison between the centre and personnel engaged in operations and staff on standby. It must be set up outside the danger zone and, if possible, in a building that is easy to locate - a city hall, school, or railway station, for example.

Table 24. Standard operating procedures for emergency control centres^a

Activation	Operations	Closing-down
Open ECC	Message flow	File messages and other documents
Mobilize staff	Information display	Release staff
Activate communications systems	Information processing	Close down communications
Prepare and post maps and display boards	Control resource mobilization and deployment	Close down ECC
Draw up support staff roster	Drafting of situation reports	Organize operational debrief
	Decision-making
	Briefings
	Reporting to higher authority

^a Reproduced from reference 6 by permission of the publisher, Emergency Management Australia (formerly Natural Disasters Organisation).

The standard operating procedures listed in Table 24 will be required for ECC operation. Individual organizations will also need to establish ECCs for their own operations.

Information management

Information management involves the gathering, handling, use, and dissemination of information related to an emergency. Tasks and systems include:

- warning systems;
- public information;
- emergency assessment.

Warning systems

Organizations responsible for emergency management should develop early-warning systems for their own use and the use of others. These early warning systems could cover the following areas:

- outbreaks of disease and epidemics;
- shortages of food;
- severe weather;
- other natural hazards;
- population movements;
- technological and industrial hazards;
- social and political unrest;
- economic crises;
- war and insurgencies.

If notification can be transmitted before an emergency strikes, the effectiveness of emergency preparedness measures can be greatly improved, especially during the early stages of the emergency. The warning system must be developed to alert the communities and emergency organizations at every level to the possible need for implementing emergency preparedness measures.

A community warning should produce appropriate responses to minimize harm. Warning messages should (6):

- provide timely information about an impending emergency;
- state the action that should be taken to reduce loss of life, injury, and property damage;
- state the consequences of failure to heed the warning;
- provide feedback to response managers on the extent of community compliance;
- cite a credible authority;
- be short, simple, and precise;
- have a personal context;
- contain active verbs;
- repeat information regularly.

Warnings should be transmitted through as many media as possible. They may be initiated in several ways: they may originate from the scene or potential scene of the emergency and be passed upwards, or they may originate from national government and be passed down to the scene of the impending emergency.

Public information

Public information in emergencies represents the deliberate, planned, and sustained effort to establish and maintain mutual understanding between those managing the response and the community. It means ensuring answers to the questions:

· What is happening?
· What should be done?
· What might happen?

Public information planning seeks to ensure that those who need the information in an emergency get it - and that those who provide the information do so in an accurate, direct, and timely way. Those who need information include:

- people who are directly affected by the emergency and have to ensure their own safety;

- people who organize the response to the emergency and prevent the situation from getting worse;

- people who disseminate public warnings and information;

- people who can contribute to an emergency response;

- people who are indirectly affected by the emergency;

- people who are interested;

- the news media.

Those who provide information include:

- people who are directly involved in the emergency and/or who organize the response to it;
- organizations with specific roles in responding to the emergency;
- the news media.

It is important to involve the news media at the planning stage of emergency preparedness. With strong, established relationships, the media can provide significant professional assistance during the response phase. When an emergency strikes, it is too late to think about planning for the role of the media.

The following are guidelines for establishing public information centres and communicating with the public.

A public information centre can be located either at a hospital or at a convenient place, not too far from the emergency area (hotel, town hall, school, etc.) or the backup reception centre. Nevertheless, it should be far enough away from where rescue activity is taking place, so that congestion and interference are reduced. The existence of such a centre and its telephone numbers should be made known through radio and television broadcasts. Families who are worried that relatives are among the victims should be invited to come to the centre. Survivors may also be asked to gather there. For several reasons, this centre can be useful when victims of an emergency die far away from their homes. It gives the bereaved a chance to meet survivors and get a first-hand report of what happened to their loved ones, how they died, and what was done to rescue them. The survivors, and possibly onlookers and rescuers, have information that often cannot be given by others. For survivors, it can be an important experience to be of help to the bereaved.

The main functions of the information centre are:

- to provide rapid, authoritative information about tragic news that can be conveyed in a humane, direct way, in a setting sheltered from public and media attention;

- to provide support and a holding environment for both survivors and helpers;

- to serve as a forum or meeting place where affected individuals and families can support each other - self-help groups may develop from this forum;

- to be a place where police can collect identification data about missing and dead people from family members;

- for use by the police to question survivors about the chain of events, as a part of their investigation;

- to help reduce the convergence of people on the emergency site, thus avoiding congestion and movement problems for rescuers.

Figure 24 shows six steps to communicating with the public.

The communication strategy should outline:

- who determines what information should be collected;
- who collects and collates information;
- who selects the information to be communicated;
- who prepares messages;
- who authorizes messages;
- who contacts the media.

An experienced media relations officer should be appointed to coordinate public information. This person should answer directly to the emergency controller or commander, and:

- establish contacts with key media personnel, understand how they work, brief them on his or her role, and determine how they can work together;

- communicate with the national emergency taskforce and committees;

- develop a continuous timetable for disseminating information on emergency management, including advertisements for the emergency tone (on radio and television) and symbol;

- present messages as a media package, including features, background information, and messages, with audio or video tapes when possible and appropriate.

Fig. 24. A process for communicating with the public^a (WHO 97564)

^aReproduced from reference 7 by permission of the publisher.

To identify information, the information coordinator should consult with emergency management authorities to identify main issues, determine their priority, collect data, and prepare a profile of the target audience.

Prepared messages should answer the following questions:

· Who... is affected, the message source, etc?
· What... is the message, the problem, the solution, etc?
· When... did it happen, should it happen, should there be action?
· Where... what place is affected, where should people go, etc?
· Why... is it important that the message be followed?
· How... to respond, to deal with the situation, etc?

These messages should also:

- reassure the audience;

- capture the audience’s attention through the use of an emergency tone, symbols, etc.

- use “catchy” wording and be conversational in tone and choice of words, be clear in whatever language is used, and avoid technical jargon;

- say where further information and help can be obtained;

- be concise (lasting 15-60 seconds);

- give accurate (technically sound) information;

- be current;

- use prominent personalities to endorse and give credibility to the messages;

- state specifically and precisely what behaviour is required, what is expected, what must be done.

When selecting communication mechanisms and sending messages, it is advisable to use a variety of media, such as television, radio, newspapers, newsletters, posters, amateur radio, public address systems, government personnel, and volunteers. Communications could include:

- news releases;

- public service announcements;

- talk shows, including call-in programmes;

- advertisements;

- flyers, circulars;

- local community personnel - emergency management committee members, service clubs, voluntary organizations, and police and fire department officers.

Key messages and important releases should be broadcast at prime time, usually 6:00-8:00 and 17:00-19:00 in most countries. Electronic and print media have news deadlines: the information coordinator should discuss these with media personnel and determine the best times of day for media releases. Representatives of other media should be informed of the time and place of releases and briefings. If the media are supplied with accurate, complete information, on time, they will be of great assistance in emergency response and recovery.

Before messages are sent to the media, they should be tested on a sample audience to ensure that they have exactly the desired effect.

Monitoring and evaluation should focus on the effectiveness, efficiency, and appropriateness of the public communication strategy and provide information for improving it. This can be done through:

- simulation exercises;
- monitoring media messages before and during emergencies;
- surveys;
- questionnaires;
- formal reviews after emergencies.

Emergency assessment

The critical component of any emergency response is the early conduct of an emergency assessment to identify urgent needs and to determine response and recovery priorities. An emergency assessment provides response and recovery managers with information about the effects of the emergency on the population. This information is collected by rapidly conducted field investigations. The early completion of this task and subsequent mobilization of resources to address the urgent needs of the affected population can significantly reduce the adverse consequences of an emergency. Inadequate assessment of human needs at the emergency site leads to inappropriate and delayed response and recovery services.

Assessment is the process of determining (8):

- the impact that an emergency has had on a community;
- the needs and priorities for immediate emergency action to save and maintain life;
- the resources available;
- possible strategies for long-term recovery and development.

Figure 25 shows how emergency assessment objectives evolve over time and Figure 26 shows an assessment process.

It is essential to distinguish between data and information - data are facts and figures, information is the interpreted data that can be used to support ideas and opinions. Much of the data that may be collected on emergencies may be irrelevant, so it is necessary to collect data that are immediately useful. This will require planning before the event and monitoring during the event. An assessment plan should outline the assessment’s objectives, type of information required, means of data collection, analysis, and interpretation, and frequency of reporting.

Fig. 25. Evolving objectives of assessment^a

Warning	· Determine action being taken by community to protect lives and facilities from expected emergency · Activate the implementation of assessment
Emergency	· Confirm the reported emergency and estimate overall magnitude of the harm · Identify, characterize, and quantify "populations at risk" · Help to identify and prioritize the actions and resources needed to reduce immediate risks · Identify local response capacity, including organizational, medical, and logistic resources · Help anticipate future serious problems · Help manage and control the immediate response
Short-term recovery	· Identify the affected community · Identify the policies of the government with regard to recovery · Estimate the additional support required from provincial, national, and international sources for recovery · Monitor the outcome and effectiveness of recovery strategies
Long-term recovery	· Determine the damage to economically significant resources and the implications for development policy · Assess the impact of the emergency on current development programmes · Identify new development opportunities created by the emergency

^aAdapted from reference 8 by permission of the publisher. (WHO 97565)

Fig. 26. The assessment process^a (WHO 97566)

^a Reproduced from reference 8 by permission of the publisher.

The information needs will be the gap between the data already to hand and the data required to form a reliable picture of the situation. Hence, the data already acquired will need to be verified, and geographical or functional areas for which there is no information checked. The community vulnerability assessment is a guide to where harm may have occurred and its seriousness, and can be used to check the completeness of existing data.

Sources of data could be the normal local channels (if they have not been disrupted), specific survey teams, or visual inspection by vehicle or aircraft.

Analysis and interpretation involve assessing the value, reliability, and accuracy of data, validating them against known facts, and incorporating them into a meaningful picture.

Reporting should be to those responsible for emergency response and recovery to allow modification of operations.

Information to collect during an emergency assessment of an emergency site might include (9):

- geographical extent of the impact of the emergency;
- population affected or at risk;
- presence of continuing hazards;
- injuries and deaths;
- availability of shelter;
- access to potable water;
- nutritional status of affected population;
- current level of sanitation;
- status of health-care infrastructure;
- extent and capacity of communications network;
- status of transportation system;
- incidence of communicable disease.

The assessment team should focus on problems that have potential solutions and affect the largest number of people. An imprecise knowledge of the affected population’s characteristics and of ongoing hazards (e.g. toxic substances or fires) makes it more difficult to conduct an emergency assessment rapidly. In addition, logistic problems and severe time constraints make it impractical to evaluate the urgent needs of every person who has been affected by the emergency. For expediency, emergency assessment is usually conducted by sampling the needs of carefully chosen subpopulations believed to represent the needs of the entire affected population. Individuals or groups of people are surveyed rapidly in a systematic fashion to ascertain the extent of their emergency needs. Usually, this is done by directly interviewing or evaluating emergency victims, or by data abstraction at response and recovery facilities that serve populations affected by an emergency. In many emergencies there may appear to be a disproportionately high number of households headed by women.

At the emergency site, assessment personnel should attempt to survey a cross-section of the affected population (e.g. a mix of rural and urban, young and old, near and remote). This is because all areas within a region may not be affected uniformly by an emergency. Some areas may contain populations so severely affected that they are rendered completely inaccessible and silent because local roads and communication systems have been destroyed. On the other hand, areas with relatively minor damage are consistently able to convey graphic images of highly localized destruction to the response and recovery organizations, potentially diverting attention and resources from more devastated regions. In addition, a population with a homogeneous exposure to an emergency may have subpopulations that are more severely affected. Experience with refugee and displaced populations has shown disproportionately high levels of morbidity and relatively high crude mortality rates among the very young. This is the result of the effects of poor nutrition and infectious disease often found in this subpopulation under such circumstances. An emergency assessment that surveyed only the male heads of household in such circumstances might fail to identify, or direct resources to, this vulnerable subpopulation.

The specific information collected and the sampling strategy employed during an emergency depend on the nature of the emergency. During a sudden-impact emergency, the initial assessment should be completed within 24-48 hours. Slow-onset emergencies, such as droughts, famines, or other situations that create displaced or refugee populations, may not be recognized as emergencies for several months. In such circumstances, public health officials should make a baseline assessment and institute long-term surveillance. This surveillance, designed to monitor the effectiveness of response and recovery activities as well as changes in the affected population’s status, may be the most important task for the assessment team. The relative importance of parts of the assessment to the overall assessment depends on the type of emergency and on other environmental factors, such as climate and geography. For example, the emergency assessment priorities related to the type of emergency are as follows:

Sudden-impact emergencies	Gradual-onset emergencies
Ongoing hazards	Mortality rates
Injuries and deaths	Nutritional status
Shelter requirements	Immunization status
Potable water	Environmental health

Emergency assessment rarely needs to be complicated to be of great value in determining emergency response priorities. Many standardized questionnaires and survey techniques exist to guide the field activities of assessment personnel. A coordinated approach to the assessment task will facilitate communications between managers of response and recovery operations and assessment personnel. Emergency assessment protocols can be easily incorporated into emergency preparedness and response activities at the local level and are highly effective when integrated in this manner. This is extremely important since the local community remains the principal unit in preparedness, mitigation, and response, despite the recent development of a massive international response and recovery network.

Flights over the emergency site and meetings with officials rarely provide an accurate and timely summation of the needs of the affected population. Consistently, a relatively small amount of key information, rapidly collected on-site from representative populations, concerning sentinel events or health conditions (e.g. death, illness, and injuries) will provide adequate public health intelligence upon which to base emergency response and recovery operations. Despite advances in technology and transportation, this task remains a labour-intensive field exercise, drawing upon a wide range of skills.

Information on rapid health assessment can be found in the WHO publication Rapid health assessment protocols for emergencies (9). The objectives of rapid health assessment are to:

- confirm the emergency;
- describe the type, impact, and possible evolution of the emergency;
- measure its present and potential health impact;
- assess the adequacy of existing response capacity and immediate additional needs;
- recommend priority action for immediate response.

WHO’s Rapid health assessment protocols for emergencies describes the basic techniques and information including:

- assembling the assessment team;
- carrying out the assessment;
- important considerations;
- common sources of error;
- presentation of results and reporting;
- techniques for surveys during rapid assessment;
- preparedness for emergencies.

Resource management

A major emergency or disaster creates special resource management problems. Arrangements essential to regular supply, such as transportation routes, communications networks, and financial systems through normal credit facilities, may be disrupted or threatened. Existing stocks of essential supplies may have been damaged or destroyed. The supply requirements may thus grow at precisely the time when the means of supply have diminished. The emergency will also create demands for additional resources, including machinery and materials to rebuild and repair facilities, fuel for machinery, and food. These resources will be required not only by those stricken by the emergency but also by those involved in the recovery work.

Resource management planning for emergencies is likely to focus on the needs of rescue, medical, welfare, and recovery services forming part of the emergency response effort but should not neglect the continuing needs of the community. Without an efficient supply system, the response to the emergency and the recovery of the local community and economy will be severely hampered. Emergency plans must therefore establish an emergency resource management organization in advance of an emergency, and supply and procurement procedures that will operate once an emergency appears imminent or occurs. Possible disruptions to the local economy and the effects on the community’s welfare must be considered in this planning and, if necessary, measures prepared to overcome them.

Resource management planning must cover:

- the principles of supply in an emergency, including the selection, procurement, distribution, use, and pre-positioning of essential stockpiles;

- the roles and responsibilities of organizations at all levels in providing supply systems in the event of emergency;

- the procedures that should be established for the proper accounting of resources obtained under this plan.

If specialist equipment is to be used, it is essential to ensure that the equipment is accompanied by a trained operator.

No matter what the emergency or the condition of the community, resources should always be sought at the community level first. This is not purely for reasons of cost and efficiency: the swamping of a community with excessive outside resources can:

- bankrupt local businesses;

- destroy local pride and self-sufficiency;

- lead to an unnatural degree of dependence on regional, national, and international resources;

- increase vulnerability.

The management of supplies from external sources after an emergency can be accomplished using a system known as the “Supply Management Project in the Aftermath of Disasters”, otherwise known as SUMA. SUMA is a systematic approach to identifying supplies received, using trained personnel and computer software to manage response and recovery supplies and the sorting process during an emergency. This system has been developed for supplies received from outside an emergency-affected country and is currently being used at the sub-national level.

There are also a number of published lists of medical and other resources that can assist in satisfying some of the material needs of emergency-affected communities.

A basic kit of materials for health emergencies is described in The new emergency health kit 1998 (10). The lists of materials are based on epidemiological research on displaced populations, and the kits have been field-tested in a variety of emergency conditions. The lists consist of drugs and medical supplies that can be used to satisfy the basic medical needs of 10 000 people for approximately 3 months.

When assembled the kits weigh 860 kg and occupy 4 m³, which means that they can be transported en masse in a small truck. To allow the appropriate distribution of drugs and medical supplies, and to allow the kit to be transported by means other than truck, the kit can be packaged as separate units.

· There are 10 basic units, each weighing 45 kg, which are intended for use by basic health workers for populations of 1000. They contain drugs, renewable supplies, and basic equipment.

· There is one supplementary unit for physicians and senior health workers, for a population of 10 000, containing drugs, essential infusions, renewable supplies, and equipment. This kit contains no material that is in the basic unit, and must be used with the basic units.

Resupply of drugs and medical supplies following the receipt of a health kit should be based on actual need, rather than requests for complete kits.

Stockpiles of emergency response and recovery supplies or requests for such supplies can be based on the publication Emergency relief items: compendium of generic specifications (11). This publication, in two volumes, specifies the most suitable resources for emergency response and recovery, and could provide guidance and assistance to:

- donor and recipient governments and institutions concerned with planning, budgeting, and the execution of assistance in emergency situations;

- procurement officials of the United Nations system, and NGOs and development agencies involved in acquiring emergency response and recovery items.

The first volume contains equipment specifications and provides guidance on needs and recommended responses for:

- telecommunications equipment;
- shelter, housing, storage, and cooking appliances;
- water supply systems;
- food items;
- sanitation and hygiene items;
- materials handling equipment;
- power supply systems.

A chapter on logistics appears at the end of the first volume, providing guidance on packaging, quality inspection, selection of mode of transport and shipping arrangements, and insurance. The second volume contains specifications for medical supplies and equipment, including essential drugs.

Descriptions of emergency kits for a variety of purposes can be found in Guide of kits and emergency items (12). These kits are grouped under the following headings:

- medical kits;
- medical modules;
- surgical instruments sets;
- logistic kits;
- miscellaneous emergency items.

Drugs are one of the most important and sensitive resources in emergency response and recovery. Both donors and recipient nations should develop policies and procedures for drug management, based on the following core donation principles (13):

- maximum benefit to the recipient;
- respect for the wishes and authority of the recipient;
- no double standards in quality;
- effective communication between donor and recipient.

There are 12 guidelines for drug donations:

1. All drug donations should be based on an expressed need and be relevant to the disease pattern in the recipient country. Drugs should not be sent without prior consent of the recipient.

2. All donated drugs or their generic equivalents should be approved for use in the recipient country and appear on the national list of essential drugs or, if a national list is not available, on the WHO Model List of Essential Drugs, unless specifically requested otherwise by the recipient.

3. The presentation, strength, and formulation of donated drugs should, as much as possible, be similar to those commonly used in the recipient country.

4. All donated drugs should be obtained from a reliable source and comply with quality standards in both donor and recipient country. The WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International Commerce (14) should be used.

5. No drugs should be donated that have been issued to patients and then returned to a pharmacy or elsewhere, or that were given to health professionals as free samples.

6. After arrival in the recipient country, all donated drugs should have a remaining shelf-life of at least one year.

7. All drugs should be labelled in a language that is easily understood by health professionals in the recipient country. The label on each individual container should at least contain the international nonproprietary name (INN, or generic name), batch number, dosage form, strength, name of manufacturer, quantity in the container, storage conditions and expiry date.

8. As much as possible, donated drugs should be presented in larger-quantity units and hospital packs.

9. All drug donations should be packed in accordance with international shipping regulations, and be accompanied by a detailed packing list that specifies the contents of each numbered carton by INN, dosage form, quantity, batch number, expiry date, volume, weight, and any special storage conditions. The weight per carton should not exceed 50 kg. Drugs should not be mixed with other supplies in the same carton.

10. Recipients should be informed of all drug donations that are being considered, have been prepared, or are actually underway.

11. In the recipient country the declared value of a drug donation should be based upon the wholesale price of its generic equivalent in that country, or, if such information is not available, on the wholesale world-market price for its generic equivalent.

12. Costs of international and local transport, warehousing, port clearance, and appropriate storage and handling should be paid by the donor agency, unless specifically agreed otherwise with the recipient in advance.

To manage drug donations, a country should (13):

· Define national guidelines for drug donations and provide them to prospective donors.

· Define administrative procedures for receiving drug donations that answer the following questions:

- Who is responsible for defining the needs, and who will prioritize them?

- Who coordinates all drug donations?

- Which documents are needed when a donation is planned? Who should receive them?

- Which procedure is used when donations do not follow the guidelines?

- What are the criteria for accepting or rejecting a donation? Who makes the final decision?

- Who coordinates reception, storage, and distribution of the donated drugs?

- How are donations valued and entered into the budget expenditure records?

- How will inappropriate donations be disposed of?

· Specify the needs for donated drugs, indicating the required quantities, prioritizing the items, and stating donations already in the pipeline or expected.

· Manage donated drugs carefully by inspection upon arrival, confirmation to donor of arrival, storage and distribution by trained professionals, and accounting of receipts and distribution to ensure the drugs are used for their original purpose.

Evacuation

Evacuation is itself a hazard, in that it may place members of a community in some danger, and will remove them from their familiar surroundings under stressful circumstances (5). Evacuation is not a one-way trip - arrangements are required for returning evacuated people to their homes. The likely stages of evacuation are warning, withdrawal, shelter and feeding, reunion, and return. The following will need to be identified:

- assembly area sites;
- evacuation centre or reception sites;
- evacuation routes and alternatives;
- organizations responsible for assisting evacuation;
- teams for the registration of evacuees;
- transport arrangements;
- means of operating evacuation centres.

Hazardous materials

Hazardous materials include at least those listed in Table A2.9 (Dangerous goods classes) in Annex 2, that is:

- explosives;
- gases - compressed, liquefied, or dissolved under pressure;
- flammable liquids;
- flammable solids;
- oxidizing agents and organic peroxides;
- poisonous (toxic) and infectious substances;
- radioactive substances;
- corrosives.

These materials may give rise to emergencies or be involved in emergencies caused by other means. When contained, stored, used, or disposed of in appropriate ways, these materials are not harmful, but when released, burnt, damaged, etc. they may be dangerous to people, property, and the environment.

The following preparedness actions are required for a community, building, or organization to reduce the possible harm caused by hazardous materials:

· Reduce the quantity of hazardous materials stored to the minimum - the fewer materials stored, the less harm may be caused.

· Ensure that the production, storage, transport, use, and disposal of hazardous materials are carried out according to the relevant standards and are regularly audited.

· Allow only trained people to handle hazardous materials.

· Maintain an inventory of hazardous materials types, quantities, and locations.

· Collect, and have available, safety data sheets on all materials; these describe the nature of the materials, the hazards associated with them, and emergency response and first-aid directions.

· Develop generic hazardous materials emergency plans for communities and regions.