6th International Disaster and Risk Conference IDRC 2016 Integrative Risk Management - Towards Resilient Cities. 28 August - 01 September 2016 in Davos, Switzerland

1. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Counterterrorism Hospitals
Preparedness and Response.
An Italian Pilot Project.
A.Rossodivita1, M.R Gismondo1, C. Picco2, A. Zoli2, G.
Rizzardini1
1Luigi Sacco Academic Hospital, Milan Italy
2 AREU – Regional Emergency Medical Service Company of
Lombardia , Italy
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2. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
GTI report 2016
32685 DEATHS
IN 2014
80% INCREASE
>11 COUNTRIES
IRAQ
NIGERIA
AFGANISTAN
PAKISTAN
SYRIA

3. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Percentages of People in Western Countries-
Domestic Islamic Extremism 2005-2015
GTI Report 2016

4. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
TE-SAT 2016 TERRORISM REPORT

5. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Attacks in Western countries accounted for a small percentage incidents,
representing 4.4 per cent of terrorist incidents and 2.6 per cent of deaths over
the last 15 years , until 2015. In 2015 – 2016 years we assisted in a progressive
escalation on terrorist attacks in Europe due to ISIS/ISIL attacks , starting from
France , and Belgium of particular concern. The four large attacks listed above
make up 91 per cent of deaths from terrorism in the West during this period
FRANCE 2015
148 DEATHS
350 CASUALTIES
TE SAT 2016 REPORT

6. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
CBRNE
To date terrorists and criminals seem to remain interested in using weapons that are
easily available, not too complex to operate, and which have direct and lethal effects.
These three factors – availability, uncomplicated knowledge and effectiveness -
encourage terrorists to use conventional firearms and explosives.
Although CBRN materials remain highly attractive to terrorists, they are difficult to
acquire, transport, handle and deploy without particular scientific knowledge and
technology.
Nevertheless, several incidents in 2015 involved the actual or attempted malevolent
use of CBRN materials with criminal or unknown intentions. In recent years, jihadist
terrorists and their sympathisers have regularly expressed threats involving CBRN
materials in their propaganda.

7. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
TERRORISM
Non Conventional Terrorism
International terrorism has
crossed many boundaries , both
geographic and ethical, since the
attack on World Trade Center in
2001, the dispersion to antrax
through the American mail
system, the terrorist attack on
Tokyo’s underground
transportation system in 1995,
had provided an important lesson
regarding the use of non
conventional and specifically
chemical and biological terrorism.
CBRNE
Chemical , biological, radiological
, nuclear and explosive (CBRNE)
incidents are low frequency ,
high impacts events, and are
encountered rarely in clinical
practice until now, but the new
terrorist attacks in Europe ,
increasingly frequent, aggressive,
unpredictable impose to first
responders and receivers of
victims to must be competent to
manage these scenarios.

8. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
HOSPITAL PREPAREDNESS AND RESPONSE
• TREATMENT LARGE NUMBER OF CASUALTIES
• RECOGNITION OF NON CONVENTIONAL ATTACKS
• EARLY DETECTION
• RAPID RESPONSE
• DECONTAMINATION
• IMPLEMENT HOSPITAL PLANS
• BED SURGE CAPACITY
• ……

9. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
HOSPITAL SENTINEL PROJECT
Actually in Italy few hospitals are really ready to response
in case of terrorist attacks to population, especially in the
field of non conventional agents, such as Biological,
Chemical, Radiological, Nuclear and Explosives
(CBRNE).The aim is to prepare a specific terrorism task-
force inside all Emergency Departments able to prepare
and train physicians and nurses in case of terrorism
attacks to the population, and to prepare hospitals to be
ready in 30 minutes after a declaration of a terroristic
attack from EMS.

10. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Lombardia District- EMS Service

11. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
BIO –Haza HOSPITAL SENTINEL PROJECT
AREU and Luigi Sacco Academic Hospital as National Referral Center for Bioterrorism
and Infectious Diseases Emergencies
to prepare a strong hospital preparedness and response to counter possible maxi-
emergencies, arising from non-conventional terrorist attacks, in particularly from
biological and chemical risk (biological, chemical and Radiological BCR)
to respond to possible" Infectious EMERGENCIES or BIO-TERRORISM attacks", and or
possible chemical attacks or "TOXIC TRAUMA".
to respond in an innovative and dynamic manner to such emergencies

12. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Hospital’s Network
The idea is to create a
"network of hospitals and
people”
To create an integrated
inter-hospitals Task Force
on counterterrorism , that
should also interact with all
institutions involved in the
fight against terrorism
Real time information,
effectiveness on specific
response and preparedness
and simplicity should be
the keys of this project.

13. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Prepare more resilient and safe hospitals is the aim of this
project to better protect population
Children safety

14. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
BIOHAZA HOSPITAL SENTINEL PROJECT 1
• Hospital safety practices, procedures and proper use of containment
equipment and isolation in biosafety; high containment infectious risk;
• Guidelines on Trauma TOXIC (conventional & non -conventional from
chemical trauma, toxins, or biological risk);
• Civil and military cooperation models
• Principles of MILITARY tactical medicine used on the battlefield
• Applications of new tools on Information Technology (IT), using specific
App created to communications during emergencies, and disasters to
support EMS and population,
• Telemedicine system to assist in remote , specialists operating within the
Emergency Department, to guarantee communication with other hospitals
in real time, to collect and share more informations on victims, medical
treatments, resources, bed surge capacity in very short time

15. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
BIOHAZA HOSPITAL SENTINEL PROJECT 2
• Creating specialized medical centers of Lombardia, particularly in the
metropolitan area of Milan to fight against bioterrorism and chemical
risks, which can operate in conjunction with all the institutions
involved in the fight against terrorism
• Referral Center for the Lombardia Region for early warning and
detection ALERT / Detection
• Specific Hospital training courses
• Field Hospitals deployment for CBRN.
• Maintaining ongoing relationships with international institutions
involved in this area (World Health Organization WHO, ECDC, CDC,
etc).

16. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
CONCLUSIONS
Terrorism acts because his actions happen when and where they are not
expecting. Often occurs and acts as an "epidemic", due to a disease caused
by natural causes; no one can predict when and how it will happen, who
will strike and manner of expression and transmission, severity and impact
on the surrounding environment.
The experience of living in this constant uncertainty has been and will be a
stimulus and challenge to seek new ways to protect population, to better
treat victims, to identify new form of civilian and military cooperation in
order to obtain a more coordinated and integrated response in combating
terrorism, to boost research, by defining more and new law enforcement
strategies to protect the more vulnerable population.

17. 6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
“Those who cannot remember the past are condemned to repeat it”
George Santayana
THANK YOU