Public Health Emergency Preparedness and Response in Ministry of Health, Labour and Welfare (MHLW)
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1 Public Health Emergency Preparedness and Response in Ministry of Health, Labour and Welfare (MHLW) Toshiyasu Teratani, M.D., Ph.D. Office of Public Health Emergency Preparedness and Response Ministry of Health, Labour, and Welfare (MHLW) Japan March 8, Hall (Tokyo university) 1
2 My history
3 Outline Introduction Public health risk management and coordination 1 : overview 2 : Response to natural disasters 3 : Response to pandemic influenza Next steps Summary 3
4 Introduction 4
5 What is Public Health? Time transition Micro vs. Macro Public Health for people, for life Health (Prevention) Medicine (treatment) Welfare (maintance functionactivity-participation)
6 Transition of Health Risk Concerns in Japan 1940s s Infectious Diseases 1960s s Environmental Pollution 1980s Medical Scandal AIDS caused by transfusions of HIV-tainted blood products 1997 MHLW framework launch 1990s - Earthquakes Emerging/Re-Emerging Diseases Medical Malpractices Terrorism Weapons of Mass Destruction Climate Change 6
7 Japan s Experience in Public Health Crisis Management Year Health Crisis Events Mass Gathering Events 1995 Hanshin-Awaji Earthquake national framework launch Tokyo Subway Sarin Attack 1996 O157 Food Poisoning 1998 Arsenic-laced Curry Incident 1999 Criticality Nuclear Accident 2000 Contamination of Daily Products by S.aureus Volcanic Eruption (Miyakejima) Kyushu-Okinawa G8 Summit 2002 SARS FIFA World Cup 2004 Niigata-Chuetsu Earthquake Acute Encephalopathy caused by Mushroom 2005 Railway Crash 2007 Niigata-Chuetsu Earthquake 2008 Imported Contaminated Dumplings Incident Tohyako G8 Summit 2009 H1N1 Pandemic Flu 2010 APEC Japan 2011 Great East Japan Earthquake, Tsunami and Fukushima Nuclear Power Plant Accident 7
8 Public Health Risk Management and Coordination 8
9 What is Health Risk Management? Operations for prevention, mitigation, and medical countermeasures for threats and risks for public health caused by and other causes. Health Crisis/emergency Unknown causes Infectious diseases pharmaceutical products, food poisoning, infectious diseases, drinking water Natural disasters Manmade disasters Source: Basic Guideline for Health Risk Management in MHLW (January, 1997) 9
10 Today topic Health Crisis/emergency 3:pandemic 2:disaster medicine 1:overview Health Crisis/Risk Management 10
11 Cycle of Health Risk/Crisis Management Health Crisis Outbreak Health Crisis Event Early Detection Rapid and Appropriate Response Stabilization+relief Short/Mid-Long Term Measures Improvement of Public Health Feedback Situation Under Control 11
12 Health Risk/Crisis Management Health Crisis Outbreak Collect Information Principles of Health Risk Management 1. Share the information - Utilize the coordination mtg 2. Prepare the system - Update contact information, implementation guidelines 3. Operate the first action Implementation Action Decision 12
13 Public Health Risk Management in MHLW Domestic and global health risk information IHR (WHO) Resear chers Public Health Centers National Hospitals National Research Institutes MHLW relevant departments/offices Local Governments Office of Public Health Emergency Preparedness and Response Coordination Information gathering and sharing Health Risk Management Coordination Meeting Action Cabinet Secretariat and Other Ministries Response to health crisis 13
14 Response to Natural Disasters 14
15 What is Disaster Situation? Demand Resource Imbalance 21
16 In a Disaster Cycle disaster preparedness disaster Interdisaster phase Rehabilitation/ Reconstruction phase Pre- phase Necessary to keep the regular health/medical system Recovery phase Impact phase Emergency phase Public health and medicine takes part in all phases rescue emergency medicine health management mental health care 16
17 Resilience and Surge Capacity Disaster Occurrence Huge increase in the needs of public health and medical care before after recovery phase time line Resilience Expand Surge Capacity 20
18 Disaster Response Transition Occurrence of disaster Acute period Sub-acute period Mid-long term Collect and share information Emergency medical care Support in securing medical care systems in facilities Health monitoring in medical relief centers Recovery of affected medical care facilities 23
19 Hanshin-awaji /6400
20 Disaster Medical System Rescue Disaster site Affected area On-site Medical Facility Triage Treatment Transportation Disaster base hospital Admission and treatment Dispatch DMAT Non-affected area Provide drugs Accept patients Wide-area transportation Information system(emis) 20
21 Basic Concept of DMAT Survive rate Traditional Medical teams 24 hrs 72 hrs 21
22 EMIS(Emergency Medical Information System) 22
23 Summary of Japan DMAT Activities after the Great East Japan Earthquake and Tsunami (3.11) 380 teams, 1800 personnel (12days) Iwate, Miyagi, Fukushima,Ibaraki 5 teams Chitose Hanamaki Activities: Hyakuri - Support hospitals - Inpatients evacuation - Regional evacuation - Wide-area transportation Fukuoka 24 teams 49 teams Osaka: Itami Dispatched by Air: DMAT 82 teams, 407 personnel 29
24 DMAT Activities Supporting disaster-base hospitals 30
25 Hanamaki Airport Staging Care Unit Received 136 pts - Wide-area air transportation: 16 pts - transported to Morioka city: 120 pts 31
26 In the C-1 jet plane to Haneda Airport Receive patients from coastal area Carry in patients to the aircraft 32
27 DMAT Supervisors in Prefectural Government Offices Fukushima Prefectural Office 33
28 Response to Pandemic Influenza 28
29 What is Pandemic? En-demic epi-demic pan-demic 29
30 What is Pandemic Influenza? When a virus derived from animals such as birds with an influenza virus enters the world of humans and acquires the ability for human to human transmission, Since humans do not have immunity against this new type of virus, - it would lead to a global pandemic, and - could result in severe virulence in individuals because of the lack of immunity (resistance) Causing major health damage (patients, severely ill patients and deaths), secondary impacts on social activities and functions, causing social stagnation and decline 30
31 Estimated Scales and Patient Numbers Inpatients: million Deaths : million The pandemic influenza control action plan estimate following the scale of the damage: (Reference) Pandemic year Known as Virus type Number of deaths Spanish Influenza H1N1 40 million Asian Influenza H2N2 2 million Hong Kong Influenza H3N2 1 million 31
32 Patient number Conceptual Illustration of Effects of Actions (According to the following policies as national crisis management) 1. To contain the range of infection as far as possible while minimizing health damage 2. Not to allow escalation into collapse of the society or economy To build a clear framework for speedy actions Peak delayed Actions not taken Actions taken Peak patient number reduced Stronger care framework Capacity for care provision Securing the minimum society infrastructure Time 32
33 33
34 Next steps 34
35 35
36 Situation awareness 36
37 All hazard approach 37
38 国土強靱化計画 (Kokudokyoujinka) = national resilience??? = National risk assessment and management??? 38
39 39
40 40
41 Management system micromanagement ICS 41
42 Triage 42
43 Whose is Public health 43
44 Summary 1. MHLW of Japan developed a framework for sharing information on potential health risks and crisis in 1997.(HIV incident) 2. Office of Public Health Emergency Preparedness and Response coordinates with relevant departments/offices for early alerting and response to address all-hazard health risks. 44
45 Summary 3. It is necessary to prepare for complex incident/disaster in Japan. Situation awareness All hazard approach Management system(customized to fit the Japan) 4.public health for/by everyone 45
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