Activities - Health risk
The health risk emerges every time critical situations possibly affecting human health are created.
In the ordinary, the planning phase of the emergency medical rescue response and preparing awareness-raising activities on how to behave in case of risk is essential. During emergencies, rescue procedures provided in municipal, provincial, and regional plans are activated.
Since 2001, the Civil Defense Department has released indications to improve rescue organization and assistance in emergencies.
The first directive, "General criteria for organizing rescue work in catastrophes," was issued in 2001 and was followed in 2003 by the document "General criteria for medicines and medical devices to be kept in a first aid post."
In 2006, the Department dedicated an internal document to the most sensitive issue in emergency management, which is psychological and psychiatric care during a major disaster: in "General criteria for psychosocial interventions in catastrophes," common goals and organizational schemes have been identified.
In 2007, the directive "Procedures and forms of medical triage" was published, setting out procedures for categorizing patients by seriousness and treatment priority in the event of a disaster.
In 2011, in light of the evolution of the National Health Service into a regional organization, Operational Guidelines were published to establish general directions for activating Regional health modules. To meet the population's health care requests from the disaster event until the restoration of regular health services, in 2013, a directive was issued establishing field medical facilities "Pass - Posto di Assistenza Socio Sanitaria." In 2016, on the other hand, CROSS - Remote Centre for Health Rescue Operations and Regional Health Referents in case of national emergency were identified by a directive.
In addition, the Department, in cooperation with the Europe Consulting cooperative, leads the Abili a proteggere project to keep the focus on rescue and assistance to people with disabilities in emergencies and foster preventive interventions in this field.
A risk to health is difficult to foresee being subsequent to other risks and calamities; planning medical and psychosocial actions in emergencies in quieter times is however particularly important to reduce the time in responding and to prevent or limit harm to persons.
Practical experience in civil protection provides an opportunity to test the urgent medical assistance procedures and to see how the camp facilities effectively work in emergencies. The activities of information and education for the population also contribute towards prevention as they reinforce the actions required to impede and handle emergencies in the best way, curbing the damaging effects of the events.
Emergency planning. The “General criteria for medical assistance in catastrophes” are the instrument used by the civil protection Department to operate emergency medical assistance, even though the regional health systems are left with their own organizational independence. These criteria establish the emergency plans both for events which local systems are capable of dealing with as well as for those exceeding their responsive capacity requiring the coordination of the National Service.
Local bodies are responsible for identifying the risks mainly affecting their territory to improve the organization of medical assistance and identify the possibility of risks associated with the principal risks, e.g. epidemics, accidents with loss of radioactive or dangerous materials, etc. A close study of the territory shows that various consequences, such as effects on people or places at risk of potential secondary disasters, can already be predicted in response planning. The variables of specific interest to characterize disasters are: frequency, intensity, territorial extension, duration, seasonal factors, rapidity of occurrence, possibility of forewarning.
Regarding prevention at the European level, the Civil Protection Department takes part in planning and updating "civil protection modules," that is, civil protection interventions with uniform operating standards, consisting of people and materials from the Member States. The purpose of the modules is to uniform and make the interventions of the civil protection systems of the Member States more rapid and effective.
Exercises. Civil protection exercises are an excellent opportunity to test emergency rescue procedures and the functioning of emergency facilities.
Information and communication. Information and education activities for the public contribute to prevention because they strengthen successful behaviors to better manage the emergency and limit the damaging effects of events. Information activities are likewise essential to improve the knowledge of risks in the territory to prevent and mitigate possible adverse effects on health.
The health intervention in emergency is determined by all actions necessary for the safety of people, and in general public health, which is part of "disaster medicine".
The Civil Protection Department has drawn up specific Criteria for the organization of health rescue and psychosocial interventions during emergencies, in which targets and procedures are set for all actors involved in the scenario of an emergency. These documents summarize the procedures for rescue and relief in “limited effect events", then manageable by local bodies, and for an "event that goes beyond the response capacity of local structures”, that requires, therefore. the intervention of the Department.
PMA (advanced medical post) and regional health modules. The core of the medical rescue chain in limited disaster response is the PMA - advanced medical post. The deployment of this structure is set out in the "General criteria for organizing medical rescue work," and its functioning is specified in the 2007 Directive on medical triage. In 2011, they were mentioned in the Directive on the activation of regional health modules, which regulates operational guidelines for coordinating regional health facilities involved in the event of a disaster. The health modules are "health task forces" ready to go, equipped with the necessary resources to travel and operate autonomously for at least 72 hours, and equipped with at least one PMA, in which physicians and nurses experienced in emergency-urgency medicine operate. The Directive prepared by the Department aiming to create a "national mobile health force" that could be quickly dispatched to reinforce the Health Service of regions affected by major disasters.
Following the 2009 Abruzzo earthquake, the Department of Civil Protection launched a restructuring of the national system of urgent medical rescue in the event of a disaster, drawing on the experience gained during the earthquake management.
Pass (socio-health care facilities). An emerging need has been to arrange field facilities to replace the unfit polyclinics to effectively guarantee primary social health care to the uninjured population. Alongside the PMA - advance medical posts, which within a few days run out of usefulness, the Pass, Posto di assistenza socio sanitaria (socio-health care facilities) were created with the Directive of the President of the Council of Ministers of April 6, 2013.
Svei Card. A further tool developed after the Abruzzo earthquake was the Svei Card, which assessed immediate needs to meet the demands of the most fragile people involved in an emergency. The tool was deployed for the first time on the ground to manage the earthquake in Central Italy by the regions of Lazio, Marche, Umbria, and Abruzzo, proving its validity.
Remote Centre for Health Rescue Operations (Cross). The latest significant step in reorganizing the national system of urgent medical rescue in the event of a disaster was the Directive on the identification of the Remote Centre for Health Rescue Operations for the coordination of urgent medical rescue and Regional Health Referents in the event of a national emergency published in the Official Gazette on August 20, 2016. The Head of Department may order the activation of the Cross to foster the operational link between the needs of the affected territory and the availability of health resources of the components and operational structures of the National Civil Protection Service.
This is the phase of rehabilitation and gradual return to normal life. At this stage, if local health facilities are still unsafe, they may be replaced temporarily by field structures designed to work for medium-long periods, such as field hospitals or medical clinics. In this way the health system ensures a regular assistance to the population.
In addition to ensuring continuity of care in post-emergency phase,psychological and psychiatric care to the population has a significant importance. It is in the post-emergency that the psychological and social consequences of the disaster start to show, affecting the responsiveness and adaptability of the individual and groups of people who cannot lead their lifestyle habits.
To encourage the return to normal habits of individuals, traders who belong to the psychosocial team work on the restoration of pre-existing social networks by creating new networks and engaging the population in different projects, including awareness raising and education on the risks and educational projects for children / teenagers.
The operators make the access to health and social services easy, providing documents on people to whom assistance has been provided in emergency and on the work, making information on risk factors and vulnerable individual and collective available.