HEALTH CBRNINC PLAN Domestic Health Response Plan for Chemical, Biological, Radiological or Nuclear Incidents of National Consequence Australian Health Protection Principal Committee ISBN: 978-1-74186-064-1 Publications approval number: 10509 Copyright Statements: Paper-based publications © Commonwealth of Australia 2014 This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. 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AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE The Australian Health Protection Principal Committee (AHPPC) is a standing committee of the Australian Health Ministers Advisory Council. Chaired by the Deputy Secretary of the Department of Health, the Committee includes representation by the Chief Health Officers of all States and Territories, the Department of Defence, Emergency Management Australia (EMA), the Chairs of its key standing committees: Communicable Disease Network Australia (CDNA); Public Health Laboratory Network (PHLN); Environmental Health Standing Committee (enHealth); National Health Emergency Management Standing Committee (NHEMS); Antimicrobial resistance Standing Committee (AMRSC) and the Blood Bourne Virus and Sexually Transmitted Infections Standing Committee (BBSTISC) and key subject matter experts. To obtain details regarding AHPPC publications, contact email [email protected]. At the time of publication, the links to websites referred to in this document were correct. AHPPC acknowledge that, at times, organisations change internet addresses, or remove information from the internet. TABLE OF CONTENTS Contents TABLE OF CONTENTS ................................................................................................................. 4 DISTRIBUTION LIST .................................................................................................................... 5 CERTIFICATE OF AMENDMENT .................................................................................................. 7 ABBREVIATIONS AND ACRONYMNS .......................................................................................... 8 AUTHORITY .......................................................................................................................... 11 Section 1: INTRODUCTION................................................................................................. 12 Section 2: AIM ................................................................................................................... 13 Section 3: SCOPE................................................................................................................ 13 Section 4: ACTIVATION ...................................................................................................... 14 Section 5: HEALTH CBRNINC PLAN Readiness Phases and Activation............................... 15 Section 6: RESPONSE COORDINATION .............................................................................. 16 Section 7: PREVENTION, PREPAREDNESS, RECOVERY AND RESILIENCE ........................... 18 Section 8: MEDIA MANAGEMENT ..................................................................................... 20 Section 9: ADMINISTRATION AND MAINTENANCE ........................................................... 21 APPENDIX 1: AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS ................. 22 APPENDIX 2: AGENCIES ROLES AND RESPONSIBILITIES .......................................................... 22 APPENDIX 3: TEMPLATE – GUIDE FOR AFFECTED JURISDICTION ............................................ 27 APPENDIX 4: RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN ........................................ 32 STANDBY PHASE ACTIONS .............................................................................................. 32 RESPONSE PHASE ACTIONS – SUMMARY ....................................................................... 33 STAND DOWN PHASE ACTIONS ...................................................................................... 34 APPENDIX 5: DETAILED RESPONSE PHASE ACTIONS ............................................................... 35 MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA ..................................................................................... 38 RESPONSE CODE 0: NO CREDIBLE THREAT ..................................................................... 38 RESPONSE CODE 1: CREDIBLE THREAT OF RELEASE ....................................................... 39 RESPONSE CODE 2: RELEASE IMMENENT ....................................................................... 40 RESPONSE CODE 3: OVERT RELEASE OR SUSPECTED COVERT RELEASE ......................... 40 RESPONSE CODE 4: MULTIPLE RELEASES OF CBRN MATERIAL....................................... 41 APPENDIX 6: KEY STAKEHOLDERS ........................................................................................... 42 APPENDIX 7: ROLES AND RESPONSIBILITIES............................................................................ 43 APPENDIX 8: MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA ......... 45 APPENDIX 9: COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES ................. 46 APPENDIX 10: INTERNATIONAL ASPECTS OF CBRN INCIDENTS ............................................. 47 APPENDIX 11: RELATED PLANS AND DOCUMENTS ................................................................. 48 APPENDIX 12: STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS .......................................................................................................................... 49 APPENDIX 13: SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS ................................................................................................ 51 APPENDIX 14: GLOSSARY/DEFINITIONS .................................................................................. 52 DISTRIBUTION LIST Australian Government Departments and Agencies Air Services Australia (ASA) Attorney-General’s Department (AGD) Attorney-General’s Department Emergency Management Australia (EMA) Australian Agency for International Development (AusAID) Australian Federal Police (AFP) Australian Government Crisis Coordination Centre (CCC) Australian Maritime Safety Authority (AMSA) Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) Department of Agriculture (Agriculture) Department of Defence (Defence) Department of Environment - Australian Antarctic Division (Environment) Department of Finance (Finance) Department of Foreign Affairs and Trade (DFAT) Department of Health (Health) Department of Human Services (DHS) Department of Immigration and Border Protection (DIBP) Department of Industry (Industry) Department of Infrastructure and Regional Development (DIRD) Department of Prime Minister and Cabinet (PM&C) Department of Social Services (DSS) The Treasury (Treasury) State and Territory Health Authorities Australian Capital Territory (ACT) New South Wales (NSW) Northern Territory (NT) Queensland (QLD) South Australia (SA) Tasmania (TAS) Victoria (VIC) Western Australia (WA) Other Authorities Australasian College for Emergency Medicine (ACEM) Australasian College of Dermatologists (ACD) Australasian College of Sports Physicians (ACSP) Australasian Faculty of Occupational and Environmental Medicine (AFOEM) Australasian Faculty of Public Health Medicine (AFPHM) Australasian Faculty of Rehabilitation Medicine (AFRM) Australia New Zealand Counter-Terrorism Committee (ANZCTC) Australian Antarctic Division Australian and New Zealand College of Anaesthetists (ANZCA) Australian and New Zealand Emergency Management Committee (ANZEMC) Australian College of Rural and Remote Medicine (ACRRM) Australian Government Crisis Committee (AGCC) Australian Medical Transport Coordination Group (AMTCG) Australian Red Cross Blood Service (ARCBS) Council of Ambulance Authorities (CAA) Joint Faculty of Intensive Care Medicine (JFICM) National Critical Care and Trauma Response Centre (NCCTRC) National Emergency Management Committee (NEMC) Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Royal Australian and New Zealand College of Psychiatrists (RANZCP) Royal Australian and New Zealand College of Radiologists (RANZCR) Royal Australian College of General Practitioners (RACGP) Royal Australian College of Medical Administrators (RACMA) Royal Australian College of Physicians (RACP) Royal Australian College of Surgeons (RACS) Royal College of Pathologists of Australasia (RCPA) SOS International World Health Organization (WHO) CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical, Biological, Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate. Recommendations for amendments or suggestions for improvement may be made at any time to: Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone: Facsimile: E-Mail: +61 2 6289 3030 +61 2 6285 3040 [email protected] Information on the current version can be obtained from the Department of Health Website http://www.health.gov.au/ Amendment No: Issue date: Amendment by: Date: ABBREVIATIONS AND ACRONYMNS ABLN Australian Biosecurity Laboratory Network ACEM Australian College for Emergency Medicine ADF Australian Defence Force AFP Australian Federal Police AGCC Australian Government Crisis Committee AGD Attorney-General’s Department AGD EMA Emergency Management Australia AGDRC Australian Government Disaster Recovery Committee Agriculture Department of Agriculture AHMAC Australian Health Ministers Advisory Council AHPPC Australian Health Protection Principal Committee AME Aeromedical Transportation AMRN Australian Medical Retrieval Network AMRSC Australian Antimicrobial Resistance Standing Committee AMTCG Australian Medical Transport Coordination Group ANSTO Australian Nuclear Science and Technology Organisation ANZCTC Australian New Zealand National Counter Terrorism Committee ANZEMC Australian New Zealand Emergency Management Committee ARPANSA Australian Radiation Protection and Nuclear Safety Agency ASIO Australian Security Intelligence Organisation ASNO Australian Safeguards and Non-Proliferation Office AusAID Australian Agency for International Development AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan AUSBURNPLAN Severe Burn Injury Annex AUSMAT Australian Medical Assistance Team AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee C4 Command, control, coordination and communication CAA Council of Ambulance Authorities CBRN Chemical, Biological, Radiological and Nuclear CCC Australian Government Crisis Coordination Centre CCAED Consultative Committee on Emergency Animal Diseases CDNA Communicable Disease Network Australia CDNA – JEG CDNA Jurisdictional Executive Group CHO State and/or Territory - Chief Health Officer CICM College of Intensive Care Medicine of Australian and New Zealand CMO Australian Government Chief Medical Officer COAG Council of Australian Governments COMDISPLAN Australian Government Disaster Response Plan CSIRO Commonwealth Scientific and Industrial Research Organisation CVO Chief Veterinary Officer CWALN Chemical Warfare Agent Laboratory Network DACC Defence Aid to the Civil Community Defence Department of Defence DFAT Department of Foreign Affairs and Trade DIBP Department of Immigration and Border Protection DIRD Department of Infrastructure and Regional Development DSS Department of Social Services DSTO Defence Science and Technology Organisation EMA Emergency Management Australia enHealth Environmental Health Committee EOC/ECC Emergency Operations/Coordination Centre FSANZ Food Standards Australia New Zealand Health Department of Health Health CBRNINC Plan Health Response Plan for Chemical, Biological, Radiological or Nuclear Incidents of National Consequence HIMU Health Issues Media Unit IAEA International Atomic Energy Agency IDC Interdepartmental Committee IDETF Interdepartmental Emergency Task Force IHR International Health Regulations LO Liaison Officer MCI Mass Casualty Incident NCC National Crisis Committee NCTH National Counter Terrorism Handbook NCTP National Counter Terrorism Plan NCCTRC National Critical Care and Trauma Response Centre NEMRN National Emergency Media Response Network NGO Non-Government Organisation NHEMS National Health Emergency Management Standing Committee NIR Department of Health National Incident Room NMS National Medical Stockpile NSC Nuclear Safety Committee OHP Office of Health Protection OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas PEP Post-Exposure Prophylaxis PHLN Public Health Laboratory Network REMPAN Radiation Emergency Medical Preparedness Assistance Network RHC Radiation Health Committee SEOC State Emergency Operations Centre SHEOC State Health Emergency Operations Centre SITF Australian Government’s Special Incident Task Force SITREP Situation Report SSBA Security Sensitive Biological Agent USAR Urban Search and Rescue AUTHORITY The Health Chemical, Biological, Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC). The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014. The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009). Professor Chris Baggoley Chair AHPPC Australian Government Department of Health Section 1: INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical, Biological, Radiological, or Nuclear Incidents of National Consequence (CBRNINC). The plan provides an agreed framework and mechanisms for the effective national coordination, response and recovery arrangements for CBRNINC. The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments. Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents. For the purpose of this plan, a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical, biological or radiological agent or activation of a nuclear device which is intended to cause harm to people. Due to combinations of geography and severity a CBRN incident, by definition, may have the potential to overwhelm local/regional response resources. The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs. A CBRNINC is defined as a CBRN incident that requires consideration of national level policy, strategy and public messaging or inter-jurisdictional assistance, where such assistance is not covered by existing arrangements. This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them. A CBRN incident may transition into a CBRNINC when a jurisdiction’s response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational management/response. Examples include the involvement of large numbers of foreign nationals, terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident. The Australian Health Protection Principal Committee (AHPPC) will determine, in consultation with the relevant State or Territory, when a CBRN incident has transitioned into a CBRNINC. The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries, including severe burn injuries. The national management of severe burn injuries requires specific considerations for effective response and optimal care. The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN). The following critical consultative mechanisms underpin this plan: the AHPPC is the peak national health emergency management committee with the power as decision makers to plan, prepare and coordinate the national Health response to significant incidents; the Australian Medical Transport Coordination Group (AMTCG), convened by the Attorney-General’s Department (AGD) Emergency Management Australia (EMA), provides a nationally coordinated medical transport response; and the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA), the Public Health Laboratory Network (PHLN), the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth). The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR). The NIR maintains lead agency status in the coordination of health assets, including hospital beds, deployment of medical countermeasures and personnel. AGD EMA is the agency responsible for planning and coordinating Australian Government’s physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN). AGD EMA maintains lead agency status for all multi-agency Australian Government coordination, including provision of medical transport through the AMTCG. In the event of a CBRN related terrorist attack, the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP). The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats. The NCTP outlines responsibilities, authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia. Section 2: AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC. The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident. By coordinating the distribution of resources in the response to an incident, it increases the ability for casualties to be provided optimal specialist and general medical care. Section 3: SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC. It is acknowledged that Australia’s health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties, particularly in regional and remote areas. The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction, including HAZMAT, infectious disease outbreaks or accidental irradiation issues. However, the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident. The Health CBRNINC Plan can be activated in conjunction with other national level plans. Section 4: ACTIVATION ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan. TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include: the occurrence or threat of a significant domestic CBRN incident; notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required; activation of OSMASCASSPLAN involving a CBRN incident; or other circumstances as deemed appropriate by the AHPPC. EXECUTION Health, in consultation with AHPPC, may issue preliminary Health CBRNINC Plan Response Phase messages. Once activated, the AHPPC can coopt relevant clinicians or subject matter experts as required. The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes. The NIR will provide agencies with Situation Reports (SitReps) for events that require activation and/or escalation of the plan. Section 5: HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5. Standby Phase Alerts of a potential or confirmed CBRN Incident of National Concern NIR placed on Standby NIR will liaise with affected jurisdiction/s Notification to AHPPC of the incident Advice Crisis Coordination Centre (CCC) of potential and actual CBRNINC Jurisdictions to identify available resources for the response (Appendix 3) Situational awareness maintained by NIR through briefings from affected and nonaffected jurisdictions Convene AHPPC AHPPC confirmation of jurisdictional capacity Response Phase Request for assistance received from affected jurisdiction/s Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan NIR activated - commence operational planning and continue to gather operational intelligence Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions If required, deployment of Australian Government and/or jurisdictional assets required to support the CBRN incident response If required, movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR Detailed response actions are at Appendix 4 Standown Phase The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking AHPPC to debrief health authorities to response phases of Health CBRNINC (disseminate post activation report and recommendations) Facilitate ongoing health recovery processes. Plan Section 6: RESPONSE COORDINATION COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable. Upon activation, the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate. In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened, the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC). The CCC will prepare and distribute the National SitRep, which is a whole of Government product/resource. Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations. Communications to the Health NIR can be directed as follows: National Incident Room t: (+61) 2 6289 3030 (24 hours) f: (+61) 2 6289 3041 e: [email protected] AERO-MEDICAL TRANSPORT CONSIDERATIONS AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan. The AMTCG includes representation from AGD EMA, Health, ADF, states and territory aeromedical coordinators, the Council of Australia Ambulances (CAA) and DFAT. NATIONAL MEDICAL STOCKPILE Following activation of the Health CBRNINC Plan, the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident. Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO. FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected, in the first instance, to absorb any costs incurred. Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction. Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans. LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements – See Appendices 1 and 6). The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency. The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies. COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested. If aero-medical (AME) transportation is required on advice from Health/AHPPC and the AMTCG, AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR. The NCTP is activated in the event of a terrorist attack. The Health CBRNINC Plan can operate independently of COMDISPLAN. However, if COMDISPLAN is activated, the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to Health/AHPPC. The Health CBRNINC Plan can operate independently of NCTP. However, if the NCTP is activated, Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH), particularly in relation to stated roles and functions of Health and the AHPPC, and to the maintenance of information security and critical infrastructure protection. Section 7: PREVENTION, PREPAREDNESS, RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution, prevention of a CBRNINC is largely a state and territory responsibility. Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007, and the National Health Security Regulations 2008. The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents. It also provides standards for the handling and transport of samples from affected animals or persons. The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent. It is implemented through specific regulation by State/Territory radiation regulatory authorities. Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan. PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories. These include: development of interoperable jurisdictional plans; collation of jurisdictional resource registers; development of hospital decontamination and protective equipment resources; regular exercises and testing of jurisdictional arrangements; delivery of jurisdictional CBRN education and training; and development and maintenance of deployable jurisdictional assets. National elements of preparedness include the structure to facilitate the Health CBRNINC Plan. These include: national level CBRN incident plans mechanisms and arrangements; national CBRN incident resource registers and stockpiles (including those in jurisdictions); regular exercises testing of national CBRN incident arrangements; and encouraging national consistency and interoperability of key national level CBRN incident capabilities. The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection, characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents. The ABLN serves as a first point of contact for all jurisdictional and national issues relating to laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national, jurisdictional and international law enforcement agencies and laboratories. RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility, with the bulk of activities being delivered by jurisdictions. Recovery in terms of the Health CBRNINC Plan includes: identification of resources deployed or consumed in the response (on replenishment of cache); recovery and repatriation of deployed medical teams and their equipment; repatriation of casualties to home jurisdictions; health support for site decontamination; national and jurisdictional operational debriefing and development of post activation report and recommendations; and delivery of mental health services. It is possible that an affected jurisdiction, which has managed a CBRN incident without external support for the acute response, may require health support during the recovery phase. This may be accessible through the Health CBRNINC Plan. RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan. Section 8: MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC. Public information will aim to reduce the potential for mixed messages and to ensure a common, national message to the general public. The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response. Public information about Health measures will be coordinated through the CMO via the NIR. MEDIA COORDINATION Health, in consultation with the AHPPC and CCC, will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC. This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases. In the event that a National Terrorist Situation is declared, the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook). Note: For International CBRN Incidents, DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response. See also Appendix 10 for further information on International CBRN Incidents. Section 9: ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via: inclusion in national exercises such as the ANZCTC capability development program; and inclusion in AHPPC exercises and drills. Health CBRNINC Plan exercises will have the following aims: to educate participating agencies and stakeholders about the Health CBRNINC Plan processes, their roles and the roles of other agencies; and to review Health CBRNINC Plan processes that can be improved or refined. PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC. A major review will be conducted every five years. It will also be reviewed, if required, following activation of the plan or learning’s from capability audits, exercise outcomes, and operations. APPENDIX 1: AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS National Health Emergency Response Arrangements DOMESTIC HEALTH RESPONSE PLAN FOR MASS CASUALTY INCIDENTS OF NATIONAL CONSEQUENCE Severe Burn Injury Annex Criminal and Terrorism Incident Annex Paediatric Annex HEALTH CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR INCIDENTS OF NATIONAL CONSEQUENCE Chemical Guidelines Radiological Guidelines Anthrax Guidelines Smallpox Plan EMERGING ISSUES OF NATIONAL SIGNIFICANCE EMERGENCY RESPONSE PLAN FOR COMMUNICABLE DISEASES AND ENVIRONMENTAL THREATS OF NATIONAL Pandemic Influenza ENABLERS Australian Health Protection Principal Committee National Health Emergency Management Standing Committee Australian Medical Assistance Teams Disaster Mental Health Working Group Public Health Laboratory Network Australian Bioterrorism Laboratory Network Communicable Disease Network Australia Environmental Health Committee National Medical Stockpile National Incident Room National Critical Care Trauma Response Centre Australian Emergency Hospital Response APPENDIX 2: AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees, agencies and other bodies during each stage of the Health CBRNINC Plan activation. AUSTRALIAN GOVERNMENT Australian Biosecurity Laboratory Network (ABLN) The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection, identification and response to biological agents of security concern. The ABLN has representatives from key public health laboratories in Victoria, Queensland, Western Australia and New South Wales (NSW). Also represented are the Australian Federal Police (AFP) Forensic Operations, NSW Police Force Forensic Counterterrorism Laboratory, Australian Animal Health Laboratory CSIRO (AAHL), Defence Science and Technology Organisation (DSTO), Technical and Forensic Intelligence, AFP. Australian Defence Force (ADF) Provide ADF representation on the AHPPC and AMTCG. Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC). Specialist CBRN technical support may be provided from the DSTO. Australian Government Disaster Recovery Committee (AGDRC) Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals, families and communities impacted by a CBRNINC. Plan and prepare for management of the social and community impacts of future disasters or critical incidents. Maintain linkages with relevant Australian Government, state and territory governments and non-government organisations involved in domestic disaster recovery. Provide advice to the Australian Government on lessons learnt in relation to operations, processes and assistance provided following onshore or offshore disasters. Australian Health Protection Principal Committee (AHPPC) National coordination of the health responses emergency operational activity. Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC. Advise on requirements and response capabilities in regard to decontamination, personal protective equipment, hospital beds, specific treatments (e.g. antidotes and antibiotics), workforce, critical care management and operating suite availability, the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN), mental Health (mental Health representative), assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health). Provide advice to Australian Health Ministers’ Advisory Council (AHMAC) on Australia’s preparedness for Health emergencies and approaches to addressing any deficits. Australian Medical Transport Coordination Group (AMTCG) Provide a national coordinated medical transport response for CBRN casualties. Australian Nuclear Science and Technology Organisation (ANSTO) Provide specialist advice on radiation and nuclear, and liaise with other Australian Government and international radiation agencies. ANSTO has deployable response teams to enhance State/Territory capacity. Provision of selected radiation laboratory services. Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) Provide specialist technical and health safety advice on radiation and nuclear matters, and liaise with other Australian Government and international radiation agencies. Convenes the RHC. Maintains the Australian Radiation Incident Register. Maintain and staff the Radiation Emergency Coordination Centre 24/7. Provision of radiation emergency response. ARPANSA has unique technical capabilities such as modelling and mapping, and deployable response teams to enhance State/Territory capacity. Provision of selected radiation laboratory services. Chemical Warfare Agent Laboratory Network (CWALN) Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination. Positive results will be regarded as preliminary and will need to be confirmed by DSTO. Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody. Communicable Disease Network Australia (CDNA) Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance, and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks. Provide policy advice to AHPPC. Maintain close links with PHLN. Defence Science and Technology Organisation (DSTO) In support of Defence and national security, DSTO provides scientific advice, technical and laboratory support. DSTO is a lead agency in the CWALN, provides definitive analysis of samples containing chemical warfare agents. Department of Health (Health) The role of Health is to provide specialist health advice, national leadership and response coordination primarily through the AHPPC, and to liaise with other Australian Government agencies and international agencies such as the WHO. For CBRNINC, Health through the NIR, is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia, including deployment from the NMS if required. Attorney–General’s Department Emergency Management Australia (EMA) The lead Australian Government agency in coordinating Australian Government Department and Agency support for response operations: Monitors all hazards through Australian, state and territory intelligence, security, law enforcement, and emergency management agencies and provides information to all relevant stakeholders. Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC). Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states, territories and other Australian Government departments and agencies. Through the AGD Public Information Cell, coordinates media management activities, including media liaison, public warnings, media monitoring, public information and preparation of joint media strategy. Coordinates Australian Government response to protective or national security threats or incidents. Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team, including liaison through the State and Territory Emergency Operation Centres. Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements. Environmental Health Committee (enHealth) Provides environmental health expertise and support for AHPPC’s emergency management role. Share information and practical resources National Health Emergency Management Standing Committee (NHEMS) May be tasked to provide advice on aspects of operational response to AHPPC. Public Health Laboratory Network (PHLN) Provide a mechanism for early warning and advice on the detection of new, emerging and rare infectious diseases. Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases. Provide strategic advice to AHPPC. Ensure optimal use of existing pathology laboratory resources. STATE AND TERRITORY AGENCIES Ambulance Service Provide initial triage, on site pre hospital treatment and transportation of CBRN casualties, in the ‘cold zone’; Coordinate transport for designated medical teams to the sites of incidents; On site coordination with medical teams; and On site medical support for incident responders. State Health Emergency Operations Centre or equivalent Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity. Coordinate reception of casualties into or within jurisdiction. State Recovery Agency (Human/Community Services Department or equivalent) Provide recovery services. Coordinate or support community relief and recovery activities. State/Territory Health Departments Maintain a list of health facilities and their CBRN capabilities. Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident. Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required. Prepare hospital and other health facilities for mass casualty medical care. Advise on the clinical management of CBRN casualties. Coordinate medical treatment and contribute to national medical coordination through the AHPPC. If needed provide resources and assets to undertake overseas aeromedical transportation, conduct triage and provide immediate care in country as requested by the Australian Government. Advise on management of mental health issues. OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES Australian Red Cross Blood Service (ARCBS) Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident. Manage supply of blood and blood products to jurisdictions. Australian Red Cross and other NGOs Provide recovery services. Provide registration services. Manage financial appeals. Commonwealth Industrial Scientific and Research Organisation (CSIRO) Vaccine development and manufacture. Measurement of DNA damage from accidental radiation exposures. Provide the Australian Animal Health Laboratory, a member of the PHLN. Poisons Information Centres Provide high quality, up-to-date and evidence-based information regarding the risk assessment, management and treatment of human poisoning to the general public and health care professionals. APPENDIX 3: TEMPLATE – GUIDE FOR AFFECTED JURISDICTION AFFECTED JURISDICTION TEMPLATE Exact location of Incident Location of health response command Location of primary health response Site: Local Hospital: Major referral hospital: Type of Incident Hazards/Special Considerations Number of casualties (Estimated or confirmed) Cat 1 (RED) Adult: Paed: Cat 2 (YELLOW) Adult: Paed: Cat 3 (GREEN) Adult: Paed: DECEASED Adult: Paed: Special Requirements (Not immediately available) Response Teams (Pre-Hospital): Emergency Ambulance Officers/Paramedics: Patient Transport Officers: Ambulance General Purpose: Medical: Response Teams (Hospital): Emergency: Medical: Nursing: Surgical/Theatre Medical: Nursing: Intensive Care Medical: Nursing: Burns: Medical: Nursing: Paediatrics Medical: Nursing: Transport Equipment STAFFED BED AVAILABLE NOW TEMPLATE Date: Adult ICU Ventilated: ICU Non-Ventilated: Burns <25%: Burns >25%: General Ward: Paediatric ICU Ventilated: ICU Non-Ventilated: Burns <25%: Burns >25%: General Ward: STAFFED BED WITHIN 24 HOURS TEMPLATE Date: Adult ICU Ventilated: ICU Non-Ventilated: Burns <25%: Burns >25%: General Ward: Paediatric ICU Ventilated: ICU Non-Ventilated: Burns <25%: Burns >25%: General Ward: *ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically ill/injured patients. *ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated, without access to ventilation. AMBULANCE RESOURCES AVAILABLE NOW TEMPLATE Date: Emergency Ambulance Staff Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): Patient Transport Officers Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): Ambulance Operations Managers Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): Ambulance General Purpose Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): *Availability means units that are able to respond whilst maintaining a supply for other demands. AMBULANCE RESOURCES AVAILABLE IN 24 HOURS Date: Emergency Ambulance Staff Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): Patient Transport Officers Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): Ambulance Operations Managers Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): Ambulance General Purpose Units: Unit Composition Officers: Paramedics: Other (e.g. specialisation): *Availability means units that are able to respond whilst maintaining a supply for other demands. APPENDIX 4: RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH Notification to Health contact officer should occur immediately. This notification should be sent to the Health National Incident Room (NIR): t: (+61) 2 6289 3030 (24 hours) f: (+61) 2 6289 3041 e: [email protected] Health will place the NIR on standby. Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation. The affected jurisdiction(s) will prepare an “affected jurisdiction template” prior to the AHPPC teleconference (see Appendix 3). The AHPPC core group can be expanded to include key clinical stakeholders/subject matter experts as required, this includes requesting activation of the AMTCG through AGD EMA. Health through the NIR will actively liaise with other Australian Government agencies. The NIR will continue to gather operational intelligence, develop a list of possible trigger points for escalation, and commence operational planning for discussion at AHPPC teleconferences. AFFECTED (PRIMARY) JURISDICTION The affected jurisdiction will: Continue management of incident; Advise Australian Government of requirements; Teleconference with AHPPC; Requests for assistance to State/Territory Emergency Management Controller; and State Emergency Controller requests tasking through AGD EMA. Continued Management of incident will include: Command, control, coordination and communication (C4) arrangements are implemented to ensure scene management, activation of state Health/CBRN plan, liaison with hospital emergency departments, critical care and trauma service. This will entail establishment of health and ambulance emergency operations centres (EOCs). In a large incident it is likely that the State/Territory Emergency Coordination and/or Operations Centre would also be activated, ensuring a whole of government approach to the incident. The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the state/territory disaster/CBRN plans. This includes the functions of triage, decontamination treatment and transport with the establishment of a casualty clearing station at the scene. The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services. This particularly applies to a CBRN terrorist or security based incident. AUSTRALIAN GOVERNMENT Liaison by the Health NIR (email [email protected] or via phone on +61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation, confirm capabilities. Health will activate the NIR (if this has not already occurred). Health will convene further teleconference(s) of the AHPPC to discuss the incident, provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required. STATES AND TERRITORIES (NOT DIRECTLY AFFECTED) Update bed and equipment status. Identify staff to respond if required (consider using AUSMAT members). Liaise with First Responders. Liaise with locally based patient transport services. Liaise with local specialist capability as required e.g. HAZMAT Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources. RESPONSE PHASE ACTIONS – SUMMARY AFFECTED (PRIMARY) JURISDICTION(S) Continue management of the incident including operational management of assets and staff sent from other jurisdictions. Continue to advise Australian Government of requirements, and to teleconference with AHPPC. AUSTRALIAN GOVERNMENT Via AHPPC and NIR, the Australian Government will receive advice from the affected jurisdiction regarding requirements. The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas. The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event. The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution, the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC. Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres, consistent with the arrangements in OSMASSCASPLAN. DEPARTMENT OF HEALTH Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government. Coordinate deployment of Australian and/or jurisdictional Health assets in support of the CBRNINC. Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG). STATES AND TERRITORIES (NOT DIRECTLY AFFECTED) Advice from AHPPC will assist AGD EMA to coordinate physical assistance from, and to, states and territories that are not directly affected. Assistance, if requested, will be tasked through AGD EMA via the relevant state or territory emergency controller. State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested. Response actions are described in detail in Appendix 4. STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA. This code-word (Stand Down) will be issued by Health through the NIR. The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business. Following Stand Down, formal debriefing processes are to be completed. This could include local, state, and national debriefs. The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan, and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities, by necessity, may still occur once the Health CBRNINC Plan has been stood down, and may be facilitated by the NIR as required. APPENDIX 5: DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release, the appropriate response code (see matrix on page 45) will be declared by the CMO, through the AHPPC and the NIR will be activated. Times of operation for all emergency response centres including the NIR, contact phone and fax numbers, 1800 public information numbers, email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat. Teleconferences will be called at the discretion of the CMO, as chair of AHPPC, or CDNA/PHLN chairs. Media liaison on the incident will be established through the NEMRN, coordinated through Health (also see page 19). AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents, or the threat of a release, the police should be advised immediately by telephone. The release zone should be regarded as a crime scene, and advice sought from police. Environmental samples should be collected by emergency services personnel at the direction of public health authorities and/or police, as outlined in Appendix 5. Detailed instructions are contained within the National Counter Terrorism Committee Suspicious Substances/Packages Assessment Guidelines, September 2011. Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material, and appropriate chain-of-custody procedures put in place. First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated. PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority. A decision as to whether PEP will be offered, and to which groups, will be taken by the state/territory health authority, in consultation with emergency services authorities. Consideration will be given to the nature of the release, accessibility of the exposed zone to the community and other groups (e.g. shopping centres, office buildings or open air sporting venues). An extensive contact tracing exercise may be necessary to identify all exposed persons. Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes. Environmental clean-up and disinfection may be required. FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the state/territory health authority and police should be advised immediately by telephone. Details of the incident or outbreak should be forwarded to the chairs of AHPPC, CDNA and PHLN, who may request an urgent meeting of the AHPPC/CDNA-JEG by teleconference, and the chair of Food Standards Australia New Zealand (FSANZ), who may recommend activation the National Food Incident Response Protocol. All states/territories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions. Where a foodstuff is implicated in the outbreak, urgent consideration should be given to implementing a nationwide recall of the food, using the usual FSANZ procedures. The recall should be given the widest possible publicity by FSANZ, and through media releases and interviews/media conferences coordinated by the NEMRN. The WHO will also be advised promptly by the Australian Government. If the implicated food has been exported to foreign countries, the operational response to the recall will be coordinated through the Department of Agriculture. The countries involved should be advised of the recall as a matter of urgency, through DFAT, on advice from FSANZ. If the implicated food has been otherwise exported (e.g. in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall, together with relevant epidemiological information, such as the dates on which the food may have been consumed. PEP should be offered as indicated to persons who have eaten the implicated foods, and discontinued only if the foodstuff is confirmed as not contaminated. COVERT RELEASE If a covert release of CBRN materials is suspected e.g. one or a small number of cases of anthrax are diagnosed, all state/territory health authorities should be contacted through the AHPPC Secretariat, and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions. Data will be collated and coordinated by the Australian Government through the AHPPC/CDNA Secretariat or the NIR, as appropriate. Information will be provided to the public on the status of the incident and protective measures which should be taken, through media releases, media conferences and interviews with the CMO, CHOs and their delegates. Appropriate technical information will also be provided to professional groups such as medical colleges, police and emergency services agencies. Extensive use will be made of the Australian Government and State health authorities’ web sites, and all communications activities will be coordinated at the Australian Government level through the NEMRN. The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which, under current National Security Public Information Guidelines, must approve all communications activities. If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period / prodromal period prior to manifest illness for the disease, both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government, to enable appropriate epidemiological studies and contact tracing to be undertaken. Border protection agencies (Agriculture, DFAT, DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented. MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0: NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia. JURISDICTIONAL ACTIONS Review laboratory capability, including test availability and validation, staff training, and surge capacity. Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available. Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident. Develop and maintain plans for receipt of activated components of the NMS. Develop and maintain plans and logistical support for rapid distribution of antibiotics, vaccine, antidotes, decorporation agents and PPE as required. AUSTRALIAN GOVERNMENT ACTIONS Regularly assess the inventory of key antibiotics in Australia e.g. doxycycline, ciprofloxacin, amoxycillin. If a vaccine is available, regularly assess the inventory, expiry dates and location of stocks of CBRN vaccine in Australia. Develop and maintain plans and logistical support for rapid deployment of the NMS as required. Develop databases for registration of exposed or symptomatic patients, clinical presentation of patients, prophylaxis or therapy administered and adverse reactions to these, and mortality/recovery. Prepare content for educational materials with the CDNA, ARPANSA or clinical toxicologists as appropriate. Review and update frequently asked question (FAQ) sheets for the public on the signs, symptoms, treatment, and preventive measures including personal hygiene measures. Develop the logistics for distribution of FAQ sheets (e.g. hard copy by mail, email, web sites, and newspaper advertisements). Do not distribute at this stage. Prepare content for posters for hospitals and doctors’ surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination. Do not distribute at this stage. Prepare summary information on case detection, diagnostic testing, clinical management, and infection control for hospitals and doctors’ surgeries. Do not distribute at this stage. Build relationships with key media personnel. RESPONSE CODE 1: CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia e.g. release of CBRN materials overseas and intelligence of threat in Australia, or overt threat from a credible terrorist group or individual. No cases in Australia. Actions as per Response Code 0, plus the following: JURISDICTIONAL ACTIONS Consider vaccination of laboratory personnel at high risk if relevant. On the basis of intelligence reports, decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel, or only those in a particular geographical location, or to defer all vaccination. Participate in teleconferences of the AHPPC, CDNA Jurisdictional Executive Group (CDNA-JEG), PHLN, and other relevant agencies as indicated by the nature of the incident. Activate logistical support for receipt of components of the NMS. Activate logistical support for rapid distribution of antibiotics and vaccines. AUSTRALIAN GOVERNMENT ACTIONS Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues. Health will convene teleconferences of the relevant agencies and authorities. Health will assess the adequacy of NMS stocks, and obtain additional supplies if necessary. Deploy supplies of the stockpile as required to strategic locations as identified by state/territory health authorities. If a vaccine is available, Health will assess the adequacy of vaccine stocks, and obtain additional supplies if necessary. Review and update the summary information on case detection, diagnostic testing, clinical management, and infection control for hospitals and doctors’ surgeries. HIMU will work closely with the Public Affairs Unit of AGD which, under current National Security Public Information Guidelines, must approve all communications activities. Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat. RESPONSE CODE 2: RELEASE IMMENENT Intelligence agencies advise that the release of CBRN materials in Australia is imminent. Actions as per Response Code 1, plus the following: JURISDICTIONAL ACTIONS PHLN, CWALN and ARPANSA / ANSTO laboratories notify clinical laboratories. Clinical and reference laboratories review their ability to respond if a release occurs. AUSTRALIAN GOVERNMENT ACTIONS Health to notify reference laboratories. Clinical laboratories to be notified by PHLN, CWALN and ARPANSA / ANSTO member laboratories. CDNA and PHLN report to AHPPC. Health will participate as necessary in the IDC which deals with national policy and implementation issues. It is likely in this scenario that the Australian Government’s Special Incident Task Force (SITF) will be convened. Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities. RESPONSE CODE 3: OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by state/territory health authorities, or covert release is suspected because, either: one case of human CBRN-related illness without plausible exposure history is diagnosed; or intelligence agencies advise that such an event has occurred. Actions as per Response Codes 1 and 2, plus the following: JURISDICTIONAL ACTIONS Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload. States and territories to initiate logging of data on exposed or symptomatic patients, clinical presentation of patients, nature of prophylaxis or therapy administered and adverse reactions to these, mortality/recovery. Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications. Health will distribute FAQ sheets for the public concerning signs, symptoms, treatment, preventive measures for the identified CBRN agent as required. Distribution by mail, email, web sites, newspaper advertisements. State health authorities notify the local police and Health of new cases where criminal activity is suspected. Liaison with police and security agencies on new suspected or confirmed CBRN-related cases, by telephone in the first instance, followed up with details in hard copy. AUSTRALIAN GOVERNMENT ACTIONS Health activates the NIR. National data to be collated by the Australian Government. Liaise and share relevant data with the Department of Agriculture. Health’s HIMU to activate the NEMRN, establish a national communications centre and invoke the national media response plan Participate in SITF. A suspected covert release of a CBRN material may constitute an act of terrorism against Australia. In this case, the NCTP may be activated. The NCTP outlines responsibilities, authorities and the mechanisms to prevent or, if they occur, manage acts of terrorism and their consequences within Australia. The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories. The response will need to take into account public anxiety and any international dimensions. The scale of the situation may also dictate special cooperative responses. Throughout the response, the primary goals are minimising loss of life, preventing further attacks, and recovery. Report to the World Health Organization (WHO) under the International Health Regulations (IHRs). RESPONSE CODE 4: MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed, or a single release has been confirmed and intelligence agencies advise that a second release is imminent. The decision to go to Code 4 will rest with Health’s Secretary, Deputy Secretary or CMO on advice from relevant intelligence agencies. Actions as per Response Code 3, plus the following: JURISDICTIONAL ACTIONS Manage surge capacity in health-care system. Report on the response and any requirements in AHPPC, CDNA and PHLN teleconferences. CDNA nominated representative informs AHPPC of status. AUSTRALIAN GOVERNMENT ACTIONS Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA. Arrange international assistance if required. Extend more widely education of the public through distribution of FAQs and media advertisements. APPENDIX 6: KEY STAKEHOLDERS Clear roles, responsibilities and lines of communication, both within the states and territories concerned, and between the states and territories and the Australian Government, are required to implement an effective response to a CBRN incident. In essence, the state and territory health authorities are responsible for initial health response to CBRN incidents. The role of Health will include overseeing the national health response, including maintenance of the NMS and (in conjunction with the AttorneyGeneral’s Public Affairs Unit) coordination of the national news media response. The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned. The roles and responsibilities of the Australian and state/territory governments are set out below. Response plans should be complementary to the following Australian Government plans, coordinated from the NIR, the health aspects of which are: National Health Emergency Response Arrangements Australian Government Disaster Response Plan (COMDISPLAN) Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN) Australian Veterinary Emergency Plan (AUSVETPLAN) National Counter-Terrorism Plan (NCTP) National Counter-Terrorism Handbook National Security Public Information Guidelines Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials Specific Australian Guidelines on various CBRN materials The Department of Agriculture coordinates AUSVETPLAN, the national plan for dealing with exotic animal disease emergencies. Health has no operational responsibilities under this plan, but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations. When the incident involves livestock or other animals, the state or territory, Department of Agriculture, primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent. The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally. This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD), which will coordinate a national veterinary response to the incident. The AGD coordinates the plans mentioned at points e, f, and g above. Health has operational, national coordination and media management roles in all these plans. APPENDIX 7: ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures, the guidelines advise the following model, and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event. State and territory plans for response to a CBRN event should give consideration to: hoax assessment and identification of suspicious unidentified substances; developing protocols for reporting to, and requesting assistance from, Health; incident-site management planning, including defining the area of contamination, determining who has been exposed, evacuation of people at risk, containing the agent, collecting evidence and samples, sealing and/or decontamination of the affected area, and confirmation that the area is safe after decontamination; data collection and data transfer for national collation; operational plans for hospitals including surge capacity; decontamination plans; promulgation of infection-control requirements in health-care facilities and the community; laboratory management and surge capacity; processes for requesting vaccine and antibiotics from the Australian Government; the state or territory’s own stock of antibiotics; logistical arrangements for the receipt and rapid distribution of the NMS; media liaison; developing databases including; prophylaxis or therapy administered and adverse reactions to these; clinical presentation of patients; and mortality/recovery register(s) of exposed or symptomatic patients. State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident. AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response, liaise with the international community, give logistic support to states and territories, activate the NIR, and provide leadership in the coordination of national emergency media management arrangements. In a large-scale emergency involving CBRN-related cases, it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies. The lead agency of the IDC or taskforce will be determined at the time of the emergency. Health maintains a stockpile of antidotes, antibiotics, vaccines and treatments to be mobilised to aid in the management of a CBRN incident. The department, in close collaboration with state and territory CHOs or their delegates, will direct the distribution of elements of the stockpile. The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment, which may be deployed to assess and respond to CBRN incidents. The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation. If a national terrorist situation is declared, overall responsibility for policy and broad strategy transfers to the Australian Government, in close consultation with relevant states or territories. This may involve determining overall policy objectives, setting priorities between policy objectives where resources are inadequate, pre-positioning resources, international liaison and determining public communication messages. The Australian Government’s role does not include operational management and deployment of emergency services. The Commissioners of Police, including the Commissioner of the Australian Federal Police (AFP), will determine the command and resourcing of the national police response. In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations. Specific response and management of a CBRN event at the Australian Government level will include: consultation to refine these guidelines with state and territory representatives; assistance to states and territories in coordinating the response, maintenance of vaccine and antibiotics stock levels, and delivery to each state and territory according to the criteria outlined at each code level; assistance to states and territories in provision of training materials; development of databases including: o stock levels and deployment of vaccine and antibiotics; communication of the national status of an event to the media and general public and to the international community through the WHO; o o adverse reactions to vaccine; exposed cases and PEP. APPENDIX 8: MEDIA RESPONSE TO A CASE OF CBRNRELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia, either naturally occurring or from a deliberate release, would generate significant media interest. Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers. The public should understand that a plan is being followed, and be given explanations for the various actions being undertaken. One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions, fears and concerns. In a deliberate CBRN release, media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012. The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak. Coordination arrangements are specified within the National Health Security Agreement. Plans include the activation of NEMRN and close liaison with state and territory governments, health departments and allied organisations that would have a role during such an event. The HIMU also provides media services to the Australian Government’s CMO who would be a key national spokesperson during a CBRN-related outbreak. The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU). The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief. OBJECTIVES In a CBRN-related outbreak, the Health communications strategy will seek to: provide national leadership and guidance to state and territory health and other relevant media teams/officers during the incident; ensure the smooth and rapid distribution of accurate information to the Australian and overseas media, relevant agencies and organisations, and the Australian public as outlined in the National Security Public Information Guidelines; and ensure that public confidence is maintained in the Australian Government’s system to respond to the incident. APPENDIX 9: COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0, it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur. The task is to increase the range and type of CBRN information available to the public, health-care providers, policy makers and the media. Communications should outline how the public-health system will respond, the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions. Pre-prepared media responses directed to those groups might be useful. The HIMU has undertaken such work, in conjunction with national security agencies and the media advisers of state and territory health departments. RESPONSE CODE 1 HIMU, in conjunction with the CMO and relevant national security agencies, will take the lead role in explaining to the media the nature of the heightened threat and the response required. This communication will include strong messages about specific measures that may need to be taken by the general public. HIMU will continue to update Code 0 communication activities. RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line. HIMU will collaborate closely with media advisers in state and territory health departments, particularly in the state or territory where the threat is imminent. HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response, including media conferences and public statements. RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management, and the NEMRN activated at its highest level of response. The national media plan for a response to a chemical, biological or radiological incident in Australia will be invoked, involving national security agencies and state and territory governments. Health will establish a national communication centre, staffed by media advisers from Health and seconded media officers from relevant Departments. The communications centre may be required to operate 24 hours a day and 7 days a week. An advisory team will be appointed, consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit. The national communication centre will respond to inquiries from the media, public and health-care providers. APPENDIX 10: INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical, biological or radiological agents with the potential to cause widespread injury, illness or death. Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect, report and respond to public health events. The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective. Health is the nationally competent authority under the IHR. INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency. ARPANSA is the national competent authority to notify IAEA of events in Australia, and receive requests for assistance. The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA. BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australia's obligations under the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540. CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development, production, stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development, production, possession or use of chemical weapons and requires the destruction of existing weapons. Australia signed the Convention in January 1993 and ratified in May 1994. Australia is an active player in ensuring that the treaty is effective in promoting international security. NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty, the Nuclear Non-Proliferation Treaty, the Convention on the Physical Protection of Nuclear Material, and various bilateral safeguards agreements with a number of countries. THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and chemical weapons, and supports Australian obligations in relation to biological weapons. APPENDIX 11: RELATED PLANS AND DOCUMENTS NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence Severe Burn Injury Annex (AUSBURNPLAN) Criminal and Terrorism Incident Annex Paediatric Annex Health CBRNINC Clinical Guidelines and Plans: Chemical Guidelines Radiological Guidelines Smallpox Plan Anthrax Guidelines OTHER PLANS AND DOCUMENTS COMDISPLAN – Australian Government Disaster Response Plan AUSASSISTPLAN – Australian Government Overseas Disaster Assistance Plan OSMASSCASPLAN – National Response Plan for Mass Casualty Incidents involving Australians Overseas AUSVETPLAN – Australian Veterinary Emergency Plan National Counter-Terrorism Plan National Counter-Terrorism Handbook National Security Public Information Guidelines National Health Security Act 2007 National Health Security Regulations 2008 National Counter Terrorism Suspicious Substances/Packages Assessment Guidelines – September 2011 ARPANSA Code of Practice for Security of Radioactive Sources Comprehensive Nuclear Test Ban Treaty Convention on the physical protection of nuclear material Convention on the early notification of a nuclear accident Convention on assistance in a nuclear or radiological emergency Code of Practice for Security of Radioactive Sources APPENDIX 12: STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS STATE AND TERRITORY HEALTH SERVICES Australian Capital Territory ACT Health Protection Service Email: Telephone: Facsimile: Pager: [email protected] (02) 6205 1700 (02) 6205 1705 (02) 9962 4155 New South Wales NSW State Health Emergency Operations Centre Email: Telephone: Facsimile: [email protected] (02) 8644 8444 (02) 8644 8450 Northern Territory NCCTRC (RDH) NT Health Centre for Disease Control Dr Steven Skov CHO Email: [email protected] Telephone: 0407 877 535 Xavier Schobben – Director Environmental Health Email: [email protected] Telephone: 0401 116 460 Queensland QLD Health, State Health Emergency Coordination Centre Email; Telephone: Facsimile: On Call Officer: [email protected] (07) 3405 6003 (07) 3008 7356 0407 127 126 South Australia SA Health, State Control Centre Email: [email protected] Telephone: (08) 8226 7115 Facsimile: (08) 8463 3820 On-Call Officer Pager Telephone: (08) 8378 9194 Pager # 104930 Tasmania TAS Department of Health and Human Services, Emergency Coordination Centre Email: Telephone: Facsimile: [email protected] (03) 6233 4127 (03) 6233 6392 Victoria Victoria Health Public Health Emergency Operations Centre Email: [email protected] On-Call Officer Pager Telephone: 1300 790 733 Facsimile: (03) 9096 0003 Western Australia WA Health State Health Emergency Operations Centre Email: [email protected] 24/7 On-Call Officer Telephone: (08) 9328 0553 SHEOC (when activated) Telephone: (08) 9222 4444 Facsimile: (08) 9222 2304 APPENDIX 13: SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC. Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry. Early isolation of that physical evidence, with a continuity chain linking it to its place in the scene, is the best result for investigators. In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims. These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal, medical procedures, movement or transport of patients and decontamination of victims. It may occur in the absence of police who would normally recognise, collect and secure the evidence. Whilst the immediate health of injured persons is always the priority of health professionals, consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever. The protocols aim to enhance the amount and quality of evidence that is recovered, with a standardised process and easy-to-follow steps. No formal training in evidence collection is required to implement the protocols. The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves. Labelling the item provides context to the article. Continuity is ensured by securing collected articles: BAG items using standard infection control precautions, changing gloves between patients. If possible, avoid cutting garments through holes caused by weapons or chemicals. Whilst it is ideal to bag each article separately, in mass casualty scenarios it may be simpler to bag all the items from one individual together. Include debris on clothing and bedding, and shrapnel removed from patients. TAG with brief details of who collected it, the time, date, location of collection and a simple description of the item, e.g. ‘trousers’. Attaching a hospital label with a unique patient identifier provides patient details. Identify wet articles on the tag for drying by forensic staff subsequently. SEAL bags to prevent loss, tampering or cross-contamination of articles. SECURE all items that are bagged, tagged and sealed in a designated locked area or under direct supervision. A log of items secured and details of handover to investigators is appropriate. Normal coronial protocols should be observed for deceased persons. Decontamination takes priority in CBRN incidents, but bagged, contaminated effects should be managed as for other evidence that is collected. In a mass casualty scenario, it is probably of greatest value to collect the effects of admitted patients only, and allow the investigators to follow up patients discharged from the Emergency Department. Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units. APPENDIX 14: GLOSSARY/DEFINITIONS Australian (Counter) Bioterrorism Laboratory Network (ABLN) The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection, identification and response to biological agents of security concern. The ABLN has representatives from key public health laboratories in Victoria, Queensland, Western Australia and New South Wales (NSW). Also represented are the Australian Federal Police (AFP) Forensic Operations, NSW Police Force Forensic Counter-terrorism Laboratory, Australian Animal Health Laboratory CSIRO (AAHL), Defence Science and Technology Organisation (DSTO), Technical and Forensic Intelligence, AFP. Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur). Agency A government or non-government agency. Attorney Generals Department Emergency Management of Australia (AGD EMA) The AGD EMA is the agency responsible for planning and coordinating Australian Government’s physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN). The AGD EMA maintains lead agency status for all multi-agency Australian Government coordination, including provision of medical transport through the AMTCG. All Hazards Dealing with all types of emergencies using common principles underpinning the emergency arrangements, as many risks can cause similar problems and similar measures, such as warning, evacuation, medical services and community recovery, will be required. Australian Government Crisis Coordination Centre (CCC) A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster. Tasking recommended by Health and the AHPPC will be actioned by the CCC. The CCC will liaise through the state and territory emergency operations centres. Australian Government Crisis Committee (AGCC) The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange, advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed. Australian Health Protection Principal Committee (AHPPC) Established in 2006 as the peak national Health emergency management committee, with the authority to plan, prepare and coordinate the national Health response to significant incidents. Australian Medical Transport Coordination Group (AMTCG) AMTCG provides a nationally coordinated medical transport response as part of Australia’s casualty response system (including for approved foreign nationals). AMTCG is convened and chaired by AGD EMA. Once convened, AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG. Australian Nuclear Science and Technology Organisation (ANSTO) An Australian Government research organisation delivering radiation advice, scientific services and products. ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor, as well as providing training and equipment calibration. Australia New Zealand Counter Terrorism Committee (ANZCTC) The ANZCTC is a non-operational body established by the Inter-Governmental Agreement (IGA) on Australia’s National Counter-Terrorism Arrangements. The ANZCTC functions as a high level body and is comprised of representatives from the Australian Government, Australian state and territory governments and the New Zealand Government. The objectives of the ANZCTC are to contribute to the security of Australia and New Zealand through: maintaining the National Counter-Terrorism Plan and associated documentation; providing expert strategic and policy advice to heads of government and other relevant ministers; coordinating an effective nation-wide counter-terrorism capability; maintaining effective arrangements for the sharing of relevant intelligence and information between all relevant agencies and jurisdictions; providing advice in relation to the administration of the special fund to maintain and develop the nation-wide capability, administered by the Australian Government on the basis of advice from the ANZCTC. Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise, advice, regulation, leading the development of standards and guidelines, national & international liaison, and research. ARPANSA is also the WHO Collaborating Centre for Radiation Protection, and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN. Australian Safeguards and Non-proliferation Office (ASNO) A division within the Australian DFAT, ASNO ensures that Australia meets its international obligations with respect to the: Chemical Weapons Convention Biological and Toxins Weapons Convention Comprehensive Test Ban Treaty Nuclear Non-proliferation Treaty Convention on the Protection of Nuclear Material Biological Agent A micro-organism which causes disease in man, plants, or animals or causes the deterioration of material. Casualties The human impact of a disaster or emergency presented in the form of numbers of people killed, injured, sick, missing or homeless. CBRN Chemical, Biological, Radiological and Nuclear CBRN incident An incident which involves the deliberate, or threatened release of a Chemical, Biological, Radiological agent or a Nuclear device with potential or actual harm to people or property. Chemical Hazards Hazards involving chemicals or processes which may realise their potential through agencies such as fire, explosion, toxic or corrosive effects. Command Refers to the direction of members and resources of an agency/organisation in the performance of the agency/organisation's roles and tasks. Authority to command is established by legislation or by agreement within the agency/organisation. Command relates to agencies/organisations only, and operates vertically within the agency/organisation. Commonwealth Industrial Scientific and Research Organisation (CSIRO) The Australian national science agency role includes multidisciplinary research in preventative health. This includes vaccine development and manufacture, and measurement of DNA damage from environmental exposures including low level ionising radiation, a tool which may be utilised in accidental radiation exposures. Communicable Disease Network of Australia (CDNA) A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance, prevention and control. CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs. Consequence Management Measures taken to alleviate suffering, damage, loss and hardship, protect public health and safety, restore essential government services and provide emergency relief to governments, businesses and individuals affected. Control Refers to the overall direction of the activities, agencies or individuals concerned. Control operates horizontally across all agencies/organisations, functions and individuals. Situations or incidents are controlled. The NatHealth Arrangements do not relate to the concept of control of the Australian health sector, nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities. Coordination Coordination is the act of managing inter-dependencies between activities. In emergency management, Coordination involves the bringing together of many organisations to pursue a common goal and to share resources, information, expertise and decision making. Crisis Management Deliberate and immediate management for whole-of-government consideration of policy, decision-making and coordination for the prevention and/or resolution of situations/incidents, in order to maintain national security and confidence in government. Chemical Warfare Agent Laboratory Network (CWALN) A network of forensic and other laboratories sponsored by EMA, the National Institute of Forensic Services (NIFS), and DSTO. CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident. Definitive analysis is provided at DSTO. Chemical Weapons Convention (CWC) The Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons and their Destruction. Defence Assistance to the Civilian Community (DACC) The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations. There are three primary DACC categories: DACC Category 1 is assistance where immediate action is necessary to save human life, alleviate suffering, prevent extensive loss of animal life or prevent widespread loss of, or damage to, property in a localised emergency situation. DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance. DACC Category 3 is assistance associated with recovery from an emergency or disaster, which is not directly related to the saving of life or property. Defence Science and Technology Organisation (DSTO) DSTO provides scientific and technical support to Defence and national security operations. DSTO has scientific expertise and laboratory capabilities in CBRN, including modelling. DSTO is a lead agency in the CWALN, providing definitive analysis of samples containing chemical warfare agents. Emergency An event, actual or imminent, which endangers or threatens to endanger, life, property or the environment, and which requires a significant or coordinated response. Environmental Health Committee (enHealth) A standing-committee of the AHPPC that provides nationally agreed Health policy advice, coordinates research, information and practical resources on environmental Health matters. Hazard A potential or existing condition that may cause harm to people or damage to property or the environment. HAZMAT Hazardous materials International Atomic Energy Agency (IAEA) IAEA is the global focal point for preparedness, event reporting, and response to nuclear and radiological incidents. They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies. International Health Regulations (IHRs) An international legal instrument binding on 194 countries across the globe, including all the Member States of the WHO. The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. The IHRs require countries to report certain disease outbreaks and public health events to the WHO. Liaison Officer (LO) A person, nominated or appointed by an organisation or functional area, to represent that organisation or functional area at a control centre, emergency operations centre, coordination centre or site control point. A liaison officer maintains communications with and conveys directions /requests to their organisation or functional area, and provides advice on the status, capabilities, actions and requirements of their organisation or functional area. Logistics The range of operational activities concerned with supply, handling, transportation, and distribution of materials. Also applicable to the transportation and support of people. Medical Assessment Element A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused, timely and accurate communication back to jurisdictions. National Crisis Committee (NCC) The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange, advice to ministers and coordination of ministerial decisions across the Federal, State and Territory governments. National Health Emergency Management Subcommittee (NHEMS) A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context. National Health Emergency Response Arrangements (NatHealth Arrangements) The principle response document of the AHPPC that outlines the strategic authorities, responsibilities, arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence. National Incident Room (NIR) An operational response capability located within Health. The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities, other Commonwealth operations centres and the international Health community. National Medical Stockpile (NMS) Is a strategic reserve of drugs, vaccines, antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident. The NMS, established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO. The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency. The contents of the NMS are determined by health on the basis of expert medical and public health advice. Non-Government Organisation (NGO) Non-profit making organisation operating at local, national or international levels, with no statutory ties with national government Nuclear Safety Committee (NSC) Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities, including the reactor at ANSTO. Preparedness Arrangements to ensure that, should an emergency occur, all those resources and services which are needed to cope with the effects can be efficiently mobilised and deployed. In relation to an emergency, includes arrangements or plans to deal with an emergency or the effects of an emergency. (Source: AGCMF) This may include establishing the plans, training, exercises, and resources necessary to achieve readiness for all hazards, including a MCI from trauma. Prevention Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or, where this is not possible, by putting in place arrangements to mitigate their effects. Public Health Laboratory Network (PHLN) A standing-committee of the AHPPC. A collaborative group of laboratories which have expertise and provide services in public health microbiology, including veterinary microbiology with a human health impact. Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases. Radiation Emergency Medical Preparedness Assistance Network (REMPAN) World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice. ARPANSA and Peter MacCallum Cancer Centre (PMCC), Melbourne together are one of 13 WHO Collaborating Centres. The role of PMCC is to provide medical advice for Australian REMPAN activities. Expert radiation medicine advice is obtainable in all states from local radiation oncology centres. Radiation Health and Safety Advisory Council Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues, community concerns, recommendations, policies, codes and standards. Radiation Health Committee (RHC) Provides advice on radiation policy, including draft standards, to the ARPANSA CEO and the Radiation Health and Safety Committee. Recovery In relation to an emergency In relation to an emergency, the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional, social, economic and physical wellbeing. In this document, refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area. Response In relation to an emergency, the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological, social, economic, environmental and physical wellbeing. Executing the plan and resources identified to perform those duties and services to preserve and protect life and property. Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards, communities and the environment. Risk Assessment The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards, target risk levels or other criteria. Risk Management The systematic application of management policies, procedures and practices to the tasks of identifying, analysing, evaluating, treating and monitoring risk. Security Sensitive Biological Agent (SSBA) Regulatory Scheme The SSBA Regulatory Scheme is administered by Health. The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents. It also provides standards for the handling and transport of samples from affected animals or persons. The Scheme builds on Australia's obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540. Standing Operating Procedures Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans. State/Territory Control Centre A dedicated (health) control facility from which a state/territory response will be coordinated. Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction. Triage The process by which casualties are sorted and prioritised according to their need for firstaid, resuscitation and emergency transportation and definitive care.
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