Force Protection and Force Health Protection During an Ebola Virus Disease Outbreak ,

1. Force Protection and Force Health Protection During an Ebola Virus Disease Outbreak,

2. Behavioral Health • Healthy Behaviors • Employee Assistance Program (EAP) • Assessment, Counseling and Referral • Work/Life • Critical Incident Stress Management (CISM) • Fitness Centers • Low Risk Maintenance • Risk Reduction • Design and Development • Fitness Center Management • Wellness & Health Promotion Management FOH Integrated Health Services • Environmental Health & Safety • Safety-injury Prevention • Ergonomics • Occupational Safety and Health Training • Emergency Response Planning & Training • Indoor Air Quality • Medical Services • Job Requirement Standards • Pre- & post-employment exam • Pre- & post-deployment exam • Law enforcement exam • Medical surveillance exam • Organizational Development • Training and Education • Clinical Trainings • EAP Presentations and Orientations • Occupational Safety and Health Training • Medical Employability • Absence Management • Return to Work • Fitness for Duty • Health Centers • First Aid and Urgent Care • Immunizations • Lactation Facilities • Workers Compensation • Case management • Linkage with DOL • Wellness & Health Promotion • Screening • Health Coaching • Interactive Classes • Behavior Change • Health Risk Assessment • Assess Health Risk Status (HRA) • Maintain Health • Address Health Risks ▪▪▪▪= productivity and performance

3. Agency for International Development • Office of Foreign Disaster Assistance (OFDA) • Mandate to alleviate human suffering, and reduce the social and economic impact of disasters worldwide • OFDA leads and coordinates the U.S. Government’s response to disasters overseas

4. FOH CBRNE Program • Since 2005 FOH has provided services to OFDA • Training • Protective clothing • Equipment • Worldwide chemical, biological, radiation, nuclear, or explosion (CBRNE) hazard database • Deployed hazard assessments and technical assistance CBRNE = Chemical / Biological / Radiological / Nuclear / Explosive

5. Objectives • Share valuable experience and lessons learned • Illuminate new opportunities for EH contributions to international disaster response • Guide attendees in preparing themselves to take advantage of those opportunities

6. The Big Picture • Host nation has invited or accepted assistance • Ambassador or Chief of Mission • Ranking USG official • Personal representative of POTUS • Regional Security Officers • Personal advisor to the ambassador or chief of mission on all security issues • Coordinate all aspects of embassy security

7. Failing to Plan is Planning to Fail • Safety and Security Plan • Crime/theft/sexual assault • Civil unrest • Vehicle accident • Residential/hotel fire • Thermal stress • Ebola virus disease • Vector-borne diseases • Food- and water-borne illness Image courtesy of Al Jazeera

8. Back to Basics I • Food/water • SalmonellaTyphi common • Boil it, cook it, peel it, or forget it • Immunizations • Infectious • Acute respiratory infections • Norovirus Image courtesy of Monroe Chicken

9. Back to Basics II • Yellow fever • Required immunization for entry visa • Dengue • Rabies • More . . . .

10. Lassa Fever • Reservoir is multimammate rat (Mastomys natalensis) • Infection via inhalation or ingestion of urine/droppings • Nosocomial transmission (BBP) • 100k – 300k infections, 80% are mild and undiagnosed • 5,000 deaths annually • 10 to 16% of Liberia hospital admissions have Lassa fever http://www.cdc.gov/vhf/lassa/index.html

11. Malaria • Estimated (WHO) 200M cases, 500k deaths annually • 90% of deaths in sub-Saharan Africa, most children < 5 • Guinea/Liberia/Sierra Leone high risk for malaria • Chloroquine-resistant malaria circulates in all areas • Malaria species present: P. falciparum 85%, P. ovale 5% to 10%, P. malariae and P. vivax rare. • Primary vectors An. gambiae and An. funestus • prefer to feed on humans • two of the most efficient malaria vectors in the world http://www.cdc.gov/malaria/index.html

12. Consequences are Magnified • You are representing the United States on the world stage • Traffic accident can be international incident • Norovirus could cripple USG response • Typhoid fever or malaria could be your ticket home on Phoenix Air

13. Need Locally Feasible Solutions

14. Take Personal Responsibility • Personal Security • Ineffective police • Relative wealth • Cultural and language barriers • Situational awareness • Personal Safety • Building codes and quality may be lacking • Emergency services may be lacking

15. Which Is the Fire Exit? This one – but never mind, it’s locked

16. This Way Out

17. Vehicles Are Highest Risk • Poor roads • Chaotic traffic • Self-driving generally prohibited • Screen drivers • Inspect vehicles • Be an active rider • Windows up, doors locked

18. Make Friends • Non-Governmental & International Organizations • International Partners Security Meeting • Other US Agencies • Embassy/Mission • Hotel Staff • Civilians • Drivers

19. Stay Visible to Your Team • Accountability board • DART Ride email system • Formal trip plans upcountry • Reduced privacy – personal time is not ‘off the grid’ Image courtesy of IB Times UK

20. Keep an Eye on Your Chokepoints

21. If You Don’t Have Redundant Comms You Don’t Have Comms • Written Communication Plan • Keep hardcopy current contact list • Memorize Post 1 • Program phones and radios, know how to use • Gear • iPhones and local mobile phones • Walkie-talkies and embassy E&E radios • Satellite phones and B-GANs

22. Risk Is Best Managed Where It Is Generated • Operational risk is dynamic • Seeing field sites and operations is crucial • Relationships with partners • 360° of informal communications • Trust among teammates • Proactive rather than reactive

23. Acknowledgements • CAPT Joseph Hughart, FOH • CAPT John Holland, FOH • CDR Doug Ebert, FOH • CDR Kiel Fisher, FOH • Mr. Shawn Bardwell, Peace Corps • Mr. Joshua Kearns USAID/OFDA • Mr. Allen Carney USAID/OFDA • Mr. Travis Betz USAID/OFDA