The Institute for Biocides and Medical Ecology in State of Emergency: Mitigating Flood Consequences in Belgrade, 2014

1. THE PARTICIPATION OF THE INSTITUTE FOR BIOCIDES AND MEDICAL ECOLOGY IN THE STATE OF EMERGENCY -FLOODS ON THE TERRITORY OF BELGRADE IN 2014- Dragana Despot, emergency medicine specialist Katarina Šerović, MD Risk management for epidemics and participation in eliminating the consequences of floods on human health

3. 123 years of work in the prevention of infectious diseases • October 5th, 1891 • October 5th,2014 123

4. The Mission of the Institute for Biocides and Medical Ecology Preventive health care institution founded by the city of Belgrade for the purpose of preventing infectious diseases by: • preventing and suppressing infectious diseases through implementation of general and specific measures of disinfection, disinsection and deratization • controlling vectors that are carriers of zoonoses, • scientific research with the highest professional and ethical standards • identifying and monitoring the implementation of the unified doctrine in the application of biocides and other assignments in accordance with the Act.

5. Vision Elite, referential healthcare institution in the field of prevention and protection of the population against contagious diseases, which develops scientific research in the field of medical ecology, respects the principles, sets the criteria and develops doctrines. 123 year-old traditionRESPONSIBILITY

7. Institute for Biocides and Medical Ecology • Given that the Institute is a part of the network of healthcare institutions, in 2013 it was accredited by the Agency for Accreditation of Healthcare Institutions for a period of 7 years.

8. Integrated system for quality management • SRPS ISO 9001:2008– The system for quality management • SRPSISO 14001:2005- The system for environmental management • SRPSOHSAS 18001:2008- The system for management of health preservation and occupational safety

9. In the upcoming period: implementISO 31000 • It describes and defines the process for risk management. • Its application influences the promotion of all other standards relating to management systems. • The implementation of ISO 31000 will lead to improvements in the existing system for risk management and the designing of a new one.

10. Institute for Biocides and Medical Ecology • A member of the government team for monitoring and treatment of mosquitoes in Serbia • The implementation of a project authorized by Ministry of Health for detection of West-Nile virus in Serbia • Bythe decision of the City Council, the Institute was put on the list of the companies and institutions qualified for the enforcement of safety measures and rescue on the territory of the city of Belgrade.

12. The resolution on determining the institutions qualified for the protection and rescue on Belgrade territory- responsibilities of the Institute - • Threat assessments • The plan for responding • Provision and availability of resources • The integration in the system for protection and rescue at a national, city and local level • Information management (information systems, reporting according to the procedure) • Position within the communication mechanisms on city level (City Institute for Public Health, Department of Health and the Ministry of Health)

13. Institute for Biocides and Medical Ecology • A member of the national CBRN (chemical, biological and radio-nuclear safety) team – actively participates in working meetings with colleagues from other referential institutions in the presence of foreign experts in the field of CBRN Sharing knowledge and strengthening the standards of biosafety and biosecurity

14. Education of employees - readiness to respond - • Response in an emergency situation – fire • Course – safety in working with biocides • Course – first aid and providing care in case of an accident • Demonstration exercise in case of: • Fire • Floods • Providing care for the injured • Safe handling of chemical waste • Endangerment assessment and plans for protection and rescue in an emergency situation (in progress)

15. The system for risk reduction and limiting the consequences of natural disasters • established operating procedures • technical equipment • increased operational readiness • trained staff (education of employees)

16. National Strategy for Protection and Rescue Objective: protection of life, health and property of citizens, environment and cultural heritage of the Republic of Serbia

17. The importance of preparation

18. THE ESSENCE OF THE MISSION OF OUR INSTITUTE

19. Outbreaks of infectious diseases (the Institute’s involvement in 2014) • Ministry of Health: a member of the unified team for mosquito control (threat of WNV infection); ЕU donated 200 000kg larvicide, divided amongst the 72 municipalities affected by floods • A member of the Task Force for Ebola: participation and preparation of the procedures for disinfection • Floods in May 2014: involved in work in six municipalities (the largest areas in Obrenovac and Lazarevac), in Obrenovac - disinfected 6000 apartments, 1800 houses and all of the flooded rural households out of the 17,000 on the territory of the municipality . • 10.000.000m2 disinfected in total

20. The floods in Serbia – May 2014 • The floods in Serbia came after a heavy rainfall in the region. A large amount of rainfall led to the formation of torrential flows, flooding and the activation of numerous landslides. • Emergency state was declared throughout the entire territory of Serbia. • On May, 16th a large quantity of water spilled from the bed of Kolubara and flooded Obrenovac and its surroundings. • The evacuation of the entire town and neighboring villages began, in which a number of rescue units and departments were involved (the army, the police, fire department, special forces) • About 25,000 people were evacuated from the area of Obrenovac. They were placed in collective centers throughout Belgrade. • The Institute for Biocides and Medical Ecology begins with the implementation of ddd measures in areas where the water had receded and newly formed collective centres for receiving evacuees from flooded territories, including the premises where Emergency Headquarters was located, as well as setting up disinfection barriers and distributing disinfectants to citizens and institutions engaged in the clearing up of the terrain.

21. State of emergency A state of emergency is a situation when the risks and threats or the consequences of disasters, emergencies and other threats to the population, the environment and material goods are of such extent and intensity that their occurrence or consequences cannot be prevented or eliminated by regular operation of the competent authorities and departments, making it necessary to use special measures, forces and resources at full capacity for the purpose of their mitigation and elimination.

22. A state of emergency is declared

23. Strategies, risk assessments, list of risks, risk management plans, plans for improving occupational safety and health Goal: to improve the capacity for response in a state of emergency (protection of the population and the health of people in the local community) Improves preparation for responding in the event of a disaster, in terms of communication, leadership and coordination in the local community

24. An area with high epidemiological risk • Endangered lives, flooded residential facilities • Evacuation of a large number of people from flooded areas, forming of temporary collective centers • The lack of food and drinking water • Water and sewage systems are not functioning • The level of wastewater reaches the maximum and holds for days • Wastewater overflows from the sewage system • Sanitary and hygienic conditions are very poor

25. An area with high epidemiological risk

26. FLOOD ENDANGERES THE LIVES AND HEALTH OF THE POPULATION • Biological hazards (agents) cause a disturbance in the established balance agent: protective system INFECTIOUS DISEASES

27. Risk management for biological hazards • Identification of biological risk • Impact assessment of identified risks to the health of employees and the health of the population in the said environment • The plan for implementation of measures for the protection of employees - mandatory occupational prevention measures • THE PLAN FOR APPLICATION OF DDD MEASURES (GENERAL AND SPECIFIC) FOR PROTECTING THE POPULATION AGAINST INFECTIOUS DISEASES

28. The floods in Serbia

30. Accommodation in collective centers • The largest collective centers for evacuated persons were: Belgrade Fair (over 500 people), Belgrade Arena, Pionir sports hall (around 250),  sports halls Stari and Novi DIF, Šumice sports center, other sports centers, numerous schools, hotels, dorms etc.

31. DDD in a state of emergencyTask 1 : protection of the population from infectious diseasesTask 2 : protection of the employees from infectious diseases

32. Exceptionally important role of DDD • Weakened protectivesystem (NATURAL AND INSTITUTIONAL) • Compromiseddefensive lines against infectiousdiseases • Deteriorating hygienic and epidemiological situation - the result of heavy rainfall which led to flooding • Increased risk of emergingand spreadingof infectious diseases - to epidemicproportions. • The cumulative effect of stress on the weakening of the immune status.

33. The first line of defense of health againstthe harmful effects of biological agents DDD measuresare effective, simple and can be applied on a large scale if there are reasonable indications.

37. The scope of ddd measures against biological agents • The scope of ddd measures depends on the phase of the natural disaster, the category ofthe biological hazard and the risk of an epidemic. • In the case of natural disasters, an epidemic can be sudden, surprising, and can result in extensive and grave consequences. • In epidemics, dddmeasures are implemented immediately and have an emphasized importance.

38. Potential biological hazards in the flood waters • Biological hazards are microorganisms including those that are genetically modified, cell cultures and human endoparasites, which can cause infection, allergy or toxicity. • Biological hazards are classified into four risk groups according to the level of potential risk of infection: Group 1 biologicalhazard - unlikely to cause disease in humans. Group 2biologicalhazard– causes disease in humans,unlikely to spread to the environment, measures of prophylaxis and treatment available. Group 3 biological hazard - causes severe disease in humans, poses a serious threat to the employees, can spread to the environment, effective measures of prophylaxis and treatment mainly available. Group 4biological hazard- causes severe disease in humans, poses a serious hazard to employees, great risk of spreading to the environment, effective measures of prophylaxis and treatment are generally not available.

39. Biological hazards during and after the flood • In the course of performing their tasks, employeesmay be exposed to biological hazards while eliminating the consequences of floods • First phase - rescue, elimination of causes that pose an immediate life threat • Second phase – cleaning of the terrain - ddd measures

40. The duty of employees isto prevent the influence of biological hazards on the health of the population in the conditions of technical exposure to the agents that impair the health potential of the individual and the system. The duty of the employer is to assess the risk of injury and damage to the health of employees,with the aim of determining the nature, extent and duration of exposure of employees,and the ways and measures ofeliminatingor reducingthese risks.

41. General and specific preventive measures (in relation to the agent) • General measures of prevention - measures of occupationalsafety and prevention of contactperson / biological agent The Institute has a policyofobligatoryimmunization - vaccination of employees against infectious diseases (for allwho perform tasks in environments with epidemiological risk) WORKING IN FLOODED AREAS

42. Get acquainted with the nature of the biological agentto ensure adequate protection • The identification of biological risk • The assessmentof impactofidentified risks onthe health of employees and the health of the population in the saidenvironment

43. The list of potential pathogens in wastewater

46. THE LIST OF POTENTIAL PATHOGENS IN WASTEWATER ***Exposure to the influence of biological agents in a flooded area, workplaces of employees involved in disinfection: firstgroup dddtechnician, warehouseclerk, headof device and grounds maintenance, operatingand technical manager of the department for sterilization of medical supplies and equipment,as well as operating technician, assistant director of ddd, headof departmentforddd, microbiology, epidemiology, laboratory technician

47. THE LIST OF POTENTIAL PATHOGENS IN THE IMMEDIATE VICINITY OF WASTEWATER IN THE FLOODED AREA

48. THE LIST OF POTENTIAL PATHOGENS IN THE IMMEDIATE VICINITY OF WASTEWATER IN THE FLOODED AREA ***Exposure to potential pathogens in the immediate vicinity of the flooded areas, workplaces of employees on field research: headof departmentfor program activities, coordinator of program activities, health associate -researcher, microbiologist, lab technician and first group ddd technician.

49. Preventive measures • Based on the Strategy for risk management, plans, procedures and guidelines have been established and implemented in the Institute relating to the potential risks. These documents guide the application of preventive measures which serve to prevent or minimize the occurrence of risks.