 EMERGENCY MANAGEMENT OF LIVESTOCK DISEASE 1. PREPARING FOR EMERGENCY DISEASES Dr Peter Harper FAO Veterinary Field Officer, FMD Task Force, Bicol Email: [email protected] |
EMERGENCY MANAGEMENT OF LIVESTOCK DISEASE 1. PREPARING FOR EMERGENCY DISEASES Dr Peter Harper FAO Veterinary Field Officer, FMD Task Force, Bicol Email: [email protected] |
Introduction to the Emergency Management Concept
Emergency Management Principles
PPRR = Prevention; Preparedness; Response; Recovery
Being Prepared is Having an Efficient System of Disease Surveillance
The Emergency Management Operations Approach
The Five C's :Command; control; coordination; communication; cooperation
The importance of Briefings and SITREPS
SMECA = Situation; Mission; Execution; Control; Administration
Effectively dealing with an emergency situation is a complex process that requires rapid deployment of an effective and disciplined response team under dynamic leadership. In the early stages of an emergency situation, there is frequently incomplete information available, however it is imperative that the most correct decisions are made rapidly, contingency and action plans implemented, sufficient resources allocated and appropriate staff mobilized, so that the impact of the disaster can be minimized.
Whilst animal health emergencies such as an outbreak of an exotic disease have unique challenges, they share many common features with any disaster response, such as an earthquake, typhoon, ferry sinking or plane crash. The Philippines authorities have had a lot of experience in responding to these situations, however exotic disease outbreaks in livestock are probably not usually considered in the same category here. Australia (and several other countries eg Hong Kong) have developed efficient systems for dealing with such threats, as demonstrated with the recent successful eradication of both exotic Avian Influenza in December 1997 and Virulent Avian Newcastle Disease in September 1998 in NSW.
This paper will present many of the concepts, discuss some of the issues and introduce parts of the terminology involved in emergency management pertaining to exotic animal disease, illustrating the role of emergency management planning in Foot and Mouth Disease preparedness. It is suggested that the Philippines animal health authorities develop a conceptual framework for and adoption of the principles of exotic disease planning at the LGU, Provincial and National levels.
Preparing for an exotic disease emergency should involve a similar systematic approach as applied in other emergency preparedness situations, best summarised as the PPRR approach:
Prevention of livestock exotic disease emergencies requires both a powerful and effective system of quarantine to minimise the risks of introduction of a disease agent, and a rapid and efficient system of disease surveillance, so that suspected exotic disease outbreaks are quickly identified and accurately diagnosed, allowing an urgent response. Presuming the successful control and eradication of the current FMD calamity, there is a real risk of reintroduction of such a highly contagious agent, particularly when incidents such as the recent illegal partial release of impounded pork from Taiwan can occur. A review of current procedures and legislative support may well be appropriate in the Philippines, with the aim of strengthening preventative measures that could reduce such risks. It is also likely that the currently available animal health surveillance system could be strengthened, improvements in field to laboratory coordination for diagnostic confirmation or exclusion be expected and more rapid reporting of disease outbreaks to the national authorities be achieved.
Preparedness for a disease outbreak such as FMD, has been ongoing for many years in countries such as Australia and has involved development of detailed contingency plans which document resource availability and detailed action plans for the emergency disease (eg Ausvetplan), improved legislative support (eg Exotic Disease of Animals Acts) and extensive national training programs (eg Exandis Training and Disaster Management Schools). There are many steps to achieving the aim of a better trained team of people capable of an efficient response to an exotic disease emergency. Initially it is a requirement that livestock industry leaders convince the community that exotic livestock disease is a national cost, and translate this into government support for prioritising emergency planning and training. Such training could include modules such as: disease diagnosis, destruction, disposal, disinfection, compensation valuation, communications, map reading, emergency center control operations, emergency planning, disease control exercises etc.
Response to an exotic disease should be a process of invoking the preparedness and planning that has already preceded. If the preparedness has been effective, the personnel involved should already know their roles and have a clear picture of their responsibilities. Emergency response plans should not only include individual disease response strategies, but also include statements of duties for each position in the response team and have nominated and trained appropriate staff for each position; preferably backup staff should also have been identified and all staff tested in their roles. It is critical that participants at the disease control centers such as the National Disease Control Center (NDCC) and Local Disease Control Center (LDCC) have experience in information management, as important early decisions such as the extent of the Restricted Area (RA), Control Area (CA), Protected Area (PA) and Buffer Zones (BZ) and correct designation of the Infected Premises (IP) and Dangerous Contact Properties (DCP), will ultimately determine the effectiveness of the response. Another major issue is the level of implementation of the disease control strategy. When the current FMD O strain is eliminated from the Philippines, part of the planning to prevent it becoming established again should it be reintroduced, would be to consider immediate "stamping out" with depopulation of infected premises, preferably with compensation payments to affected owners.
Recovery is a process that has assumed increasing importance in recent years as we recognise the powerful impacts that disaster situations have on both the victims and the personnel involved in the response. Dealing with misinformation in the media by proactive media management can alleviate much of the fear that is generated in the early stages of a response, particularly where the livelihood of people is threatened, there is an initial rejection of products from the species affected (eg pork in th ecurrent FMD outbreak, beef in the BSE outbreak in the UK), and dramatic scenes of animal destruction have been presented by the media. However more importantly is the involvement of agencies and personnel from social support groups (eg medical, church, family and community support etc) capable of providing the individual psychological support for people traumatised by the events.
The recovery process requires rebuilding the confidence of trading partners and local, provincial, national and international livestock industry participants, plus the general community. This is best achieved by demonstration of the efficiency of the lead agency (eg BAI) in dealing with the emergency and early positive evidence that the immediate response has been effective.
Note that those selected to operate in the "pressure cooker" atmosphere of an LDCC or NDCC, the experience can be extremely demanding due to the massive information "overload" in the early stages. This can be very stressful and adequate provision for staff needs (rest, meals etc) and their timely replacement (5 days is considered a maximum without replacement) is required to maintain efficiency and avoid "failure".
Effective disease surveillance at the national level requires the systematic observation, recognition, diagnosis, recording and reporting of disease. If this is not happening smoothly, quickly and efficiently with the endemic diseases of importance, then can we expect it to suddenly happen with an "emergency disease" ( particularly as many exotic disease are initially considered as part of the normal background of disease and misdiagnosed for a period)?. Certainly the speed and adequacy of detail of reports of FMD can be improved and we have taken considerable steps to facilitate this (eg vehicles, cellular phones, equipment kits). It is disappointing that delays between the initial recognition and reporting of FMD are still substantial in some instances, and the completed disease investigation report forms are scant in detail and description. Elements of systematic disease investigation will be discussed, with a focus on arriving at a considered mophological differential than astrological diagnosis, plus detailed risk assessment of the implications of the outbreak.
Professional credibility demands instant action for a serious disease such as FMD with the objective of obtaining all the relevant epidemiological information possible so that the outbreak can be properly controlled. Alarmingly, we hear of outbreaks of FMD that have provoked little more than the issuance of antibiotics and a thinly worded report sheet indicating an FMD diagnosis. Each investigation is an opportunity to learn and should excite the "detective skills" of the investigator as he or she tries to piece together the facts that led to the appearance of the outbreak, so that an informed control procedure can be put in place.
Disease investigation philosophy is a process of conscious learning , leading the way to improved knowledge. It is all about accurate observation and recording, and as Goethe stated:
Thinking is more interesting than knowing but less interesting than looking.
| A thorough clinical, pathological and epidemiological examination should lead to both a morphological diagnosis or disease description summary, a differential diagnosis of disease possibilities and an epidemiological synopsis of the significant facts which contributed to the disease outbreak. For example, a typically positive FMD case in a backyard piggery could be reported as: Specimen collected from a 4 month old grower male pig, displaying acute(subacute, chronic) mild (moderate, severe) locally extensive (focal, diffuse) vesicular to necrotising (non-suppurative, suppurative, granulomatous etc) epidermitis of the snout and coronary band, with a single vesicle up to 3 cm diameter on the snout and hyperaemia and early vesicle formation up to 1.5 cm diameter on the anterior aspect of the coronary band of all feet. Only animal affected of 3 at risk. Owner fed uncooked restaurant swill 3 days ago. Source of swill identified and other contact farms and carrier traced, with isolation, surveillance and disinfection occurring currently. Affected pig destroyed and burned and unaffected pigs isolated. All pens and feeding equipment, etc disinfected with soda ash and clothing washed. Owner instructed in improved hygiene and to prevent visitors from access to piggery |
This is a only brief introduction to the complex subject of disease investiagtion and diagnosis, however outlines a systematic approach that will hopefully assist the veterinarian to more accurately observe and record the pieces of the puzzle that fit together to arrive at a satisfactory conclusion to a disease investigation. Even the most experienced of veterinarians should wisely and regularly seek the counsel of colleagues, laboratory tests, textbooks and other literature and computer programs to assist them in the learning process we call disease investigation, and so continue the development of their skills as veterinary scientists.
The optimum management of an emergency response should involve interaction with staff from a multitude of agencies (eg police, disaster response groups), some of whom are better trained through experience of emergency situations. To facilitate this, Australia has developed a system of Local Emergency Management Committees (LEMC) and District or Regional Emergency Management Committees (DEMC) so that the people from these different agencies meet regularly and develop response plans together that maximise the skills and resources of the agencies involved. For example it is necessary that animal health personnel responsible for establishing an LDCC ensure that the local providers of telephone services are able to quickly resource a sophisticated system of telecommunications that allow multiple calls and faxes to occur simultaneously.
The lead combat agency for any particular disaster is charged with developing the contingency plan for each emergency eg the police may well be the lead agency for managing an environmental disaster, however animal health authorities are intimately involved as a secondary agency, particularly when animals are affected (eg provision of feed to animals stranded by floods). The lead combat agency for an exotic animal disease outbreak would be expected to be the BAI of the DA. Note that the Memorandum of Agreement for FMD Control and Eradication (Annexes F and G, National Plan for the Control and Eradication of FMD in the Philippines, 1996) documents the roles of numerous agencies in support of the program. At the National level is included the:
� Departments of Science and Technology,
� Interior and Local Government,
� National Defence,
� Philippine National Police (PNP),
� University of Philippines,
� National Hog Raisers Association
� At the regional level is included the DA, NMIC, DILG, PNP, PNP-Aviation Security Command, Philippines Information Agency, Department of Education, Culture and Sports and the Agricultural Training Institutes.
2. EMERGENCY MANAGEMENT OPERATIONS
The officers required to set up the command center for an exotic disease emergency (eg LDCC) should utilise the FIVE C's in their management approach:
Command requires designated authority and staff of or associated with the lead combat agency should understand this clearly from the previous planning process. Appropriate structures (eg legislation) should have been implemented to immediately clarify any confusion that might normally exist in day to operations eg the PVO's and MVO's in an emergency disease could be directed by the lead combat agency (eg BAI) through the Director or Chief Veterinary Officer rather than their normal chain of command to Governors or Mayors. It is the role of the commander of the lead combat agency to ensure that the planning arrangements are implemented and the resources of other agencies required are harnessed.
Control also signals the need for "direct line" management with the OIC (Officer In Charge) of the LDCC designated the Controller. Many institutions have moved to a "flatter" or level playing field in their management style, however fighting an emergency disease is fighting a war and to be a winner requires defined leadership and responsibility with control of all decisions made, money spent, animals destroyed, media released, staff employed etc. With FMD it is worth noting that the infected pig is a massive " virus factory" and the longer the delay in destruction and disposal, the more virus released to the environment.
Coordination is essential, none more so in getting the resources and assistance of the cooperating agencies required in the response. In an ideal world the process of Emergency Management Liaison will have paved the way for this to happen, and Memoranda of Agreement will already be in place. However such planning is by necessity a framework only and coordinated meetings at the highest levels are often necessary to get interagency support happening. With FMD, industry groups will need to be involved early as the tough decisions will impact adversely on individuals, such as a few infected commercial piggery owners where stamping out means whole herd slaughter. Compensation arrangements should have been predetermined in principle in the planning process.
Communication is the "nuts and bolts" of an emergency operation and clear lines of communication between the field teams; laboratories and control centers should be established immediately. Inevitably there will be a system "failure" such as delayed or inconclusive test results or specimens lost in transit, good communication can minimize the impact of such incidents. Also, many tasks may require using personnel from other agencies, who do not possess the background knowledge to make, informed decisions in unclear situations; their special needs should be tactfully communicated. This is of importance in FMD when operational staffs are dealing with a highly contagious agent and have limited understanding of the risks they pose to the further spread of the disease.
Cooperation is the tool that tightens the bolts and makes the control center "buzz"; energy levels can be palpable when things are running smoothly. If the right staff have been selected and adequately trained, cooperation readily develops as people focus on a common task.
An adequate site for the LDCC or NDCC will have been determined as part of the planning process, and it should be a large open room that is able to be converted quickly to a communications center, with state of the art telecommunications. Any partitioning should be for notices only and not interfere with free communication between sections; individual offices are not preferred.
Emergency management in the LDCC is best facilitated through a defined system of direct line management, with officers reporting through the Manager of their section to the Deputy Controller, who reports to the Controller who is in-charge of the overall operations of the LDCC. The Controller is in frequent communication with the head of the NDCC who is usually the Chief Veterinary Officer or his appointee.
The LDCC should have the following 5 sections:
So who should be tasked to the control center? Australian experience has shown that personnel to lead these sections should be chosen carefully for their leadership qualities and although veterinarians are essential for the VI Section, they may not necessarily be the most appropriate leaders for other sections where practical "on the job skills" are required. For example an experienced piggery operations manager may be most appropriate to lead IPOPS whilst RAMS could be led by a very experienced quarantine officer or animal technician for an FMD outbreak in the Philippines, however literacy and communication skills are critical competencies for such people. Media and Admin should be led by people who do these tasks as a regular part of their employment and have the skills to operate efficiently under pressure.
Essential to strong leadership and development of a disciplined "teamwork" approach by staff is a sense of "ownership" of the operation by all involved. This should commence immediately a new staff member arrives. The Admin section should dedicate staff to cater for the "housekeeping" needs of personnel and also attend to an initial briefing covering both an outline of the emergency situation and what the roles and responsibilities of the new arrivals are. Coordination of replacement staff is also a priority and it has proven essential that at least half a day "handover" time is necessary to bring the replacement up to speed.
In most emergency operation control centers, there is so much to be done that Managers are too busy attending to "ad-hoc" meetings and preparing briefing notes to properly brief new staff and delegate individual tasks. Therefore a 2IC; second in command should be appointed that can be relied on to do these functions and keep the section Manager fully informed, plus be sensitive to the need for support staff to feel intensely involved.
A major issue in control centers is the realistic intrusion of VIP's and media that have to be attended to immediately; this requires the Media section to develop a public relations policy and clear lines of responsibility so that a consistent and appropriate message is delivered. It is essential to keep control of public perception by proactive media management.
Accurate record keeping is important in emergency situations as significant decisions may have to be made in quickly assembled meetings using rapidly written notes of telephone conversations or verbal reports. It is a truism that every time a story is passed from one person to the next, it is changed to an alarming extent, with loss of detail and substituted embellishment, so that in a few short passes, the facts can become horribly twisted. Recording information as presented becomes critical for the decision makers and so to protect your credibility, write it down immediately and check it!
Thus develops the real challenge of emergency management, that is, information processing and storage and naturally, transfer to other persons and into hopefully positive change.
Thus critical to an effective emergency response is an efficient method of information management; data must be filed in an easily retrievable fashion and constantly updated. For example a responsibility of the VI Section in an exotic disease outbreak is to maintain a sufficiently large map to record the visual geographic spread of the disease as IP's, DCP's, RA's and CA's are designated. These should also be an adjacent whiteboard with listings of properties and critical information (e.g. number affected, at risk, contact numbers, etc). As further information is reported and submitted for logging in and updating the written individual property files it is also recorded by the designated "information officer" whose task it is to keep the map and white board relevant and accessible to people from all sections. Thus a report confirming that a DCP is now an IP would be recorded in at least 3 sites.
Briefings between the NDCC and LDCC and of all staff involved should be conducted at least twice daily, and contain a report from the Manager of each section. This is best preceded by a within section meeting to ensure that all the relevant developments are shared and reported.
The initial and subsequent briefings should be in the form of a progressive Situation Report (SITREP). The extent of the SITREP can vary depending on the needs of the audience, however for those not used to preparing them, they are best designed using the SMECA FORMAT. SMECA defines the essential steps to establishing an effective response and ensures that staffs are clear about what they are required to do. The section leaders should regularly report developments through the Deputy Controller so that the SITREPS are accurate and informative.
In a new outbreak of FMD, the Situation statement will define the event to that point in time such as a description of the extent of the outbreak.
The Mission statement will outline the aims of the response, such as the rapid elimination of the infection.
The Execution statement will provide the details of the response approach, such as the definition of the RA and CA and plans and progress in destruction, disposal and disinfection in the IP's and determination of the status of DCP's etc.
The Control statement details the steps in place to keep the operation functional e.g. updates on management of each section.
The Administration statement is primarily concerned with resource management, particularly financial and staffing requirements.
Whilst there exist many differences in the Philippines animal health system compared to that of countries such as Australia that present enormous challenges for emergency livestock disease management, the above concepts and principles are common to any situation that demands rapid implementation of disease control methodologies. Specific disease and operational differences should be built into all planning documents including the FMD Disease Strategy action plan of PHILEMPRES (Philippines Animal Disease Emergency Plan).
Consideration of the issues raised in the above discussion could provide a valuable framework on which to build a system of emergency animal disease management for the future development of the Philippines livestock industries. Conversely, failure to address the issue will leave the Philippines at great risk that any future exotic infectious agent entering the country will become established, and potentially cost the Philippines economy countless millions of pesos and a prolonged exclusion from world trade in livestock and their products. Successful implementation of such a system of exotic disease preparedness could ensure that the Philippines leads other ASEAN countries into a new era of livestock animal health management, particularly on this eve of the new millenium.