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RAPID HEALTH ASSESSMENT PROTOCOLS FOR EMERGENCIES
( By WHO - OMS, 1999 )

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1 - Preparedness

If the rapid assessment is to be useful for guiding emergency health response, it must be clear in advance which individuals make the decisions on emergency interventions because they must receive the information and recommendations made by the rapid assessment team. Moreover, it is essential that responsibilities for each particular emergency health action are clearly defined at national, regional, and local levels. Ideally, the rapid assessment should be conducted as the cooperative effort of all organizations with responsibilities for emergency response.

While it is impossible to plan for all potential emergencies, the challenge for all health programmes is how best to make emergency preparedness a part of their current activities, to both strengthen existing services and prepare for emergency response. Emergency preparedness includes:


- policy development for preparedness, response and recovery;
- vulnerability assessment;
- emergency planning;
- training and education; and
- monitoring and evaluation.

Emergency plans should be prepared by the ministry of health for all anticipated emergencies. These plans should include a description of:


- management structure (emergency powers, control, command, communication, emergency coordination centres, and post-emergency review);

- organization roles (description by role, description by organization, description by sector and emergency operation centres);

- information management (alerting, emergency assessment, information processing, public information, reporting, and translation and interpreting);

- resource management (resource coordination, administration, financial procedures, external assistance);

- summary of vulnerability assessment;

- maps; and

- emergency contacts.


Provisions for the assessment should be part of these emergency plans. There should be clear mechanisms in place for incorporating the assessment findings in emergency decision-making.

Emergency health response does not always need to wait for the collection of data. Experience has shown that emergencies have specific, predictable patterns of impact on public health. Selected health responses can and should be planned in advance, ready to be carried out without awaiting the results of rapid health assessment.

An example of this is the higher risk of measles epidemics among children in displaced populations living in camps. In countries at increased risk of internal or cross-border displacements, the national programme of immunization should include strategies to prevent such outbreaks as part of preparedness planning. Another example applies to countries at increased risk of sudden-impact emergencies such as earthquakes: routine hospital management in these areas must include formulating mass casualty plans and holding regular emergency practice drills. In communities with chemical plants, formulating in advance standard treatment guidelines for chemical exposure makes prompt case management possible, should a chemical incident occur.

Preparedness checklist

These questions can be adapted for specific types of health emergencies. They can also provide a focus for health preparedness activities at regional, district, and community levels.


1. Is there a national health policy regarding emergency preparedness, response, and recovery? Is the policy being implemented?

2. Is there a person within the ministry of health in charge of promoting, developing, and coordinating emergency preparedness, response, and recovery activities?

3. What coordination in emergency preparedness activities exists between the health sector, civil defence, and key ministries (such as the ministry of the interior and the ministry of agriculture)?

4. What joint activities in emergency preparedness, response, and recovery are undertaken between the ministry of health, United Nations organizations, and nongovernmental organizations (NGOs)?

5. Are there operational plans for health response to natural, man-made or other emergencies?

6. Have mass casualty management plans been developed (both pre-hospital and hospital) at national level as well as for individual hospitals?

7. What health and nutrition surveillance measures have been taken for the early detection of health emergencies (high-risk seasons, geographical areas identified; early warning procedures in place; national reference laboratory established; surveillance system established and working)?

8. What preparedness steps have been taken by environmental health services?

9. Have facilities and areas been identified and designated as temporary settlements in the event of emergencies? What provisions have been made for health care? (Include details such as general or special health services, staffing, supplies, water, and sanitation.)

10. What training activities are devoted to emergency preparedness, response, and recovery in the health sector (at national, regional, and district levels) and what organizations are involved?

11. What resources are available to facilitate a rapid health response (e.g. an organized communications centre in the ministry of health, emergency budget, access to transport, and emergency medical supplies)?

12. Is there a system for updating information on the key human and material resources needed for an emergency health response (e.g. updated inventories of essential drugs, and four-wheel-drive vehicles)?

13. What opportunities exist to test emergency plans through, for example, simulation exercises and drills?


Organizational preparedness

The measures listed below are of particular concern to managers within the ministry of health. Such measures are essential components of health emergency preparedness and should be reflected in all the ministry’s technical programmes.

The following structures for emergency health response should be in place:


- a position in the ministry of health with overall authority and responsibility for emergency health response;

- executive structures at all levels, with clear responsibilities for emergency health response (e.g. emergency health committees at community, district, regional, and central levels);

- a clear chain of command from central to peripheral levels for emergency health management;

- working links at all levels between the ministry of health, national emergency response and recovery organizations, the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations High Commissioner for Refugees (UNHCR), the United Nations Development Programme (UNDP), the World Food Programme (WFP), NGOs, and bilateral and intergovernmental organizations involved in health and nutrition; and

- coordination with other sectors, such as health, lifelines, transport, police and investigation, and social welfare.


Prepare emergency plans for anticipated emergencies

It is important to identify emergencies likely to occur at national and subnational levels, and their probable health consequences. Simple emergency plans, prepared and approved within the ministry of health, should outline the administrative and technical responsibilities and procedures necessary for a timely response. These plans and procedures should then be distributed to the relevant organizations involved in emergency response.

Existing information and experience gained in past emergencies are useful in setting priorities. The following questions should be considered:


· Where were the high-risk areas in past health emergencies? Who are the populations at risk? Based on experience, when are the high-risk seasons?

· What is the likely health impact of a flood or epidemic of meningitis? (Consider the number of cases, hospital admissions, and deaths.)


Compile and update information for prompt response


· Establish procedures for communicating early signs of possible emergencies between health authorities, key ministries, national emergency response organizations, international organizations, and NGOs so that a prompt alert is signaled.

· Keep updated lists and maps of health facilities, with information on bed capacity and specialist services available.

· Keep an updated inventory of NGOs working in health in the country, and their areas of expertise and experience in emergencies.

· In areas at high risk for health emergencies, have detailed maps available showing airfields, access roads, health facilities, and major water sources.


Clarify areas of responsibility and accountability


· Clarify who is responsible for emergency health action at each administrative level.
· Determine which organization is responsible for:



- multi-organization coordination in an emergency (lead agency for the rapid assessment);
- clearance, storage, and transport of emergency items;
- directing technical health response; and
- other critical activities such as travel clearances.

Standardize approaches to international health assistance


· Clarify reporting channels or lines of accountability for international organizations and NGOs.

· Develop standard procedures for requesting external health assistance.

· Establish standard working procedures for the importation and expedited clearance of emergency health items and drugs.


Anticipate needs for budget, transport, and communications


· Establish procedures for accessing funds and resources in health emergencies.

· Identify emergency options for rapid surface and air transport of personnel and emergency health items.

· Set up procedures for rapid collection, transport, and analysis of laboratory specimens.

· Establish procedures for emergency communication with peripheral areas.


Deal with the technical aspects

Plans of action should be developed for the early detection of and response to anticipated health emergencies. A useful starting point is to review and map existing data on past emergencies to identify areas of greatest risk, and assess local response capacity. The rapid health assessment team or person should ask people from the ministry of health or provincial or district health services the following questions:


· What is the distribution of facilities, number of beds, number of specialist services, and seasonal access to the area and facilities?

· How many health workers are there in the area and what is their level of experience?

· What are the likely effects of specific emergencies on health services in the areas identified as high risk (e.g. consider the number of admissions and the outpatient attendance)?

· What is needed for a prompt emergency response (e.g. hospital staff trained in mass casualty management, experienced epidemiologist, improved radio communication, and training of clinicians for better diagnosis)?

· Where are the gaps (in technical expertise, material supplies, emergency logistics, communication, and managerial skills)?


Establish early warning procedures


· Define the early signs that would signal an “emergency alert”. Can or could they be detected early through improved surveillance and reporting?

· Develop guidelines to help health personnel at all levels recognize and report these signs.

· Intensify surveillance for specific epidemic diseases during high-risk transmission periods.


Preparedness for rapid assessment

An important function of emergency planning is to identify in advance those warning signals which indicate that a rapid health assessment is needed. Alerts for these signals should also be determined, as shown in Table 1.

These alerts should be related to local conditions and expected seasonal variations. Ideally they will be triggered by ongoing activities such as epidemiological and nutritional surveillance.

Although all of the following seven measures are not always feasible, they are very desirable if the assessment is to be carried out rapidly.


1. Lines of authority within the ministry of health should be defined and clearly stated.

2. Organizational networks and partnerships should be maintained for mobilizing personnel and resources for the rapid assessment.

3. National, subnational, and district maps of high-risk areas, showing settlements, water sources, main transport routes, and health facilities, should be developed, kept updated, and made easily available.

4. Data collection forms, specimen containers, and other items essential for specific types of field assessments should be kept at the national and subnational levels.

5. Reference laboratories and special shipment procedures for rapid analysis of specimens should be identified in advance.

6. Communication channels between the assessment team, local authorities, decision-makers, and participating organizations should be agreed upon and kept open.

7. Qualified personnel should be identified in advance for rapid health assessment in specific types of emergencies.


Preparedness provides an opportunity to identify local skilled individuals as potential assessors in different types of emergencies, and to highlight gaps in technical expertise in advance. Although a rapid health assessment is usually best undertaken by a team, the composition of the group will vary according to the type of emergency.

Table 1.Warning signals of emergencies



















Warning signal


Alert


An increase in hospitals reporting cases of meningococcal meningitis


Give alert for a meningitis outbreak


Above-expected seasonal levels of the disease in one district



Rising prices of staple cereals, and migration of people into an area that is expected to have a major crop failure at harvest time


Give famine alert


Increasing hospital admissions with signs of irritation of the eyes, skin, and mucous membranes in a community near a chemical plant


Give alert for a chemical accident


For instance, it is more important that a nutritionist participate in assessing a refugee influx than a meningitis outbreak. However, an individual skilled in epidemiology or public health should be a member of every assessment team.


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