Health risk. Activities
The health risk emerges every time critical situations possibly affecting human health are created.
In ordinary circumstances, the planning phase of emergency medical rescue responses and the preparation of awareness-raising activities on how to behave in case of risk are important. During emergencies, rescue procedures provided in municipal, provincial, and regional plans are activated.
Since 2001, the Civil Protection Department has issued guidelines to enhance the organization of rescue efforts and emergency assistance. The initial directive, titled "General criteria for organizing rescue work in catastrophes," was released in 2001, followed by the document "General criteria for medicines and medical devices to be kept in a first aid post.
In 2006, the Department created an internal document addressing the most sensitive issue in emergency management: psychological and psychiatric care during a major disaster. Titled "General criteria for psychosocial interventions in catastrophes," it identifies common goals and organizational schemes.
In 2007, the directive "Procedures and forms of medical triage" was published, establishing protocols for categorizing patients by severity and treatment priority in the event of a disaster.
In 2011, the National Health Service evolved into a regional organization, and operational guidelines were published to provide general directions for activating Regional health modules. In 2013, a directive was issued to set up field medical facilities called "Pass - Posto di Assistenza Socio Sanitaria" to meet the population's healthcare needs during a disaster until regular health services are restored. Additionally, in 2016, a directive established CROSS - Remote Centre for Health Rescue Operations and identified Regional Health Referents to be activated in case of a national emergency.
In addition, the Department, in cooperation with the Europe Consulting cooperative, leads the Abili a proteggere project to keep the focus on rescue and assistance to people with disabilities in emergencies and foster preventive interventions in this field.
Predicting health risks is difficult as they often follow other emergencies and disasters. That's why planning medical and psychosocial responses during quieter times is crucial. This helps reduce response time and prevent or limit harm to people.
Gaining practical experience in civil protection allows us to test emergency medical procedures and evaluate the effectiveness of camp facilities during emergencies. Informing and educating the population also helps with prevention by reinforcing the necessary actions to prevent and manage emergencies, mitigating their damaging effects.
Emergency planning. The "General criteria for medical assistance in catastrophes" are the instruments the Civil Protection Department uses to operate emergency medical assistance, even though the regional health systems are left with their organizational autonomy. These criteria establish the emergency plans for events that local systems can deal with and those exceeding their responsive capacity requiring the coordination of the National Service.
Local bodies are responsible for identifying the risks mainly affecting their territory to improve the organization of medical assistance and determine the possibility of risks associated with the principal risks, e.g., epidemics, accidents with loss of radioactive or dangerous materials, etc. A close study of the territory shows that various consequences, such as effects on people or places at risk of potential secondary disasters, can already be predicted in response planning. The variables of specific interest to characterize disasters are frequency, intensity, territorial extension, duration, seasonal factors, rapidity of occurrence, and possibility of forewarning.
Local authorities are responsible for identifying the main risks that affect their area. This helps improve the organization of medical assistance and assess the potential risks, such as epidemics, accidents involving radioactive or hazardous materials, and more. By closely studying the territory, it's possible to predict various consequences and plan responses, such as the effects on people or places at risk of secondary disasters. To characterize disasters, specific variables of interest include frequency, intensity, territorial extension, duration, seasonal factors, rapidity of occurrence, and the possibility of forewarning.
At the European level, the Civil Protection Department develops and maintains "civil protection modules," which are standardized intervention units made up of people and resources from the Member States. These modules aim to standardize and improve the efficiency of civil protection interventions across the Member States.
Exercises. Civil protection exercises are an excellent opportunity to test emergency rescue procedures and the functioning of emergency facilities.
Information and communication. The information and education initiatives for the general public play a crucial role in prevention as they help reinforce effective behaviors to handle emergencies and minimize their harmful impacts effectively. Information activities are also vital in enhancing awareness of risks within a specific area to prevent and reduce potential adverse effects on health.
The health intervention during an emergency encompasses all necessary actions for ensuring people's safety and public health and is a part of "disaster medicine."
The Civil Protection Department has established specific criteria for organizing health rescue and psychosocial interventions during emergencies. These criteria outline the targets and procedures for all actors involved in emergency scenarios. The documents describe the procedures for rescue and relief in both "limited effect events," which can be managed by local bodies, and for events that exceed the response capacity of local structures, requiring intervention from the Department.
Advanced medical post (PMA) and regional health modules. The key component of the medical response chain in limited disaster situations is the PMA - advanced medical post. The establishment of this structure is outlined in the "General criteria for organizing medical rescue work," and its operations are specified in the 2007 Directive on medical triage. In 2011, they were referenced in the Directive on the activation of regional health modules, which regulates the operational guidelines for coordinating regional health facilities involved in disaster response. The health modules are "health task forces" prepared and equipped to travel and operate independently for at least 72 hours. Each module is equipped with at least one Advanced medical post (PMA) staffed by experienced emergency-urgency medicine physicians and nurses. This directive was drafted by the Department to establish a "national mobile health force" that could be rapidly deployed to support the Health Service in regions affected by major disasters.
Following the 2009 Abruzzo earthquake, the Civil Protection Department reorganized the national system for urgent medical rescue in case of a disaster, drawing on the experience gained during the earthquake response.
Socio-health care facilities (PASS). An emerging need has arisen to set up field facilities to replace the unfit polyclinics and ensure effective primary social health care for the general population. In addition to the Advanced medical posts (PMA), which are no longer helpful within a few days, the Socio-health care facilities (PASS - Posto di Assistenza Socio Sanitaria) were established by the Directive of the President of the Council of Ministers of April 6, 2013.
Svei Card. After the Abruzzo earthquake, a new tool called the Svei Card was developed. This tool assessed the immediate needs of the most vulnerable people affected by the emergency. It was first deployed during the earthquake in Central Italy, and the regions of Lazio, Marche, Umbria, and Abruzzo proved it effective.
Remote Centre for Health Rescue Operations (CROSS). The latest significant step in reorganizing the national system for urgent medical rescue in the event of a disaster was the Directive on the identification of the Remote Centre for Health Rescue Operations for the coordination of urgent medical rescue and Regional Health Referents in the event of a national emergency published in the Official Journal on August 20, 2016. The Head of Department is authorized to activate the Cross to facilitate the operational link between the needs of the affected territory and the availability of health resources from the components and operational structures of the National Civil Protection Service.
This is the phase of rehabilitation and gradual return to everyday life. If local health facilities are still unsafe at this stage, they may be temporarily replaced by field structures designed to operate for medium to long periods, such as field hospitals or medical clinics. This ensures that the population continues to receive regular assistance from the health system.
Besides ensuring continuity of care in the post-emergency phase, providing psychological and psychiatric care for the community is crucial. At this stage, the psychological and social impacts of the disaster become evident, which can affect the adaptability and responsiveness of individuals and groups.
To help individuals return to their regular routines, psychosocial team members work on reinstating previous social networks and forming new ones. They also engage the community in various projects such as awareness campaigns, educational initiatives on risk management, and projects for children and teenagers.
In addition, operators facilitate access to health and social services, provide records of people who have been provided with emergency care and interventions, and make available information on individual and collective risk and vulnerability factors.