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HEALTH CBRNINC PLAN Domestic Health Response Plan for Chemical, Biological, Radiological or Nuclear Incidents of National Consequence
60

HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

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Page 1: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

HEALTH CBRNINC PLAN

Domestic Health Response Plan for

Chemical Biological Radiological or Nuclear

Incidents of National Consequence

CBRNINC PLAN VERSION 1

Page | 2

ISBN 978-1-74186-064-1 Publications approval number 10509

Copyright Statements

Paper-based publications

copy Commonwealth of Australia 2014

This work is copyright You may reproduce the whole or part of this work in unaltered form for your own personal use or if you are part of an organisation for internal use within your organisation but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so Requests and inquiries concerning reproduction and rights are to be sent to the Online Services and External Relations Branch Department of Health GPO Box 9848 Canberra ACT 2601 or via e-mail to copyrighthealthgovau

Internet sites

copy Commonwealth of Australia 2014

This work is copyright You may download display print and reproduce the whole or part of this work in unaltered form for your own personal use or if you are part of an organisation for internal use within your organisation but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so Requests and inquiries concerning reproduction and rights are to be sent to the Online Services and External Relations Branch Department of Health GPO Box 9848 Canberra ACT 2601 or via e-mail to copyrighthealthgovau

CBRNINC PLAN VERSION 1

Page | 3

AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE The Australian Health Protection Principal Committee (AHPPC) is a standing committee of the Australian Health Ministers Advisory Council Chaired by the Deputy Secretary of the Department of Health the Committee includes representation by the Chief Health Officers of all States and Territories the Department of Defence Emergency Management Australia (EMA) the Chairs of its key standing committees Communicable Disease Network Australia (CDNA) Public Health Laboratory Network (PHLN) Environmental Health Standing Committee (enHealth) National Health Emergency Management Standing Committee (NHEMS) Antimicrobial resistance Standing Committee (AMRSC) and the Blood Bourne Virus and Sexually Transmitted Infections Standing Committee (BBSTISC) and key subject matter experts To obtain details regarding AHPPC publications contact email ahppcsecretariathealthgovau At the time of publication the links to websites referred to in this document were correct AHPPC acknowledge that at times organisations change internet addresses or remove information from the internet

CBRNINC PLAN VERSION 1

Page | 4

TABLE OF CONTENTS

Contents

TABLE OF CONTENTS 4

DISTRIBUTION LIST 5

CERTIFICATE OF AMENDMENT 7

ABBREVIATIONS AND ACRONYMNS 8

AUTHORITY 11

Section 1 INTRODUCTION 12

Section 2 AIM 13

Section 3 SCOPE 13

Section 4 ACTIVATION 14

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation 15

Section 6 RESPONSE COORDINATION 16

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE 18

Section 8 MEDIA MANAGEMENT 20

Section 9 ADMINISTRATION AND MAINTENANCE 21

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS 22

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES 22

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION 29

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN 32

STANDBY PHASE ACTIONS 32

RESPONSE PHASE ACTIONS ndash SUMMARY 33

STAND DOWN PHASE ACTIONS 34

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS 35

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS

RELEASE IN AUSTRALIA 38

RESPONSE CODE 0 NO CREDIBLE THREAT 38

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE 39

RESPONSE CODE 2 RELEASE IMMENENT 39

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE 40

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL 41

APPENDIX 6 KEY STAKEHOLDERS 42

APPENDIX 7 ROLES AND RESPONSIBILITIES 43

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA 45

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES 46

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS 47

APPENDIX 11 RELATED PLANS AND DOCUMENTS 48

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

49

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH

PROFESSIONALS 50

APPENDIX 14 GLOSSARYDEFINITIONS 51

CBRNINC PLAN VERSION 1

Page | 5

DISTRIBUTION LIST

Australian Government Departments and Agencies

Air Services Australia (ASA)

Attorney-Generalrsquos Department (AGD)

Attorney-Generalrsquos Department Emergency Management Australia (EMA)

Department of Immigration and Border Protection (DIBP)

Australian Federal Police (AFP)

Australian Government Crisis Coordination Centre (CCC)

Australian Maritime Safety Authority (AMSA)

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Department of Human Services (DHS)

Department of Agriculture

Department of Defence

Department of Environment - Australian Antarctic Division

Department of Social Services

Department of Finance

Department of Foreign Affairs and Trade (DFAT)

Department of Health (Health)

Department of Infrastructure and Regional Development

Department of Prime Minister and Cabinet (PMampC)

Department of Industry

The Treasury

Other Authorities

Australian Antarctic Division

Australasian College for Emergency Medicine (ACEM)

Australasian College of Dermatologists (ACD)

Australasian College of Sports Physicians (ACSP)

Australasian Faculty of Occupational and Environmental Medicine (AFOEM)

Australasian Faculty of Public Health Medicine (AFPHM)

Australasian Faculty of Rehabilitation Medicine (AFRM)

Australian and New Zealand College of Anaesthetists (ANZCA)

Australian and New Zealand Emergency Management Committee (ANZEMC)

Australian College of Rural and Remote Medicine (ACRRM)

CBRNINC PLAN VERSION 1

Page | 6

Australian Government Crisis Committee (AGCC)

Australian Medical Transport Coordination Group (AMTCG)

Australian Red Cross Blood Service (ARCBS)

Council of Ambulance Authorities (CAA)

Joint Faculty of Intensive Care Medicine (JFICM)

Australia New Zealand Counter-Terrorism Committee (ANZCTC)

National Critical Care and Trauma Response Centre (NCCTRC)

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)

Royal Australian and New Zealand College of Ophthalmologists (RANZCO)

Royal Australian and New Zealand College of Psychiatrists (RANZCP)

Royal Australian and New Zealand College of Radiologists (RANZCR)

Royal Australian College of General Practitioners (RACGP)

Royal Australian College of Medical Administrators (RACMA)

Royal Australian College of Physicians (RACP)

Royal Australian College of Surgeons (RACS)

Royal College of Pathologists of Australasia (RCPA)

SOS International

World Health Organization (WHO)

State and Territory Health Authorities

Australian Capital Territory

New South Wales

Northern Territory

Queensland

South Australia

Tasmania

Victoria

Western Australia

CBRNINC PLAN VERSION 1

Page | 7

CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate Recommendations for amendments or suggestions for improvement may be made at any time to Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone +61 2 6289 3030 Facsimile +61 2 6285 3040 E-Mail healthopshealthgovau Information on the current version can be obtained from the Department of Health Website httpwwwhealthgovau

Amendment No Issue Date Amended By Date

CBRNINC PLAN VERSION 1

Page | 8

ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

CBRNINC PLAN VERSION 1

Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 2: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 2

ISBN 978-1-74186-064-1 Publications approval number 10509

Copyright Statements

Paper-based publications

copy Commonwealth of Australia 2014

This work is copyright You may reproduce the whole or part of this work in unaltered form for your own personal use or if you are part of an organisation for internal use within your organisation but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so Requests and inquiries concerning reproduction and rights are to be sent to the Online Services and External Relations Branch Department of Health GPO Box 9848 Canberra ACT 2601 or via e-mail to copyrighthealthgovau

Internet sites

copy Commonwealth of Australia 2014

This work is copyright You may download display print and reproduce the whole or part of this work in unaltered form for your own personal use or if you are part of an organisation for internal use within your organisation but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so Requests and inquiries concerning reproduction and rights are to be sent to the Online Services and External Relations Branch Department of Health GPO Box 9848 Canberra ACT 2601 or via e-mail to copyrighthealthgovau

CBRNINC PLAN VERSION 1

Page | 3

AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE The Australian Health Protection Principal Committee (AHPPC) is a standing committee of the Australian Health Ministers Advisory Council Chaired by the Deputy Secretary of the Department of Health the Committee includes representation by the Chief Health Officers of all States and Territories the Department of Defence Emergency Management Australia (EMA) the Chairs of its key standing committees Communicable Disease Network Australia (CDNA) Public Health Laboratory Network (PHLN) Environmental Health Standing Committee (enHealth) National Health Emergency Management Standing Committee (NHEMS) Antimicrobial resistance Standing Committee (AMRSC) and the Blood Bourne Virus and Sexually Transmitted Infections Standing Committee (BBSTISC) and key subject matter experts To obtain details regarding AHPPC publications contact email ahppcsecretariathealthgovau At the time of publication the links to websites referred to in this document were correct AHPPC acknowledge that at times organisations change internet addresses or remove information from the internet

CBRNINC PLAN VERSION 1

Page | 4

TABLE OF CONTENTS

Contents

TABLE OF CONTENTS 4

DISTRIBUTION LIST 5

CERTIFICATE OF AMENDMENT 7

ABBREVIATIONS AND ACRONYMNS 8

AUTHORITY 11

Section 1 INTRODUCTION 12

Section 2 AIM 13

Section 3 SCOPE 13

Section 4 ACTIVATION 14

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation 15

Section 6 RESPONSE COORDINATION 16

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE 18

Section 8 MEDIA MANAGEMENT 20

Section 9 ADMINISTRATION AND MAINTENANCE 21

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS 22

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES 22

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION 29

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN 32

STANDBY PHASE ACTIONS 32

RESPONSE PHASE ACTIONS ndash SUMMARY 33

STAND DOWN PHASE ACTIONS 34

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS 35

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS

RELEASE IN AUSTRALIA 38

RESPONSE CODE 0 NO CREDIBLE THREAT 38

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE 39

RESPONSE CODE 2 RELEASE IMMENENT 39

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE 40

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL 41

APPENDIX 6 KEY STAKEHOLDERS 42

APPENDIX 7 ROLES AND RESPONSIBILITIES 43

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA 45

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES 46

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS 47

APPENDIX 11 RELATED PLANS AND DOCUMENTS 48

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

49

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH

PROFESSIONALS 50

APPENDIX 14 GLOSSARYDEFINITIONS 51

CBRNINC PLAN VERSION 1

Page | 5

DISTRIBUTION LIST

Australian Government Departments and Agencies

Air Services Australia (ASA)

Attorney-Generalrsquos Department (AGD)

Attorney-Generalrsquos Department Emergency Management Australia (EMA)

Department of Immigration and Border Protection (DIBP)

Australian Federal Police (AFP)

Australian Government Crisis Coordination Centre (CCC)

Australian Maritime Safety Authority (AMSA)

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Department of Human Services (DHS)

Department of Agriculture

Department of Defence

Department of Environment - Australian Antarctic Division

Department of Social Services

Department of Finance

Department of Foreign Affairs and Trade (DFAT)

Department of Health (Health)

Department of Infrastructure and Regional Development

Department of Prime Minister and Cabinet (PMampC)

Department of Industry

The Treasury

Other Authorities

Australian Antarctic Division

Australasian College for Emergency Medicine (ACEM)

Australasian College of Dermatologists (ACD)

Australasian College of Sports Physicians (ACSP)

Australasian Faculty of Occupational and Environmental Medicine (AFOEM)

Australasian Faculty of Public Health Medicine (AFPHM)

Australasian Faculty of Rehabilitation Medicine (AFRM)

Australian and New Zealand College of Anaesthetists (ANZCA)

Australian and New Zealand Emergency Management Committee (ANZEMC)

Australian College of Rural and Remote Medicine (ACRRM)

CBRNINC PLAN VERSION 1

Page | 6

Australian Government Crisis Committee (AGCC)

Australian Medical Transport Coordination Group (AMTCG)

Australian Red Cross Blood Service (ARCBS)

Council of Ambulance Authorities (CAA)

Joint Faculty of Intensive Care Medicine (JFICM)

Australia New Zealand Counter-Terrorism Committee (ANZCTC)

National Critical Care and Trauma Response Centre (NCCTRC)

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)

Royal Australian and New Zealand College of Ophthalmologists (RANZCO)

Royal Australian and New Zealand College of Psychiatrists (RANZCP)

Royal Australian and New Zealand College of Radiologists (RANZCR)

Royal Australian College of General Practitioners (RACGP)

Royal Australian College of Medical Administrators (RACMA)

Royal Australian College of Physicians (RACP)

Royal Australian College of Surgeons (RACS)

Royal College of Pathologists of Australasia (RCPA)

SOS International

World Health Organization (WHO)

State and Territory Health Authorities

Australian Capital Territory

New South Wales

Northern Territory

Queensland

South Australia

Tasmania

Victoria

Western Australia

CBRNINC PLAN VERSION 1

Page | 7

CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate Recommendations for amendments or suggestions for improvement may be made at any time to Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone +61 2 6289 3030 Facsimile +61 2 6285 3040 E-Mail healthopshealthgovau Information on the current version can be obtained from the Department of Health Website httpwwwhealthgovau

Amendment No Issue Date Amended By Date

CBRNINC PLAN VERSION 1

Page | 8

ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

CBRNINC PLAN VERSION 1

Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

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Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

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Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

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Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

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Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 3: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

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AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE The Australian Health Protection Principal Committee (AHPPC) is a standing committee of the Australian Health Ministers Advisory Council Chaired by the Deputy Secretary of the Department of Health the Committee includes representation by the Chief Health Officers of all States and Territories the Department of Defence Emergency Management Australia (EMA) the Chairs of its key standing committees Communicable Disease Network Australia (CDNA) Public Health Laboratory Network (PHLN) Environmental Health Standing Committee (enHealth) National Health Emergency Management Standing Committee (NHEMS) Antimicrobial resistance Standing Committee (AMRSC) and the Blood Bourne Virus and Sexually Transmitted Infections Standing Committee (BBSTISC) and key subject matter experts To obtain details regarding AHPPC publications contact email ahppcsecretariathealthgovau At the time of publication the links to websites referred to in this document were correct AHPPC acknowledge that at times organisations change internet addresses or remove information from the internet

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TABLE OF CONTENTS

Contents

TABLE OF CONTENTS 4

DISTRIBUTION LIST 5

CERTIFICATE OF AMENDMENT 7

ABBREVIATIONS AND ACRONYMNS 8

AUTHORITY 11

Section 1 INTRODUCTION 12

Section 2 AIM 13

Section 3 SCOPE 13

Section 4 ACTIVATION 14

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation 15

Section 6 RESPONSE COORDINATION 16

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE 18

Section 8 MEDIA MANAGEMENT 20

Section 9 ADMINISTRATION AND MAINTENANCE 21

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS 22

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES 22

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION 29

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN 32

STANDBY PHASE ACTIONS 32

RESPONSE PHASE ACTIONS ndash SUMMARY 33

STAND DOWN PHASE ACTIONS 34

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS 35

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS

RELEASE IN AUSTRALIA 38

RESPONSE CODE 0 NO CREDIBLE THREAT 38

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE 39

RESPONSE CODE 2 RELEASE IMMENENT 39

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE 40

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL 41

APPENDIX 6 KEY STAKEHOLDERS 42

APPENDIX 7 ROLES AND RESPONSIBILITIES 43

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA 45

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES 46

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS 47

APPENDIX 11 RELATED PLANS AND DOCUMENTS 48

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

49

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH

PROFESSIONALS 50

APPENDIX 14 GLOSSARYDEFINITIONS 51

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DISTRIBUTION LIST

Australian Government Departments and Agencies

Air Services Australia (ASA)

Attorney-Generalrsquos Department (AGD)

Attorney-Generalrsquos Department Emergency Management Australia (EMA)

Department of Immigration and Border Protection (DIBP)

Australian Federal Police (AFP)

Australian Government Crisis Coordination Centre (CCC)

Australian Maritime Safety Authority (AMSA)

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Department of Human Services (DHS)

Department of Agriculture

Department of Defence

Department of Environment - Australian Antarctic Division

Department of Social Services

Department of Finance

Department of Foreign Affairs and Trade (DFAT)

Department of Health (Health)

Department of Infrastructure and Regional Development

Department of Prime Minister and Cabinet (PMampC)

Department of Industry

The Treasury

Other Authorities

Australian Antarctic Division

Australasian College for Emergency Medicine (ACEM)

Australasian College of Dermatologists (ACD)

Australasian College of Sports Physicians (ACSP)

Australasian Faculty of Occupational and Environmental Medicine (AFOEM)

Australasian Faculty of Public Health Medicine (AFPHM)

Australasian Faculty of Rehabilitation Medicine (AFRM)

Australian and New Zealand College of Anaesthetists (ANZCA)

Australian and New Zealand Emergency Management Committee (ANZEMC)

Australian College of Rural and Remote Medicine (ACRRM)

CBRNINC PLAN VERSION 1

Page | 6

Australian Government Crisis Committee (AGCC)

Australian Medical Transport Coordination Group (AMTCG)

Australian Red Cross Blood Service (ARCBS)

Council of Ambulance Authorities (CAA)

Joint Faculty of Intensive Care Medicine (JFICM)

Australia New Zealand Counter-Terrorism Committee (ANZCTC)

National Critical Care and Trauma Response Centre (NCCTRC)

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)

Royal Australian and New Zealand College of Ophthalmologists (RANZCO)

Royal Australian and New Zealand College of Psychiatrists (RANZCP)

Royal Australian and New Zealand College of Radiologists (RANZCR)

Royal Australian College of General Practitioners (RACGP)

Royal Australian College of Medical Administrators (RACMA)

Royal Australian College of Physicians (RACP)

Royal Australian College of Surgeons (RACS)

Royal College of Pathologists of Australasia (RCPA)

SOS International

World Health Organization (WHO)

State and Territory Health Authorities

Australian Capital Territory

New South Wales

Northern Territory

Queensland

South Australia

Tasmania

Victoria

Western Australia

CBRNINC PLAN VERSION 1

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CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate Recommendations for amendments or suggestions for improvement may be made at any time to Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone +61 2 6289 3030 Facsimile +61 2 6285 3040 E-Mail healthopshealthgovau Information on the current version can be obtained from the Department of Health Website httpwwwhealthgovau

Amendment No Issue Date Amended By Date

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ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

CBRNINC PLAN VERSION 1

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CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

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Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 4: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 4

TABLE OF CONTENTS

Contents

TABLE OF CONTENTS 4

DISTRIBUTION LIST 5

CERTIFICATE OF AMENDMENT 7

ABBREVIATIONS AND ACRONYMNS 8

AUTHORITY 11

Section 1 INTRODUCTION 12

Section 2 AIM 13

Section 3 SCOPE 13

Section 4 ACTIVATION 14

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation 15

Section 6 RESPONSE COORDINATION 16

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE 18

Section 8 MEDIA MANAGEMENT 20

Section 9 ADMINISTRATION AND MAINTENANCE 21

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS 22

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES 22

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION 29

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN 32

STANDBY PHASE ACTIONS 32

RESPONSE PHASE ACTIONS ndash SUMMARY 33

STAND DOWN PHASE ACTIONS 34

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS 35

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS

RELEASE IN AUSTRALIA 38

RESPONSE CODE 0 NO CREDIBLE THREAT 38

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE 39

RESPONSE CODE 2 RELEASE IMMENENT 39

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE 40

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL 41

APPENDIX 6 KEY STAKEHOLDERS 42

APPENDIX 7 ROLES AND RESPONSIBILITIES 43

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA 45

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES 46

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS 47

APPENDIX 11 RELATED PLANS AND DOCUMENTS 48

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

49

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH

PROFESSIONALS 50

APPENDIX 14 GLOSSARYDEFINITIONS 51

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Page | 5

DISTRIBUTION LIST

Australian Government Departments and Agencies

Air Services Australia (ASA)

Attorney-Generalrsquos Department (AGD)

Attorney-Generalrsquos Department Emergency Management Australia (EMA)

Department of Immigration and Border Protection (DIBP)

Australian Federal Police (AFP)

Australian Government Crisis Coordination Centre (CCC)

Australian Maritime Safety Authority (AMSA)

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Department of Human Services (DHS)

Department of Agriculture

Department of Defence

Department of Environment - Australian Antarctic Division

Department of Social Services

Department of Finance

Department of Foreign Affairs and Trade (DFAT)

Department of Health (Health)

Department of Infrastructure and Regional Development

Department of Prime Minister and Cabinet (PMampC)

Department of Industry

The Treasury

Other Authorities

Australian Antarctic Division

Australasian College for Emergency Medicine (ACEM)

Australasian College of Dermatologists (ACD)

Australasian College of Sports Physicians (ACSP)

Australasian Faculty of Occupational and Environmental Medicine (AFOEM)

Australasian Faculty of Public Health Medicine (AFPHM)

Australasian Faculty of Rehabilitation Medicine (AFRM)

Australian and New Zealand College of Anaesthetists (ANZCA)

Australian and New Zealand Emergency Management Committee (ANZEMC)

Australian College of Rural and Remote Medicine (ACRRM)

CBRNINC PLAN VERSION 1

Page | 6

Australian Government Crisis Committee (AGCC)

Australian Medical Transport Coordination Group (AMTCG)

Australian Red Cross Blood Service (ARCBS)

Council of Ambulance Authorities (CAA)

Joint Faculty of Intensive Care Medicine (JFICM)

Australia New Zealand Counter-Terrorism Committee (ANZCTC)

National Critical Care and Trauma Response Centre (NCCTRC)

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)

Royal Australian and New Zealand College of Ophthalmologists (RANZCO)

Royal Australian and New Zealand College of Psychiatrists (RANZCP)

Royal Australian and New Zealand College of Radiologists (RANZCR)

Royal Australian College of General Practitioners (RACGP)

Royal Australian College of Medical Administrators (RACMA)

Royal Australian College of Physicians (RACP)

Royal Australian College of Surgeons (RACS)

Royal College of Pathologists of Australasia (RCPA)

SOS International

World Health Organization (WHO)

State and Territory Health Authorities

Australian Capital Territory

New South Wales

Northern Territory

Queensland

South Australia

Tasmania

Victoria

Western Australia

CBRNINC PLAN VERSION 1

Page | 7

CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate Recommendations for amendments or suggestions for improvement may be made at any time to Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone +61 2 6289 3030 Facsimile +61 2 6285 3040 E-Mail healthopshealthgovau Information on the current version can be obtained from the Department of Health Website httpwwwhealthgovau

Amendment No Issue Date Amended By Date

CBRNINC PLAN VERSION 1

Page | 8

ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

CBRNINC PLAN VERSION 1

Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

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Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 5: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 5

DISTRIBUTION LIST

Australian Government Departments and Agencies

Air Services Australia (ASA)

Attorney-Generalrsquos Department (AGD)

Attorney-Generalrsquos Department Emergency Management Australia (EMA)

Department of Immigration and Border Protection (DIBP)

Australian Federal Police (AFP)

Australian Government Crisis Coordination Centre (CCC)

Australian Maritime Safety Authority (AMSA)

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Department of Human Services (DHS)

Department of Agriculture

Department of Defence

Department of Environment - Australian Antarctic Division

Department of Social Services

Department of Finance

Department of Foreign Affairs and Trade (DFAT)

Department of Health (Health)

Department of Infrastructure and Regional Development

Department of Prime Minister and Cabinet (PMampC)

Department of Industry

The Treasury

Other Authorities

Australian Antarctic Division

Australasian College for Emergency Medicine (ACEM)

Australasian College of Dermatologists (ACD)

Australasian College of Sports Physicians (ACSP)

Australasian Faculty of Occupational and Environmental Medicine (AFOEM)

Australasian Faculty of Public Health Medicine (AFPHM)

Australasian Faculty of Rehabilitation Medicine (AFRM)

Australian and New Zealand College of Anaesthetists (ANZCA)

Australian and New Zealand Emergency Management Committee (ANZEMC)

Australian College of Rural and Remote Medicine (ACRRM)

CBRNINC PLAN VERSION 1

Page | 6

Australian Government Crisis Committee (AGCC)

Australian Medical Transport Coordination Group (AMTCG)

Australian Red Cross Blood Service (ARCBS)

Council of Ambulance Authorities (CAA)

Joint Faculty of Intensive Care Medicine (JFICM)

Australia New Zealand Counter-Terrorism Committee (ANZCTC)

National Critical Care and Trauma Response Centre (NCCTRC)

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)

Royal Australian and New Zealand College of Ophthalmologists (RANZCO)

Royal Australian and New Zealand College of Psychiatrists (RANZCP)

Royal Australian and New Zealand College of Radiologists (RANZCR)

Royal Australian College of General Practitioners (RACGP)

Royal Australian College of Medical Administrators (RACMA)

Royal Australian College of Physicians (RACP)

Royal Australian College of Surgeons (RACS)

Royal College of Pathologists of Australasia (RCPA)

SOS International

World Health Organization (WHO)

State and Territory Health Authorities

Australian Capital Territory

New South Wales

Northern Territory

Queensland

South Australia

Tasmania

Victoria

Western Australia

CBRNINC PLAN VERSION 1

Page | 7

CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate Recommendations for amendments or suggestions for improvement may be made at any time to Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone +61 2 6289 3030 Facsimile +61 2 6285 3040 E-Mail healthopshealthgovau Information on the current version can be obtained from the Department of Health Website httpwwwhealthgovau

Amendment No Issue Date Amended By Date

CBRNINC PLAN VERSION 1

Page | 8

ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

CBRNINC PLAN VERSION 1

Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 6

Australian Government Crisis Committee (AGCC)

Australian Medical Transport Coordination Group (AMTCG)

Australian Red Cross Blood Service (ARCBS)

Council of Ambulance Authorities (CAA)

Joint Faculty of Intensive Care Medicine (JFICM)

Australia New Zealand Counter-Terrorism Committee (ANZCTC)

National Critical Care and Trauma Response Centre (NCCTRC)

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)

Royal Australian and New Zealand College of Ophthalmologists (RANZCO)

Royal Australian and New Zealand College of Psychiatrists (RANZCP)

Royal Australian and New Zealand College of Radiologists (RANZCR)

Royal Australian College of General Practitioners (RACGP)

Royal Australian College of Medical Administrators (RACMA)

Royal Australian College of Physicians (RACP)

Royal Australian College of Surgeons (RACS)

Royal College of Pathologists of Australasia (RCPA)

SOS International

World Health Organization (WHO)

State and Territory Health Authorities

Australian Capital Territory

New South Wales

Northern Territory

Queensland

South Australia

Tasmania

Victoria

Western Australia

CBRNINC PLAN VERSION 1

Page | 7

CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate Recommendations for amendments or suggestions for improvement may be made at any time to Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone +61 2 6289 3030 Facsimile +61 2 6285 3040 E-Mail healthopshealthgovau Information on the current version can be obtained from the Department of Health Website httpwwwhealthgovau

Amendment No Issue Date Amended By Date

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Page | 8

ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

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Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

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Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

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Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

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Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

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Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 7: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 7

CERTIFICATE OF AMENDMENT The Department of Health (Health) will review the Domestic Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (Health CBRNINC Plan) as appropriate Recommendations for amendments or suggestions for improvement may be made at any time to Assistant Secretary Health Emergency Management Branch Office of Health Protection Australian Government Department of Health MDP 140 GPO Box 9848 Canberra ACT 2601 Phone +61 2 6289 3030 Facsimile +61 2 6285 3040 E-Mail healthopshealthgovau Information on the current version can be obtained from the Department of Health Website httpwwwhealthgovau

Amendment No Issue Date Amended By Date

CBRNINC PLAN VERSION 1

Page | 8

ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

CBRNINC PLAN VERSION 1

Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

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Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

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Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

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Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

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Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

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Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

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Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

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Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

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APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

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APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

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Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

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AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

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STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

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OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

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APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

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APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 8: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 8

ABBREVIATIONS AND ACRONYMNS

ABLN Australian Biosecurity Laboratory Network

ACEM Australian College for Emergency Medicine

ADF Australian Defence Force

AFP Australian Federal Police

AGCC Australian Government Crisis Committee

AGCMF Australian Government Crisis Management Framework

AGD Attorney-Generalrsquos Department

AGD EMA Emergency Management Australia

AGDRC Australian Government Disaster Recovery Committee

Agriculture Department of Agriculture

AHMAC Australian Health Ministers Advisory Council

AHPPC Australian Health Protection Principal Committee

AME Aeromedical Transportation

AMRN Australian Medical Retrieval Network

AMRSC Australian Antimicrobial Resistance Standing Committee

AMTCG Australian Medical Transport Coordination Group

ANSTO Australian Nuclear Science and Technology Organisation

ANZCTC Australian New Zealand National Counter Terrorism Committee

ANZEMC Australian New Zealand Emergency Management Committee

ARPANSA Australian Radiation Protection and Nuclear Safety Agency

ASIO Australian Security Intelligence Organisation

ASNO Australian Safeguards and Non-Proliferation Office

AusAID Australian Agency for International Development

AUSASSISTPLAN Australian Government Overseas Disaster Assistance Plan

AUSBURNPLAN Severe Burn Injury Annex

AUSMAT Australian Medical Assistance Team

AUSTRAUMA Plan Domestic Response Plan for Mass Casualty Incidents of National Consequence

BBSTISC Blood Bourne Virus and Sexually Transmitted Infections Standing Committee

C4 Command control coordination and communication

CAA Council of Ambulance Authorities

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Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

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Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

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Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

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Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

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Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

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Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

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Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

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Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

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Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

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Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 9: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 9

CBRN Chemical Biological Radiological and Nuclear

CCC Australian Government Crisis Coordination Centre

CCEAD Consultative Committee on Emergency Animal Diseases

CDNA Communicable Disease Network Australia

CDNA - JEG CDNA Jurisdictional Executive Group

CHO State andor Territory - Chief Health Officer

CICM College of Intensive Care Medicine of Australian and New Zealand

CMO Australian Government Chief Medical Officer

COAG Council of Australian Governments

COMDISPLAN Australian Government Disaster Response Plan

CSIRO Commonwealth Scientific and Industrial Research Organisation

CVO Chief Veterinary Officer

CWC Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CWALN Chemical Warfare Agent Laboratory Network

DACC Defence Aid to the Civil Community

Defence Department of Defence

DFAT Department of Foreign Affairs and Trade

DIBP Department of Immigration and Border Protection

DIRD Department of Infrastructure and Regional Development

DSS Department of Social Services

DSTO Defence Science and Technology Organisation

EMA Emergency Management Australia

enHealth Environmental Health Committee

EOCECC Emergency OperationsCoordination Centre

FSANZ National Food Standards Australia New Zealand

Health Department of Health

Health CBRNINC Plan Health Response Plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence

HIMU Health Issues Media Unit

IAEA International Atomic Energy Agency

IDC Interdepartmental Committee

IDETF Interdepartmental Emergency Task Force

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 10: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 10

IHR International Health Regulations

LO Liaison Officer

MCI Mass Casualty Incident

NCC National Crisis Committee

NCTC National Counter Terrorism Committee

NCTH National Counter Terrorism Handbook

NCTP National Counter Terrorism Plan

NCCTRC National Critical Care and Trauma Response Centre

NEMRN National Emergency Media Response Network

NGO Non-Government Organisation

NHEMS National Health Emergency Management Standing Committee

NIR Department of Health National Incident Room

NMS National Medical Stockpile

NSC Nuclear Safety Committee

OHP Office of Health Protection

OSMASSCASPLAN National Response Plan for Mass Casualty Incidents Involving Australians Overseas

PEP Post-Exposure Prophylaxis

PHLN Public Health Laboratory Network

REMPAN Radiation Emergency Medical Preparedness Assistance Network

RHC Radiation Health Committee

SEOC State Emergency Operations Centre

SHEOC State Health Emergency Operations Centre

SITF Australian Governmentrsquos Special Incident Task Force

SITREP Situation Report

SSBA Security Sensitive Biological Agent

USAR Urban Search and Rescue

CBRNINC PLAN VERSION 1

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AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

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Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

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Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

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Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

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Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

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Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

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Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

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Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 11: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 11

AUTHORITY

The Health Chemical Biological Radiological or Nuclear Incidents of National Consequence Plan (Health CBRNINC Plan) was developed by the National Health Emergency Management Standing Committee (NHEMS) of the Australian Heath Protection Principal Committee (AHPPC) The Health CBRNINC Plan was endorsed by the AHPPC on 28 February 2014 The Health CBRNINC Plan has been developed under the auspices of the National Health Emergency Response Arrangements (NatHealth Arrangements 2009) Professor Chris Baggoley Chair AHPPC Australian Government Department of Health

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 12: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 12

Section 1 INTRODUCTION The Health CBRNINC Plan is the domestic response plan for Chemical Biological Radiological or Nuclear Incidents of National Consequence (CBRNINC) The plan provides an agreed framework and mechanisms for the effective national coordination response and recovery arrangements for CBRNINC The Health CBRNINC Plan acknowledges that the primary responsibility for managing the impacts of CBRN incidents within their respective jurisdictions lies with the state and territory governments Each jurisdiction has a mandate under state or territory emergency legislation for the prevention and management of emergencies and disasters including CBRN incidents For the purpose of this plan a CBRN incident is defined as an incident which involves the threatened or deliberate release of a chemical biological or radiological agent or activation of a nuclear device which is intended to cause harm to people Due to combinations of geography and severity a CBRN incident by definition may have the potential to overwhelm localregional response resources The principle premise underpinning the Health CBRNINC Plan is that it will operate when a CBRNINC occurs A CBRNINC is defined as a CBRN incident that requires consideration of national level policy strategy and public messaging or inter-jurisdictional assistance where such assistance is not covered by existing arrangements This plan should be read in conjunction with the Australian Government Crisis Management Framework (AGCMF) to clarify the responsibilities of the key Australian Government agencies involved and how information should flow between them A CBRN incident may transition into a CBRNINC when a jurisdictionrsquos response resources are overwhelmed (either immediately or exhausted over time) or the CBRN incident has inherent complex political management implications above and beyond the routine jurisdictional clinical and operational managementresponse Examples include the involvement of large numbers of foreign nationals terrorist or criminal activities or complex logistical implications related to the geography or scale of a CBRN incident The Australian Health Protection Principal Committee (AHPPC) will determine in consultation with the relevant State or Territory when a CBRN incident has transitioned into a CBRNINC The Health CBRNINC Plan acknowledges that a CBRN incident may include a range of injuries including severe burn injuries The national management of severe burn injuries requires specific considerations for effective response and optimal care The coordination of mass burn casualty incidents may require the activation of the Severe Burn Injury Annex under the AUSTRAUMA Plan (AUSBURNPLAN) The following critical consultative mechanisms underpin this plan

the AHPPC is the peak national health emergency management committee with the power as decision makers to plan prepare and coordinate the national Health response to significant incidents

the Australian Medical Transport Coordination Group (AMTCG) convened by the Attorney-Generalrsquos Department (AGD) Emergency Management Australia (EMA) provides a nationally coordinated medical transport response and

CBRNINC PLAN VERSION 1

Page | 13

the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

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Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

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APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

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APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

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Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

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AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

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STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

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APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

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Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

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Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 13: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

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the expert advice provided by AHPPC Standing Committees in particular the Communicable Disease Network Australia (CDNA) the Public Health Laboratory Network (PHLN) the National Health Emergency Management Standing Committee (NHEMS) and the Environmental Health Committee (enHealth)

The national contact point for health coordination of a CBRNINC is the Department of Health (Health) National Incident Room (NIR) The NIR maintains lead agency status in the coordination of health assets including hospital beds deployment of medical counter-measures and personnel AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG In the event of a CBRN related terrorist attack the coordination arrangements will be in accordance with the National Counter Terrorism Plan (NCTP) The Australian New Zealand National Counter-Terrorism Committee (ANZCTC) has established cooperative plans between the Australian Government and states and territories to manage terrorist incidents or threats The NCTP outlines responsibilities authorities and the mechanisms to prevent or manage acts of terrorism and their consequences within Australia

Section 2 AIM The aim of the Health CBRNINC Plan is to provide a nationally agreed framework for the coordination and response arrangements for national health sector operations in response to a CBRNINC The objective is to minimise the impact of a CBRNINC on the health system of the affected jurisdiction(s) and individuals affected in the event of a CBRN incident By coordinating the distribution of resources in the response to an incident it increases the ability for casualties to be provided optimal specialist and general medical care

Section 3 SCOPE The Health CBRNINC Plan describes the domestic national coordination arrangements required in the event of a CBRNINC It is acknowledged that Australiarsquos health system frequently functions at or near capacity and a CBRN incident may require activation of the Health CBRNINC Plan even in the face of relatively small numbers of casualties particularly in regional and remote areas The Health CBRNINC Plan is not a plan to deal with accidental or routine incidents which fall within the capability of an individual jurisdiction including HAZMAT infectious disease outbreaks or accidental irradiation issues However the Health CBRNINC Plan may be used to facilitate national options planning in the event of an apparently significant CBRN incident The Health CBRNINC Plan can be activated in conjunction with other national level plans

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Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

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Page | 15

Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

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Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

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Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

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Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

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Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

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Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

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APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

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APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

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Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 14: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 14

Section 4 ACTIVATION

ACTIVATION AUTHORITY The Chair of the AHPPC (or nominated delegate) has the authority to activate Health CBRNINC Plan

TRIGGERS The key triggers for activation of the Health CBRNINC Plan may include

the occurrence or threat of a significant domestic CBRN incident

notification by an affected jurisdiction that assistance in managing the health aspects of a CBRN incident may be required

activation of OSMASCASSPLAN involving a CBRN incident or

other circumstances as deemed appropriate by the AHPPC

EXECUTION Health in consultation with AHPPC may issue preliminary Health CBRNINC Plan Response Phase messages Once activated the AHPPC can coopt relevant clinicians or subject matter experts as required The Health NIR will advise relevant Australian Government and state and territory health authorities of the appropriate Health CBRNINC Plan response phase and response codes The NIR will provide agencies with Situation Reports (SitReps) for events that require activation andor escalation of the plan

CBRNINC PLAN VERSION 1

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Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

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Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

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Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

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APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

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APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

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APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

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APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

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Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

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Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

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Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

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Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

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Section 5 HEALTH CBRNINC PLAN Readiness Phases and Activation Response phase actions and codes are detailed in Appendices 4 and 5

STANDBY PHASE

Alerts of a potential or confirmed CBRN Incident of National Concern

NIR placed on Standby

NIR will liaise with affected jurisdictions

Notification to AHPPC of the incident

Advise Crisis Coordination Centre (CCC) of potential or actual CBRNINC

Jurisdictions to identify available resources for the response (Appendix 3)

Situational awareness maintained by NIR through briefings from affected and non-affected jurisdictions

Convene AHPPC

AHPPC confirmation of jurisdictional capacity

RESPONSE PHASE

Request for assistance received from affected jurisdictions

Activation of the AUSTRAUMAPLAN and the Health CBRNINC Plan

NIR activated - commence operational planning and continue to gather operational intelligence

Situational awareness is maintained by NIR through briefings from affected and non-affected jurisdictions

If required deployment of Australian Government andor jurisdictional assets required to support the CBRN incident response

If required movement of patients from an affected jurisdiction and movement of resources into an affected jurisdiction

AGD EMA to coordinate transport for mass casualty through the AMTCG on advice from the NIR

Detailed response actions are at Appendix 4

STANDOWN PHASE

The AHPPC will authorise the stand down of the response when all consequence management actions requiring national coordination have been completed (acknowledging recovery efforts will be occurring and potentially ongoing) and there is no likelihood of any additional immediate tasking

AHPPC to debrief health authorities to response phases of Health CBRNINC Plan (disseminate post activation report and recommendations)

Facilitate ongoing health recovery processes

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Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

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Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

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Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

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Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 16: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 16

Section 6 RESPONSE COORDINATION

COMMUNICATIONS All telephone requests and instructions are to be confirmed by e-mail or facsimile to the NIR as soon as practicable Upon activation the NIR will provide timely SitReps to relevant Australian Government agencies and state and territory AHPPC members participating in Health CBRNINC Plan operations and for the information of others as appropriate In circumstances in which an Australian Government Crisis Committee (AGCC) or National Crisis Committee (NCC) is also convened the activation of the NIR will be reported to the Australian Government Crisis Coordination Centre (CCC) The CCC will prepare and distribute the National SitRep which is a whole of Government productresource Subsequent SitReps will be promulgated to all relevant agencies providing current information on Health CBRNINC Plan operations Communications to the Health NIR can be directed as follows National Incident Room t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

AERO-MEDICAL TRANSPORT CONSIDERATIONS

AGD EMA through the AMTCG will coordinate aero-medical evacuation when required under this Plan The AMTCG includes representation from AGD EMA Health ADF states and territory aero-medical coordinators the Council of Australia Ambulances (CAA) and DFAT

NATIONAL MEDICAL STOCKPILE

Following activation of the Health CBRNINC Plan the Australian Government Chief Medical Officer (CMO) if appropriate will consult with state and territory health authorities and other relevant agencies (including international agencies if deemed necessary) to determine the availability of CBRN counter-measures that may be required to respond to an incident Deployment of any items from the National Medical Stockpile (NMS) will be determined on a case-by-case basis by the CMO

FINANCIAL CONSIDERATIONS All agencies in all jurisdictions involved in Health CBRNINC Plan operations are expected in the first instance to absorb any costs incurred Details of expenditure should be recorded at all stages of Health CBRNINC Plan operations by all agencies in each jurisdiction

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 17: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 17

Internal agency authorisations for expenditure of funds and deployment of resources in response to Health CBRNINC Plan activation are the responsibility of that agency and should be included in their agency plans

LINKAGES TO NATIONAL LEVEL PLANS AND GUIDELINES

The Health CBRNINC Plan operates under the auspices of the National Health Emergency Response Arrangements 2009 (NatHealth Arrangements ndash See Appendices 1 and 6) The COMDISPLAN provides the framework for addressing state and territory requests for Commonwealth physical assistance arising from any type of emergency The NCTP provides the framework for addressing state and territory requests for Commonwealth assistance arising from terrorism emergencies COMDISPLAN is normally activated when Australian Government assistance for emergency response or short-term recovery is requested or likely to be requested If aero-medical (AME) transportation is required on advice from HealthAHPPC and the AMTCG AGD EMA will provide coordination (through AMTCG) for all AME transportation in close liaison with the NIR The NCTP is activated in the event of a terrorist attack The Health CBRNINC Plan can operate independently of COMDISPLAN However if COMDISPLAN is activated the Health CBRNINC Plan acknowledges that the formal COMDISPLAN pathways and requests for national health sector assistance must follow the prescribed arrangements for COMDISPLAN in requests being directed from the Nominated Official to AGD EMA and AGD EMA tasking to HealthAHPPC The Health CBRNINC Plan can operate independently of NCTP However if the NCTP is activated Health CBRNINC Plan operations will comply with the mechanisms stipulated in the NCTP and National Counter-Terrorism Handbook (NCTH) particularly in relation to stated roles and functions of Health and the AHPPC and to the maintenance of information security and critical infrastructure protection

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 18: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 18

Section 7 PREVENTION PREPAREDNESS RECOVERY AND RESILIENCE PREVENTION Under the Australian Constitution prevention of a CBRNINC is largely a state and territory responsibility Health is responsible for managing the Security Sensitive Biological Agents (SSBA) Scheme under the National Health Security Act 2007 and the National Health Security Regulations 2008 The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for the Code of Practice for Security of Radioactive Sources which aims to decrease the likelihood of unauthorised access to radioactive sources by persons with malicious intent It is implemented through specific regulation by StateTerritory radiation regulatory authorities Prevention of CBRNINC is not within the scope of the Health CBRNINC Plan

PREPAREDNESS The majority of CBRN incident preparedness activities are conducted by the states and territories These include

development of interoperable jurisdictional plans

collation of jurisdictional resource registers

development of hospital decontamination and protective equipment resources

regular exercises and testing of jurisdictional arrangements

delivery of jurisdictional CBRN education and training and

development and maintenance of deployable jurisdictional assets National elements of preparedness include the structure to facilitate the Health CBRNINC Plan These include

national level CBRN incident plans mechanisms and arrangements

national CBRN incident resource registers and stockpiles (including those in jurisdictions)

regular exercises testing of national CBRN incident arrangements and

encouraging national consistency and interoperability of key national level CBRN incident capabilities

The Australian Biosecurity Laboratory Network (ABLN) is responsible for developing and maintaining nationally-consistent guidelines for the detection characterisation and surveillance of biological threat agents and would advise on funding and resources needed to address capacity and capability related to biological threat agents

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 19: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 19

The ABLN serves as a first point of contact for all jurisdictional and national issues relating to

laboratory diagnosis or surveillance of biological threat agents and a link to relevant key national jurisdictional and international law enforcement agencies and laboratories

RECOVERY Recovery following a CBRN incident is a shared national and jurisdictional responsibility with the bulk of activities being delivered by jurisdictions Recovery in terms of the Health CBRNINC Plan includes

identification of resources deployed or consumed in the response (on replenishment of cache)

recovery and repatriation of deployed medical teams and their equipment

repatriation of casualties to home jurisdictions

health support for site decontamination

national and jurisdictional operational debriefing and development of post activation report and recommendations and

delivery of mental health services It is possible that an affected jurisdiction which has managed a CBRN incident without external support for the acute response may require health support during the recovery phase This may be accessible through the Health CBRNINC Plan

RESILIENCE Community resilience is not considered as part of the Health CBRNINC Plan

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

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Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

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Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

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Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 20: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 20

Section 8 MEDIA MANAGEMENT PUBLIC INFORMATION The Australian Government and the governments of the states and territories will coordinate the release of public information on the CBRNINC Public information will aim to reduce the potential for mixed messages and to ensure a common national message to the general public The common message will aim to ensure the public receives consistent information about the responsibilities of all agencies involved and the nature of the response Public information about Health measures will be coordinated through the CMO via the NIR

MEDIA COORDINATION Health in consultation with the AHPPC and CCC will be responsible for coordinating national media statements on the Health aspects of the response to a CBRNINC This will be established through the National Emergency Media Response Network (NEMRN) Health will nominate a Media Liaison Officer (MLO) supported by the NIR who will work in conjunction with the AHPPC and CCC to manage public information releases In the event that a National Terrorist Situation is declared the media management arrangements that apply to National Terrorist Situations override this plan (refer to the National Counter-Terrorism Plan and National Counter-Terrorism Handbook)

Note For International CBRN Incidents DFAT and DSS are responsible for coordinating media statements on the Australian Government aspects of a response See also Appendix 10 for further information on International CBRN Incidents

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 21: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 21

Section 9 ADMINISTRATION AND MAINTENANCE PLAN TESTING Health will coordinate testing of the Health CBRNINC Plan via

inclusion in national exercises such as the ANZCTC capability development program and

inclusion in AHPPC exercises and drills Health CBRNINC Plan exercises will have the following aims

to educate participating agencies and stakeholders about the Health CBRNINC Plan processes their roles and the roles of other agencies and

to review Health CBRNINC Plan processes that can be improved or refined

PLAN REVIEW Health will coordinate periodic reviews and evaluation of the Health CBRNINC Plan through the AHPPC A major review will be conducted every five years It will also be reviewed if required following activation of the plan or learningrsquos from capability audits exercise outcomes and operations

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 22: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 22

APPENDIX 1 AUSTRALIAN HEALTH PROTECTION PRINCIPAL COMMITTEE PLANS

Domestic

Response Plan for Mass Casualty

Incidents of National

Consequence

Health

Chemical Biological

Radiological Nuclear

Incidents of National

Consequence

Emergency

Response Plan for

Communicable Diseases and

Environmental Health Threats

of National

Significance

NNaattiioonnaall HHeeaalltthh EEmmeerrggeennccyy RReessppoonnssee

AArrrraannggeemmeennttss

Severe Burn Injury Annex

Criminal and Terrorism

Incident Annex

Paediatric Annex

Pandemic Influenza Chemical Guidelines

Radiological Guidelines

ENABLERS Australian Health Protection Principal Committee

National Health Emergency Management Standing Committee Australian Medical Assistance Teams

Disaster Mental Health Working Group Public Health Laboratory Network

Australian Bioterrorism Laboratory Network Communicable Disease Network Australia

Environmental Health Committee National Medical Stockpile

National Incident Room National Critical Care Trauma Response Centre

Australian Emergency Hospital Response

Emerging Issues

of National

Significance

Smallpox Plan

Anthrax Guidelines

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 23: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 23

APPENDIX 2 AGENCIES ROLES AND RESPONSIBILITIES The following tables summarise potential roles and responsibilities of committees agencies and other bodies during each stage of the Health CBRNINC Plan activation

AUSTRALIAN GOVERNMENT

Committees Role

Australian Biosecurity Laboratory Network (ABLN)

ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Australian Defence Force (ADF)

Provide ADF representation on the AHPPC and AMTCG

Assistance may be provided under arrangements for Defence Assistance to the Civil Community (DACC)

Specialist CBRN technical support may be provided from the DSTO

Australian Government Disaster Recovery Committee (AGDRC)

Provide advice on and coordination of implementation of the tailored recovery assistance measures to assist Australian individuals families and communities impacted by a CBRNINC

Plan and prepare for management of the social and community impacts of future disasters or critical incidents

Maintain linkages with relevant Australian Government state and territory governments and non-government organisations involved in domestic disaster recovery

Provide advice to the Australian Government on lessons learnt in relation to operations processes and assistance provided following onshore or offshore disasters

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

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APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 24: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 24

Australian Health Protection Principal Committee (AHPPC)

National coordination of the health responses emergency operational activity

Provide high-level strategic and clinical advice on health and medical capabilities and on coordination of national Health response to CBRNINC

Advise on requirements and response capabilities in regard to decontamination personal protective equipment hospital beds specific treatments (eg antidotes and antibiotics) workforce critical care management and operating suite availability the secondary transport logistic requirements (Defence and Australian Medical Retrieval Network (AMRN) mental Health (mental Health representative) assets and logistic infrastructure available from state and territories (jurisdictional representatives) as well as the maintenance of supplies and central logistics (Health)

Provide advice to Australian Health Ministersrsquo Advisory Council (AHMAC) on Australiarsquos preparedness for Health emergencies and approaches to addressing any deficits

Australian Medical Transport Coordination Group (AMTCG)

Provide a national coordinated medical transport response for CBRN casualties

Australian Nuclear Science and Technology Organisation (ANSTO)

Provide specialist advice on radiation and nuclear and liaise with other Australian Government and international radiation agencies

ANSTO has deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Provide specialist technical and health safety advice on radiation and nuclear matters and liaise with other Australian Government and international radiation agencies Convenes the RHC

Maintains the Australian Radiation Incident Register

Maintain and staff the Radiation Emergency Coordination Centre 247

Provision of radiation emergency response ARPANSA has unique technical capabilities such as modelling and mapping and deployable response teams to enhance StateTerritory capacity

Provision of selected radiation laboratory services

CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 25

Chemical Warfare Agent Laboratory Network (CWALN)

Member laboratories will analyse environmental samples suspected of containing chemical warfare agents in order to confirm or exclude the presence and extent of contamination Positive results will be regarded as preliminary and will need to be confirmed by DSTO Samples will be collected by appropriately protected emergency service personnel and transported in a safe manner consistent with relevant regulations and maintaining chain of custody

Communicable Disease Network Australia (CDNA)

Convene urgent teleconferences to share and evaluate the latest developments in communicable disease surveillance and provide specialist assistance and coordinate actions during outbreaks and potential outbreaks Provide policy advice to AHPPC Maintain close links with PHLN

Defence Science and Technology Organisation (DSTO)

In support of Defence and national security DSTO provides scientific advice technical and laboratory support DSTO is a lead agency in the CWALN provides definitive analysis of samples containing chemical warfare agents

Department of Health (Health)

The role of Health is to provide specialist health advice national leadership and response coordination primarily through the AHPPC and to liaise with other Australian Government agencies and international agencies such as the WHO

For CBRNINC Health through its National Incident Room is responsible for the activation of the Health CBRNINC Plan via the AHPPC and for the coordination of the Health response in Australia including deployment from the NMS if required

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

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Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 26: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 26

AttorneyndashGeneralrsquos Department Emergency Management Australia (EMA)

The lead Australian Government agency in coordinating Australian government Department and Agency support for response operations AGD EMA

Monitors all hazards through Australian state and territory intelligence security law enforcement and emergency management agencies and provides information to all relevant stakeholders

Coordinates the consequence management arrangements of an emergency and provides Commonwealth Incident Coordination (CIC)

Maintains a suite of Australian Government Plans and Arrangements that provide for Commonwealth assistance to states territories and other Australian Government departments and agencies

Through the AGD Public Information Cell coordinates media management activities including media liaison public warnings media monitoring public information and preparation of joint media strategy

Coordinates Australian Government response to protective or national security threats or incidents

Tasking recommended by Health and the AHPPC will be actioned by AGD EMA through the dedicated Incident Management Team including liaison through the State and Territory Emergency Operation Centres

Chairs the AGDRC and coordinates Australian Government social and community recovery arrangements

Environmental Health Committee (enHealth)

Provides environmental health expertise and support for AHPPCrsquos emergency management role Share information and practical resources

National Health Emergency Management Standing Committee (NHEMS)

May be tasked to provide advice on aspects of operational response to AHPPC

Public Health Laboratory Network (PHLN)

Provide a mechanism for early warning and advice on the detection of new emerging and rare infectious diseases Provide nationwide access to a comprehensive range of pathology and laboratory services for control of communicable diseases Provide strategic advice to AHPPC Ensure optimal use of existing pathology laboratory resources

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 27: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 27

STATE AND TERRITORY AGENCIES

Agency Role

Ambulance Service

Provide initial triage on site pre hospital treatment and transportation of CBRN casualties in the lsquocold zonersquo

Coordinate transport for designated medical teams to the sites of incidents

On site coordination with medical teams and

On site medical support for incident responders

State Health Emergency Operations Centre or equivalent

Coordinate integration of State and Territory Government planning and operational activity with Australian Government planning and operational activity

Coordinate reception of casualties into or within jurisdiction

State Recovery Agency (HumanCommunity Services Department or equivalent)

Provide recovery services

Coordinate or support community relief and recovery activities

StateTerritory Health Departments

Maintain a list of health facilities and their CBRN capabilities

Establish a mechanism to rapidly identify capacity for surge in the event of a CBRN incident

Establish a mechanism to identify staff that can be deployed and equipment that can be provided to an affected jurisdiction if required

Prepare hospital and other health facilities for mass casualty medical care

Advise on the clinical management of CBRN casualties

Coordinate medical treatment and contribute to national medical coordination through the AHPPC

If needed provide resources and assets to undertake overseas aeromedical transportation conduct triage and provide immediate care in country as requested by the Australian Government

Advise on management of mental health issues

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 28: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 28

OTHER NON GOVERNMENT ORGANISATIONS AND SUPPORT AGENCIES

Agency Role

Australian Red Cross Blood Service (ARCBS)

Provide blood and blood products as required to an affected jurisdiction in the event on of a CBRN incident

Manage supply of blood and blood products to jurisdictions

Australian Red Cross and other NGOs

Provide recovery services

Provide registration services

Manage financial appeals

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

Vaccine development and manufacture

Measurement of DNA damage from accidental radiation exposures

Provide the Australian Animal Health Laboratory a member of the PHLN

Poisons Information Centres

Provide high quality up-to-date and evidence-based information regarding the risk assessment management and treatment of human poisoning to the general public and health care professionals

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 29: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 29

APPENDIX 3 TEMPLATE ndash GUIDE FOR AFFECTED JURISDICTION

Affected Jurisdiction Template

Exact location of Incident

Location of health

response command

Location of primary health

response

Site

Local Hospital

Major referral hospital

Type of Incident

HazardsSpecial Considerations

Number of casualties

Estimated or

confirmed

Cat 1 (RED)

Cat 2 (YELLOW) Cat 3 (GREEN) DECEASED

Adult

Adult

Adult

Adult

Paed

Paed

Paed

Paed

Special

Requirements

Not immediately

available

Response Teams Pre-Hospital

Response Teams Hospital Transport Equipment

Medical Nursing

Emergency Ambulance OfficersParamedics

Emergency

Patient Transport Officers

SurgicalTheatre

Intensive Care

Ambulance General Purpose

Burns

Medical

Paediatrics

CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

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Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

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Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

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Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

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Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 30

Staffed Bed Available Now Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

Staffed Bed Within 24 Hours Date

ICU Ventilated

ICU Non-Ventilated

Burns lt25 Burns gt25 General Ward

Adult

Paediatric

ICU Ventilated refers to a bed in a recognised intensive care ward with access to specialised medical and nursing services and resourced to treat critically illinjured patients ICU non-ventilated refers to beds that receive the same level of care as an ICU Ventilated without access to ventilation

Ambulance Resources Available to Respond Now Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

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Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

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The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

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APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 31

Ambulance Resources Available to Respond in 24 Hours Date

Units

Unit Composition

Officers Paramedics Other (eg specialisation)

Emergency Ambulance Staff

Patient Transport Officers

Ambulance Operations Managers

Ambulance General Purpose

Availability means units that are able to respond whilst maintaining a supply for other demands

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

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Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 32: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 32

APPENDIX 4 RESPONSE ACTIVITY UNDER HEALTH CBRNINC PLAN

STANDBY PHASE ACTIONS DEPARTMENT OF HEALTH

Notification to Health contact officer should occur immediately

This notification should be sent to the Health National Incident Room (NIR) t (+61) 2 6289 3030 (24 hours) f (+61) 2 6289 3041 e healthopshealthgovau

Health will place the NIR on standby

Health will notify AHPPC members and convene a teleconference of the AHPPC at the earliest opportunity to advise of the situation The affected jurisdiction(s) will prepare an ldquoaffected jurisdiction templaterdquo prior to the AHPPC teleconference (see Appendix 3) The AHPPC core group can be expanded to include key clinical stakeholderssubject matter experts as required this includes requesting activation of the AMTCG through AGD EMA

Health through the NIR will actively liaise with other Australian Government agencies

The NIR will continue to gather operational intelligence develop a list of possible trigger points for escalation and commence operational planning for discussion at AHPPC teleconferences

AFFECTED (PRIMARY) JURISDICTION

The affected jurisdiction will

Continue management of incident

Advise Australian Government of requirements

Teleconference with AHPPC

Requests for assistance to StateTerritory Emergency Management Controller and

State Emergency Controller requests tasking through AGD EMA

Continued Management of incident will include

Command control coordination and communication (C4) arrangements are implemented to ensure scene management activation of state HealthCBRN plan liaison with hospital emergency departments critical care and trauma service This will entail establishment of health and ambulance emergency operations centres (EOCs) In a large incident it is likely that the StateTerritory Emergency Coordination andor Operations Centre would also be activated ensuring a whole of government approach to the incident

The affected jurisdiction will be required to ensure appropriate pre-hospital response and incident site management in accordance with the stateterritory disasterCBRN

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 33: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 33

plans This includes the functions of triage decontamination treatment and transport with the establishment of a casualty clearing station at the scene The safety of first responders must be ensured through close liaison with other combat agencies especially police and fire services This particularly applies to a CBRN terrorist or security based incident

AUSTRALIAN GOVERNMENT

Liaison by the Health NIR (email healthopshealthgovau or via phone on

+61 2 6289 3030) with relevant Australian Government agencies and jurisdictions to establish current situation confirm capabilities

Health will activate the NIR (if this has not already occurred)

Health will convene further teleconference(s) of the AHPPC to discuss the incident provide further definition of the incident and allow non-affected jurisdictions to progress making arrangements to assist if required

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Update bed and equipment status

Identify staff to respond if required (consider using AUSMAT members)

Liaise with First Responders

Liaise with locally based patient transport services

Liaise with local specialist capability as required eg HAZMAT

Participate in teleconferences with AHPPC and advise of available resource status to contribute to national summary of available resources

RESPONSE PHASE ACTIONS ndash SUMMARY AFFECTED (PRIMARY) JURISDICTION(S)

Continue management of the incident including operational management of assets and staff sent from other jurisdictions

Continue to advise Australian Government of requirements and to teleconference with AHPPC

AUSTRALIAN GOVERNMENT

Via AHPPC and NIR the Australian Government will receive advice from the affected jurisdiction regarding requirements

The National Critical Care and Trauma Response Centre (NCCTRC) at Royal Darwin Hospital may be activated to act as a stabilisation hub for a CBRNINC in Northern Australia or overseas

CBRNINC PLAN VERSION 1

Page | 34

The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

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Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

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Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

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Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

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Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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The Health CBRNINC Plan can act as a supporting document to OSMASSCASPLAN in such an international event The arrangements in the Health CBRNINC Plan are particularly relevant in planning for patient distribution the support of any established staging area and ensuring appropriate clinical coordination through the AHPPC

Requests for state and territory assistance will be through AGD EMA to the state and territory emergency operations centres consistent with the arrangements in OSMASSCASPLAN

DEPARTMENT OF HEALTH

Through the AHPPC escalate the Health CBRNINC Plan to Response phase after request

for assistance received from affected jurisdiction(s) or tasking received from Commonwealth Government

Coordinate deployment of Australian andor jurisdictional Health assets in support of the CBRNINC

Coordinate movement of patients from an affected jurisdiction if required (may be coordinated through the AMTCG)

STATES AND TERRITORIES (NOT DIRECTLY AFFECTED)

Advice from AHPPC will assist AGD EMA to coordinate physical assistance from and to states and territories that are not directly affected Assistance if requested will be tasked through AGD EMA via the relevant state or territory emergency controller

State and territories not directly affected will participate in AHPPC teleconferences and update jurisdictional capacity templates as required or requested

Response actions are described in detail in Appendix 4

STAND DOWN PHASE ACTIONS The AHPPC will declare a stand down of the Health CBRNINC Plan only after all agencies have been cleared of any further tasking by the AGD-EMA This code-word (Stand Down) will be issued by Health through the NIR The Health CBRNINC Plan will be stood down when all consequence management activities requiring national coordination have been completed and all affected facilities and jurisdictions are able to resume normal business Following Stand Down formal debriefing processes are to be completed This could include local state and national debriefs The AHPPC will debrief Health response coordination through the three phases of the Health CBRNINC Plan and disseminate a post activation report and recommendations to all AHPPC members Ongoing recovery activities by necessity may still occur once the Health CBRNINC Plan has been stood down and may be facilitated by the NIR as required

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APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

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FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

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The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

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MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

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Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

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Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

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AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

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Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 35: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 35

APPENDIX 5 DETAILED RESPONSE PHASE ACTIONS IMMEDIATE RESPONSE If confirmed as a genuine deliberate CBRN agent release the appropriate response code (see matrix on page 45) will be declared by the CMO through the AHPPC and the NIR will be activated Times of operation for all emergency response centres including the NIR contact phone and fax numbers 1800 public information numbers email addresses and details of operational procedures will be promulgated to CDNA Jurisdictional Executive Group (CDNA-JEG) and PHLN by the Secretariat Teleconferences will be called at the discretion of the CMO as chair of AHPPC or CDNAPHLN chairs Media liaison on the incident will be established through the NEMRN coordinated through Health (also see page 19)

AEROSOL RELEASE OR SUSPICIOUS SUBSTANCE INCIDENTS In the event of a suspected aerosol release of CBRN agents or the threat of a release the police should be advised immediately by telephone The release zone should be regarded as a crime scene and advice sought from police Environmental samples should be collected by emergency services personnel at the direction of public health authorities andor police as outlined in Appendix 5 Detailed instructions are contained within the National Counter Terrorism Committee Suspicious SubstancesPackages Assessment Guidelines September 2011 Environmental samples and clinical specimens collected from those exposed should be regarded as potential forensic material and appropriate chain-of-custody procedures put in place First responders and any members of the public who have possibly been exposed should be offered post-exposure prophylaxis (PEP) if indicated PEP is to be discontinued only if the incident is confirmed as a hoax or on advice from the state or territory health authority A decision as to whether PEP will be offered and to which groups will be taken by the stateterritory health authority in consultation with emergency services authorities Consideration will be given to the nature of the release accessibility of the exposed zone to the community and other groups (eg shopping centres office buildings or open air sporting venues) An extensive contact tracing exercise may be necessary to identify all exposed persons Names and contact details of all exposed persons should be taken by the local health authority for follow-up purposes Environmental clean-up and disinfection may be required

CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 36

FOOD-BORNE RELEASE If food-borne release of CBRN material is suspected the stateterritory health authority and police should be advised immediately by telephone Details of the incident or outbreak should be forwarded to the chairs of AHPPC CDNA and PHLN who may request an urgent meeting of the AHPPCCDNA-JEG by teleconference and the chair of Food Standards Australia New Zealand (FSANZ) who may recommend activation the National Food Incident Response Protocol All statesterritories should make urgent inquiries as to the incidence and aetiology of recent cases of gastrointestinal disturbance presenting to emergency departments of hospitals in their jurisdictions Where a foodstuff is implicated in the outbreak urgent consideration should be given to implementing a nationwide recall of the food using the usual FSANZ procedures The recall should be given the widest possible publicity by FSANZ and through media releases and interviewsmedia conferences coordinated by the NEMRN The WHO will also be advised promptly by the Australian Government If the implicated food has been exported to foreign countries the operational response to the recall will be coordinated through the Department of Agriculture The countries involved should be advised of the recall as a matter of urgency through DFAT on advice from FSANZ If the implicated food has been otherwise exported (eg in meals provided to passengers on international airlines or cargo or cruise ships) the Australian Government will urgently advise WHO and the countries served by those airlines and vessels of the food recall together with relevant epidemiological information such as the dates on which the food may have been consumed PEP should be offered as indicated to persons who have eaten the implicated foods and discontinued only if the foodstuff is confirmed as not contaminated

COVERT RELEASE If a covert release of CBRN materials is suspected eg one or a small number of cases of anthrax are diagnosed all stateterritory health authorities should be contacted through the AHPPC Secretariat and an urgent teleconference of the AHPPC convened to determine whether cases may have occurred in their jurisdictions Data will be collated and coordinated by the Australian Government through the AHPPCCDNA Secretariat or the NIR as appropriate Information will be provided to the public on the status of the incident and protective measures which should be taken through media releases media conferences and interviews with the CMO CHOs and their delegates Appropriate technical information will also be provided to professional groups such as medical colleges police and emergency services agencies Extensive use will be made of the Australian Government and State health authoritiesrsquo web sites and all communications activities will be coordinated at the Australian Government level through the NEMRN

CBRNINC PLAN VERSION 1

Page | 37

The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

CBRNINC PLAN VERSION 1

Page | 38

MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

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APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

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Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

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Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

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Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

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Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

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National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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The Department of Health Issues Media Unit (HIMU) will work closely with the Public Affairs Unit of the Australian Government AGD which under current National Security Public Information Guidelines must approve all communications activities If a patient with CBRN-related illness has an overseas travel history which coincides with the incubation period prodromal period prior to manifest illness for the disease both the country from which the patient came and WHO will immediately be advised of the case by the Australian Government to enable appropriate epidemiological studies and contact tracing to be undertaken Border protection agencies (Agriculture DFAT DIBP) and the Australian Government Department of Infrastructure and Regional Development will also be notified to enable additional controls to be implemented

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MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

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RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

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CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

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AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

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APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

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Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

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Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

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Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

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Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

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APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

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APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

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MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS RELEASE IN AUSTRALIA RESPONSE CODE 0 NO CREDIBLE THREAT Intelligence organisations advise there is no credible threat of a deliberate release of CBRN materials in Australia JURISDICTIONAL ACTIONS

Review laboratory capability including test availability and validation staff training and surge capacity

Consider a list of high-risk laboratory personnel who may be appropriate for vaccination if available

Develop and implement CBRN training programs for health-care workers and emergency workers who would be called upon to respond to an incident

Develop and maintain plans for receipt of activated components of the NMS

Develop and maintain plans and logistical support for rapid distribution of antibiotics vaccine antidotes decorporation agents and PPE as required

AUSTRALIAN GOVERNMENT ACTIONS

Regularly assess the inventory of key antibiotics in Australia eg doxycycline ciprofloxacin amoxycillin

If a vaccine is available regularly assess the inventory expiry dates and location of stocks of each vaccine in Australia

Develop and maintain plans and logistical support for rapid deployment of the NMS as required

Develop databases for registration of exposed or symptomatic patients clinical presentation of patients prophylaxis or therapy administered and adverse reactions to these and mortalityrecovery

Prepare content for educational materials with the CDNA ARPANSA or clinical toxicologists as appropriate

Review and update frequently asked question (FAQ) sheets for the public on the signs symptoms treatment and preventive measures including personal hygiene measures

Develop the logistics for distribution of FAQ sheets (eg hard copy by mail email web sites and newspaper advertisements) Do not distribute at this stage

Prepare content for posters for hospitals and doctorsrsquo surgeries concerning procedures for decontamination of clothing if a patient presents without prior decontamination Do not distribute at this stage

Prepare summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries Do not distribute at this stage

Build relationships with key media personnel

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 39: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 39

RESPONSE CODE 1 CREDIBLE THREAT OF RELEASE Intelligence authorities advise that there is a credible threat of release of CBRN materials in Australia eg release of CBRN materials overseas and intelligence of threat in Australia or overt threat from a credible terrorist group or individual No cases in Australia Actions as per Response Code 0 plus the following JURISDICTIONAL ACTIONS

Consider vaccination of laboratory personnel at high risk if relevant On the basis of intelligence reports decisions are to be taken as to whether to offer vaccination to the entire laboratory personnel or only those in a particular geographical location or to defer all vaccination

Participate in teleconferences of the AHPPC CDNA Jurisdictional Executive Group (CDNA-JEG) PHLN and other relevant agencies as indicated by the nature of the incident

Activate logistical support for receipt of components of the NMS

Activate logistical support for rapid distribution of antibiotics and vaccines

AUSTRALIAN GOVERNMENT ACTIONS

Health will participate as necessary in the Australian Government Interdepartmental Committee (IDC) which deals with national policy and implementation issues

Health will convene teleconferences of the relevant agencies and authorities

Health will assess the adequacy of NMS stocks and obtain additional supplies if necessary Deploy supplies of the stockpile as required to strategic locations as identified by stateterritory health authorities

If a vaccine is available Health will assess the adequacy of vaccine stocks and obtain additional supplies if necessary

Review and update the summary information on case detection diagnostic testing clinical management and infection control for hospitals and doctorsrsquo surgeries

HIMU will work closely with the Public Affairs Unit of AGD which under current National Security Public Information Guidelines must approve all communications activities

Health will notify the AGD CCC of actions taken and provide any other information relevant to the elevated threat

RESPONSE CODE 2 RELEASE IMMENENT

Intelligence agencies advise that the release of CBRN materials in Australia is imminent Actions as per Response Code 1 plus the following JURISDICTIONAL ACTIONS

PHLN CWALN and ARPANSA ANSTO laboratories notify clinical laboratories

Clinical and reference laboratories review their ability to respond if a release occurs

AUSTRALIAN GOVERNMENT ACTIONS

Health to notify reference laboratories Clinical laboratories to be notified by PHLN CWALN and ARPANSA ANSTO member laboratories

CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 40

CDNA and PHLN report to AHPPC

Health will participate as necessary in the IDC which deals with national policy and implementation issues

It is likely in this scenario that the Australian Governmentrsquos Special Incident Task Force (SITF) will be convened Health is a member of that task force and will ensure open dialogue with the SITF about actions being taken by health authorities

RESPONSE CODE 3 OVERT RELEASE OR SUSPECTED COVERT RELEASE Overt release of CBRN materials in Australia is identified by stateterritory health authorities or covert release is suspected because either

one case of human CBRN-related illness without plausible exposure history is diagnosed or

intelligence agencies advise that such an event has occurred

Actions as per Response Codes 1 and 2 plus the following JURISDICTIONAL ACTIONS

Reference laboratories implement staff rosters to deal with CBRN agent identification and additional workload

States and territories to initiate logging of data on exposed or symptomatic patients clinical presentation of patients nature of prophylaxis or therapy administered and adverse reactions to these mortalityrecovery Particular attention to be paid to adverse reactions in pregnant women and children in respect of off-label indications

Health will distribute FAQ sheets for the public concerning signs symptoms treatment preventive measures for the identified CBRN agent as required Distribution by mail email web sites newspaper advertisements

State health authorities notify the local police and Health of new cases where criminal activity is suspected

Liaison with police and security agencies on new suspected or confirmed CBRN-related cases by telephone in the first instance followed up with details in hard copy

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

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Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 41: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 41

AUSTRALIAN GOVERNMENT ACTIONS

Health activates the NIR

National data to be collated by the Australian Government

Liaise and share relevant data with the Department of Agriculture

Healthrsquos HIMU to activate the NEMRN establish a national communications centre and invoke the national media response plan

Participate in SITF

A suspected covert release of a CBRN material may constitute an act of terrorism against Australia In this case the NCTP may be activated The NCTP outlines responsibilities authorities and the mechanisms to prevent or if they occur manage acts of terrorism and their consequences within Australia The ramifications of any terrorist attack will necessitate high-level decision making in the Australian Government and the states and territories

The response will need to take into account public anxiety and any international dimensions The scale of the situation may also dictate special cooperative responses Throughout the response the primary goals are minimising loss of life preventing further attacks and recovery

Report to the World Health Organization (WHO) under the International Health Regulations (IHRs)

RESPONSE CODE 4 MULTIPLE RELEASES OF CBRN MATERIAL This situation is to apply when two or more releases of CBRN material in Australia have been confirmed or a single release has been confirmed and intelligence agencies advise that a second release is imminent The decision to go to Code 4 will rest with Healthrsquos Secretary Deputy Secretary or CMO on advice from relevant intelligence agencies Actions as per Response Code 3 plus the following JURISDICTIONAL ACTIONS

Manage surge capacity in health-care system

Report on the response and any requirements in AHPPC CDNA and PHLN teleconferences

CDNA nominated representative informs AHPPC of status

AUSTRALIAN GOVERNMENT ACTIONS

Assist jurisdictions with coordination of medical response from other jurisdictions through AHPPC and EMA

Arrange international assistance if required

Extend more widely education of the public through distribution of FAQs and media advertisements

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

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Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 42: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 42

APPENDIX 6 KEY STAKEHOLDERS Clear roles responsibilities and lines of communication both within the states and territories concerned and between the states and territories and the Australian Government are required to implement an effective response to a CBRN incident In essence the state and territory health authorities are responsible for initial health response to CBRN incidents The role of Health will include overseeing the national health response including maintenance of the NMS and (in conjunction with the Attorney-Generalrsquos Public Affairs Unit) coordination of the national news media response The response to the threat may differ between jurisdictions according to lead authority arrangements and the requirements of the State concerned The roles and responsibilities of the Australian and stateterritory governments are set out below Response plans should be complementary to the following Australian Government plans coordinated from the NIR the health aspects of which are 1 National Health Emergency Response Arrangements

2 Australian Government Disaster Response Plan (COMDISPLAN)

3 Australian Government Overseas Disaster Assistance Plan (AUSASSISTPLAN)

4 Australian Veterinary Emergency Plan (AUSVETPLAN)

5 National Counter-Terrorism Plan (NCTP)

6 National Counter-Terrorism Handbook

7 National Security Public Information Guidelines

8 Guidance on the national coordination arrangements for responding to the deliberate use of chemical biological and radiological materials

9 Specific Australian Guidelines on various CBRN materials

The Department of Agriculture coordinates AUSVETPLAN the national plan for dealing with exotic animal disease emergencies Health has no operational responsibilities under this plan but may provide assistance to the States and Territories under COMDISPLAN in support of AUSVETPLAN operations When the incident involves livestock or other animals the state or territory Department of Agriculture primary industries or other relevant animal health authority will respond operationally according to the national AUSVETPLAN Disease Strategy for the relevant CBRN agent The Australian Chief Veterinary Officer (CVO) will also be notified of the event and national arrangements made to ensure effective management of the disease both nationally and internationally This may involve convening the Consultative Committee on Emergency Animal Diseases (CCEAD) which will coordinate a national veterinary response to the incident The AGD coordinates the plansdocuments mentioned at pointrsquos e f and g above Health has operational national coordination and media management roles in all these plans

CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

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Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 43

APPENDIX 7 ROLES AND RESPONSIBILITIES STATE AND TERRITORY ROLES AND RESPONSIBILITIES While each state and territory needs to determine governance structures the guidelines advise the following model and the states and territories should decide on levels of authority and clarify roles and responsibilities in a CBRN event State and territory plans for response to a CBRN event should give consideration to

hoax assessment and identification of suspicious unidentified substances

developing protocols for reporting to and requesting assistance from Health

incident-site management planning including defining the area of contamination determining who has been exposed evacuation of people at risk containing the agent collecting evidence and samples sealing andor decontamination of the affected area and confirmation that the area is safe after decontamination

data collection and data transfer for national collation

operational plans for hospitals including surge capacity

decontamination plans

promulgation of infection-control requirements in health-care facilities and the community

laboratory management and surge capacity

processes for requesting vaccine and antibiotics from the Australian Government

the state or territoryrsquos own stock of antibiotics

logistical arrangements for the receipt and rapid distribution of the NMS

media liaison

developing databases including

prophylaxis or therapy administered and adverse reactions to these

clinical presentation of patients and

mortalityrecovery register(s) of exposed or symptomatic patients

State and Territory Departments of Agriculture are responsible for the response to animal health aspects of an incident AUSTRALIAN GOVERNMENT ROLES AND RESPONSIBILITIES Health will provide overall national coordination of the health response liaise with the international community give logistic support to states and territories activate the NIR and provide leadership in the coordination of national emergency media management arrangements In a large-scale emergency involving CBRN-related cases it is likely that the Australian Government will form an Inter-Departmental Committee (IDC) or taskforce to coordinate the work of Australian Government departments and agencies The lead agency of the IDC or taskforce will be determined at the time of the emergency

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Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

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APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

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APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

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APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

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Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

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APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

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APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

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Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

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Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

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Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 44: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 44

Health maintains a stockpile of antidotes antibiotics vaccines and treatments to be mobilised to aid in the management of a CBRN incident The department in close collaboration with state and territory CHOs or their delegates will direct the distribution of elements of the stockpile The Australian Defence Force (ADF) maintains the Special Operations Engineering Regiment which may be deployed to assess and respond to CBRN incidents The circumstances of a terrorist event will determine whether or not security agencies will declare it a national terrorist situation If a national terrorist situation is declared overall responsibility for policy and broad strategy transfers to the Australian Government in close consultation with relevant states or territories This may involve determining overall policy objectives setting priorities between policy objectives where resources are inadequate pre-positioning resources international liaison and determining public communication messages The Australian Governmentrsquos role does not include operational management and deployment of emergency services The Commissioners of Police including the Commissioner of the Australian Federal Police (AFP) will determine the command and resourcing of the national police response In other respects the management arrangements in a national terrorist situation will replicate those in other terrorist situations Specific response and management of a CBRN event at the Australian Government level will include

consultation to refine these guidelines with state and territory representatives

assistance to states and territories in coordinating the response maintenance of vaccine

and antibiotics stock levels and delivery to each state and territory according to the criteria

outlined at each code level

assistance to states and territories in provision of training materials

communication of the national status of an event to the media and general public and to

the international community through the WHO

development of databases including

o stock levels and deployment of vaccine and antibiotics

o adverse reactions to vaccine

o exposed cases and PEP

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 45: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 45

APPENDIX 8 MEDIA RESPONSE TO A CASE OF CBRN-RELATED ILLNESS IN AUSTRALIA BACKGROUND A CBRN-related illness outbreak in Australia either naturally occurring or from a deliberate release would generate significant media interest Good communication during such an event is crucial to reduce public anxiety and improve the effectiveness of emergency service responders and health-care workers The public should understand that a plan is being followed and be given explanations for the various actions being undertaken One of the primary communication objectives is to instil and maintain public confidence by providing the public with information that addresses their questions fears and concerns In a deliberate CBRN release media arrangements and public statements would be coordinated as specified in the ANZCTC National Counter-Terrorism Plan 2012 The HIMU would play a leading role in the national coordination of health-related media responses to a CBRN-related outbreak Coordination arrangements are specified within the National Health Security Agreement Plans include the activation of NEMRN and close liaison with state and territory governments health departments and allied organisations that would have a role during such an event The HIMU also provides media services to the Australian Governmentrsquos CMO who would be a key national spokesperson during a CBRN-related outbreak The HIMU is also a key member of national security media arrangements undertaken by the Australian Government AGD Public Affairs Unit (PAU) The HIMU will work closely with AGD PAU whose responsibility it is to coordinate the Whole of Government talking points brief OBJECTIVES In a CBRN-related outbreak the Health communications strategy will seek to

provide national leadership and guidance to state and territory health and other relevant media teamsofficers during the incident

ensure the smooth and rapid distribution of accurate information to the Australian and overseas media relevant agencies and organisations and the Australian public as outlined in the National Security Public Information Guidelines and

ensure that public confidence is maintained in the Australian Governmentrsquos system to respond to the incident

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 46: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 46

APPENDIX 9 COMMUNICATIONS ACTIVITIES ACCORDING TO RESPONSE CODES RESPONSE CODE 0 At Code 0 it is important to start to build relationships with key media personnel who can be used to convey information to the public should an event occur The task is to increase the range and type of CBRN information available to the public health-care providers policy makers and the media Communications should outline how the public-health system will respond the roles and responsibilities of the different sectors involved and reasonable expectations regarding the scope and effects of public-health actions Pre-prepared media responses directed to those groups might be useful The HIMU has undertaken such work in conjunction with national security agencies and the media advisers of state and territory health departments RESPONSE CODE 1 HIMU in conjunction with the CMO and relevant national security agencies will take the lead role in explaining to the media the nature of the heightened threat and the response required This communication will include strong messages about specific measures that may need to be taken by the general public HIMU will continue to update Code 0 communication activities RESPONSE CODE 2 Health will activate a dedicated CBRN agent web site and a national telephone inquiry line HIMU will collaborate closely with media advisers in state and territory health departments particularly in the state or territory where the threat is imminent HIMU will also work closely with national security agencies and will activate the NEMRN to coordinate a national public response including media conferences and public statements RESPONSE CODES 3 AND 4 The full resources of HIMU will be deployed to handle media management and the NEMRN activated at its highest level of response The national media plan for a response to a chemical biological or radiological incident in Australia will be invoked involving national security agencies and state and territory governments Health will establish a national communication centre staffed by media advisers from Health and seconded media officers from relevant Departments The communications centre may be required to operate 24 hours a day and 7 days a week An advisory team will be appointed consisting of medical officers familiar with CBRN response plans and guidelines and epidemiologists from the Health Medical and Science Advisory Unit The national communication centre will respond to inquiries from the media public and health-care providers

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 47: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 47

APPENDIX 10 INTERNATIONAL ASPECTS OF CBRN INCIDENTS INTERNATIONAL HEALTH REGULATIONS Australia is signatory to the IHR which requires notification to WHO of the release of chemical biological or radiological agents with the potential to cause widespread injury illness or death Australia is expected to effectively manage public health threats and strengthen and maintain the capacity to detect report and respond to public health events The National Health Security Agreement provides the mechanisms to enable cooperation at all levels of Australian government to achieve enhanced surveillance and information exchange to support this objective Health is the nationally competent authority under the IHR

INTERNATIONAL RADIATION CONVENTIONS Australia is signatory to the international Convention on the early notification of a nuclear accident and Convention on assistance in a nuclear or radiological emergency ARPANSA is the national competent authority to notify IAEA of events in Australia and receive requests for assistance The ARPANSA Code of Practice for Security of Radioactive Sources is consistent with the objectives of the IAEA

BIOLOGICAL AND TOXINS WEAPONS CONVENTION (BWC) The SSBA Regulatory Scheme contributes to fulfilment of Australias obligations under the Convention on the Prohibition of the Development Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction (BWC) and UN Security Council Resolution 1540

CHEMICAL WEAPONS CONVENTION (CWC) The Convention on the prohibition of the development production stockpiling and use of chemical weapons and their destruction (CWC) is an international treaty that bans the development production possession or use of chemical weapons and requires the destruction of existing weapons Australia signed the Convention in January 1993 and ratified in May 1994 Australia is an active player in ensuring that the treaty is effective in promoting international security

NUCLEAR NON-PROLIFERATION Australia has international obligations under the Comprehensive Nuclear Test Ban Treaty the Nuclear Non-Proliferation Treaty the Convention on the Physical Protection of Nuclear Material and various bilateral safeguards agreements with a number of countries

THE AUSTRALIAN SAFEGUARDS AND NON-PROLIFERATION OFFICE (ASNO) ASNO ensures Australia meets its international obligations in relation to nuclear and

chemical weapons and supports Australian obligations in relation to biological weapons

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

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APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 48: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 48

APPENDIX 11 RELATED PLANS AND DOCUMENTS

NATIONAL HEALTH EMERGENCY RESPONSE ARRANGEMENTS

AUSTRAUMAPLAN Domestic Response Plan for Mass Casualty Incidents of National Consequence

Severe Burn Injury Annex (AUSBURNPLAN)

Criminal and Terrorism Incident Annex

Paediatric Annex

Health CBRNINC Clinical Guidelines

Chemical Guidelines

Radiological Guidelines

Smallpox Guidelines

Anthrax Guidelines

OTHER PLANS and DOCUMENTS

COMDISPLAN - Australian Government Disaster Response Plan

AUSASSISTPLAN ndash Australian Government Overseas Disaster Assistance Plan

OSMASSCASPLAN ndash National Response Plan for Mass Casualty Incidents involving Australians Overseas

AUSVETPLAN ndash Australian Veterinary Emergency Plan

National Counter-Terrorism Plan

National Counter-Terrorism Handbook

National Security Public Information Guidelines

National Health Security Act 2007

National Health Security Regulations 2008

National Counter Terrorism Suspicious SubstancesPackages Assessment Guidelines ndash September 2011

ARPANSA Code of Practice for Security of Radioactive Sources

Comprehensive Nuclear Test Ban Treaty

Convention on the physical protection of nuclear material

Convention on the early notification of a nuclear accident

Convention on assistance in a nuclear or radiological emergency

Code of Practice for Security of Radioactive Sources

CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 49

APPENDIX 12 STATE AND TERRITORY EMERGENCY OPERATIONS CENTRE CONTACT DETAILS

State

Territory Agency Email Phone(s)

ACT HPS

ACT Health

Health Protection Service

hpsactgovau T (02) 6205 1700

F (02) 6205 1705

Pager (02) 9962 4155

NSW SHEOC

NSW Health

NSW State Health Emergency Operations Centre

hsfacambulancenswgovau T (02) 8644 8444

F (02) 8644 8450

NCCTRC (RDH)

NT Health

Centre for Disease Control

Dr Steven Skov CHO stevenskovntgovau

Xavier Schobben ndash Director Environmental Health

Xavierschobbenntgovau

T 0407 877 535

T 0401 116 460

QLD SHECC

QLD Health

State Health Emergency

Coordination Centre

shecchealthqldgovau

T (07) 3405 6003

F (07) 3008 7356

On Call Officer 0407 127 126

SA SCC-H

SA Health

State Control Centre - Health

emergencymanagementHealthsagovau

T (08) 8226 7115

F (08) 8463 3820

On-Call Officer Pager

T 08 8378 9194

Pager 104930

TAS DHHS

ECC

TAS Dept of Health and

Human Services Emergency

Coordination Centre

(when activated)

emermandhhstasgovau T (03) 6233 4127

F (03) 6233 6392

VIC PHEOC

Vic Health

Victoria Public Health

Emergency Operations Centre

semcdhsvicgovau

On-Call Officer Pager

T 1300 790 733

F (03) 9096 0003

WA SHEOC

WA Health

State Health Emergency

Operations Centre

sheocHealthwagovau 247 On-Call Officer

T (08) 9328 0553

SHEOC (when activated)

T (08) 9222 4444

F (08) 9222 2304

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

Page 50: HEALTH CBRNINC PLAN - Department of Health | …File/health-cbrninc-plan-feb2014.pdf · MATRIX FOR THE INVESTIGATION AND RESPONSE TO A SUSPECTED CBRN MATERIALS ... REMPAN Radiation

CBRNINC PLAN VERSION 1

Page | 50

APPENDIX 13 SYNOPSIS OF THE PROTOCOLS FOR EVIDENTIARY RECOVERY BY HEALTH PROFESSIONALS These protocols were developed by the ANZCTC through consultation with relevant Health experts and endorsed by AHPPC Recovery of physical evidence is crucial in assisting police investigators to establish lines of enquiry Early isolation of that physical evidence with a continuity chain linking it to its place in the scene is the best result for investigators In a mass casualty scenario it is likely that health professionals may be the first to have contact with the victims These first contacts provide an opportunity to secure valuable physical evidence that may be lost through clothing removal medical procedures movement or transport of patients and decontamination of victims It may occur in the absence of police who would normally recognise collect and secure the evidence Whilst the immediate health of injured persons is always the priority of health professionals consideration and attention to the evidentiary recovery process will give investigators opportunities that may be otherwise lost forever The protocols aim to enhance the amount and quality of evidence that is recovered with a standardised process and easy-to-follow steps No formal training in evidence collection is required to implement the protocols The best forensic value is obtained by isolation of physical evidence in a suitable container by a person wearing fresh gloves Labelling the item provides context to the article Continuity is ensured by securing collected articles

BAG items using standard infection control precautions changing gloves between patients If possible avoid cutting garments through holes caused by weapons or chemicals Whilst it is ideal to bag each article separately in mass casualty scenarios it may be simpler to bag all the items from one individual together Include debris on clothing and bedding and shrapnel removed from patients

TAG with brief details of who collected it the time date location of collection and a simple description of the item eg lsquotrousersrsquo Attaching a hospital label with a unique patient identifier provides patient details Identify wet articles on the tag for drying by forensic staff subsequently

SEAL bags to prevent loss tampering or cross-contamination of articles

SECURE all items that are bagged tagged and sealed in a designated locked area or under direct supervision A log of items secured and details of handover to investigators is appropriate

Normal coronial protocols should be observed for deceased persons Decontamination takes priority in CBRN incidents but bagged contaminated effects should be managed as for other evidence that is collected In a mass casualty scenario it is probably of greatest value to collect the effects of admitted patients only and allow the investigators to follow up patients discharged from the Emergency Department Further information on the protocols is obtainable from jurisdictional Police Counter-Terrorism units

CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 51

APPENDIX 14 GLOSSARYDEFINITIONS

Australian (Counter) Bioterrorism Laboratory Network (ABLN)

The ABLN brings together laboratory experts from public health and law enforcement sectors to strengthen national capacity and enhance coordination of detection identification and response to biological agents of security concern The ABLN has representatives from key public health laboratories in Victoria Queensland Western Australia and New South Wales (NSW) Also represented are the Australian Federal Police (AFP) Forensic Operations NSW Police Force Forensic Counter-terrorism Laboratory Australian Animal Health Laboratory CSIRO (AAHL) Defence Science and Technology Organisation (DSTO) Technical and Forensic Intelligence AFP

Affected jurisdiction A state or territory where a CBRN incident has occurred (or is expected to occur)

Agency

A government or non-government agency

Attorney Generals Department Emergency Management of Australia (AGD EMA)

The AGD EMA is the agency responsible for planning and coordinating Australian Governmentrsquos physical assistance to jurisdictions under the auspices of the Australian Government Disaster Response Plan (COMDISPLAN) AGD EMA maintains lead agency status for all multi-agency Australian Government coordination including provision of medical transport through the AMTCG

All Hazards

Dealing with all types of emergencies using common principles underpinning the emergency arrangements as many risks can cause similar problems and similar measures such as warning evacuation medical services and community recovery will be required

Australian Government Crisis Coordination Centre (CCC)

A dedicated facility provided by AGD EMA that will coordinate the non-Health specific consequence management arrangements of the disaster Tasking recommended by Health and the AHPPC will be actioned by the CCC The CCC will liaise through the state and territory emergency operations centres

CBRNINC PLAN VERSION 1

Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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Page | 52

Australian Government Crisis Committee (AGCC)

The primary forum for coordinating the Australian Government response to a major incident including consolidating information and coordinating information exchange advising ministers and coordinating implementation of ministerial decisions and coordinating with states and territories to implement additional measures if needed

Australian Health Protection Principal Committee (AHPPC)

Established in 2006 as the peak national Health emergency management committee with the authority to plan prepare and coordinate the national Health response to significant incidents

Australian Medical Transport Coordination Group (AMTCG)

AMTCG provides a nationally coordinated medical transport response as part of Australiarsquos casualty response system (including for approved foreign nationals) AMTCG is convened and chaired by AGD EMA Once convened AGD EMA will coordinate all aero-Australian medical transportation of casualties with the support of the AMTCG

Australian Nuclear Science and Technology Organisation (ANSTO)

An Australian Government research organisation delivering radiation advice scientific services and products ANSTO operates the Open Water Australian Lightwater (OPAL) research nuclear reactor as well as providing training and equipment calibration

CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 53

Australia New Zealand Counter Terrorism Committee (ANZCTC)

The ANZCTC is a non-operational body established by the

Inter-Governmental Agreement (IGA) on Australiarsquos

National Counter-Terrorism Arrangements The ANZCTC

functions as a high level body and is comprised of

representatives from the Australian Government

Australian state and territory governments and the New

Zealand Government

The objectives of the ANZCTC are to contribute to the

security of Australia and New Zealand through

maintaining the National Counter-Terrorism Plan and

associated documentation

providing expert strategic and policy advice to heads

of government and other relevant ministers

coordinating an effective nation-wide counter-

terrorism capability

maintaining effective arrangements for the sharing of

relevant intelligence and information between all

relevant agencies and jurisdictions

providing advice in relation to the administration of

the special fund to maintain and develop the nation-

wide capability administered by the Australian

Government on the basis of advice from the ANZCTC

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

Part of the Department of Health portfolio responsible for protecting the health and safety of people and the environment from the harmful effects of ionising and non-ionising radiation through the provision of expertise advice regulation leading the development of standards and guidelines national amp international liaison and research ARPANSA is also the WHO Collaborating Centre for Radiation Protection and jointly with Peter MacCallum Cancer Centre is a member of the WHO REMPAN

Australian Safeguards and Non-proliferation Office (ASNO)

A division within the Australian DFAT ASNO ensures that Australia meets its international obligations with respect to the

Chemical Weapons Convention

Biological and Toxins Weapons Convention

Comprehensive Test Ban Treaty

Nuclear Non-proliferation Treaty

Convention on the Protection of Nuclear Material

CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

CBRNINC PLAN VERSION 1

Page | 55

Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

CBRNINC PLAN VERSION 1

Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 54

Biological Agent A micro-organism which causes disease in man plants or animals or causes the deterioration of material

Casualties

The human impact of a disaster or emergency presented in the form of numbers of people killed injured sick missing or homeless

CBRN Chemical Biological Radiological and Nuclear

CBRN incident

An incident which involves the deliberate or threatened release of a Chemical Biological Radiological agent or a Nuclear device with potential or actual harm to people or property

Chemical Hazards

Hazards involving chemicals or processes which may realise their potential through agencies such as fire explosion toxic or corrosive effects

Command

Refers to the direction of members and resources of an agencyorganisation in the performance of the agencyorganisations roles and tasks Authority to command is established by legislation or by agreement within the agencyorganisation Command relates to agenciesorganisations only and operates vertically within the agencyorganisation

Commonwealth Industrial Scientific and Research Organisation (CSIRO)

The Australian national science agency role includes multidisciplinary research in preventative health This includes vaccine development and manufacture and measurement of DNA damage from environmental exposures including low level ionising radiation a tool which may be utilised in accidental radiation exposures

Communicable Disease Network of Australia (CDNA)

A standing-committee of the AHPPC responsible for national public health coordination of communicable disease surveillance prevention and control CDNA provides policy advice on the control of communicable disease and liaises with other regional communicable disease agencies and programs

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Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

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International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

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National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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Consequence Management

Measures taken to alleviate suffering damage loss and hardship protect public health and safety restore essential government services and provide emergency relief to governments businesses and individuals affected

Control

Refers to the overall direction of the activities agencies or individuals concerned Control operates horizontally across all agenciesorganisations functions and individuals Situations or incidents are controlled The NatHealth Arrangements do not relate to the concept of control of the Australian health sector nor is it intended to direct or replace incident management arrangements by individual jurisdictions or health authorities

Coordination

Coordination is the act of managing inter-dependencies between activities In emergency management Coordination involves the bringing together of many organisations to pursue a common goal and to share resources information expertise and decision making

Crisis Management

Deliberate and immediate management for whole-of-government consideration of policy decision-making and coordination for the prevention andor resolution of situationsincidents in order to maintain national security and confidence in government

Chemical Warfare Agent Laboratory Network (CWALN)

A network of forensic and other laboratories sponsored by EMA the National Institute of Forensic Services (NIFS) and DSTO CWALN use nationally agreed protocols for preliminary confirmation of the presence of chemical warfare agent in environmental samples associated with sites contaminated in a terrorist incident Definitive analysis is provided at DSTO

Chemical Weapons Convention (CWC)

The Convention on the Prohibition of the Development Production Stockpiling and Use of Chemical Weapons and their Destruction

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Page | 56

Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

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Defence Assistance to the Civilian Community (DACC)

The provision of Defence resources for the performance of emergency or non-emergency support within Australia and its territories that are primarily the responsibility of the civil community or other government organisations There are three primary DACC categories DACC Category 1 is assistance where immediate action is necessary to save human life alleviate suffering prevent extensive loss of animal life or prevent widespread loss of or damage to property in a localised emergency situation DACC Category 2 is assistance where action is necessary to save human life or alleviate suffering during a more extensive or continuing disaster following initial Category 1 assistance DACC Category 3 is assistance associated with recovery from an emergency or disaster which is not directly related to the saving of life or property

Defence Science and Technology Organisation (DSTO)

DSTO provides scientific and technical support to Defence and national security operations DSTO has scientific expertise and laboratory capabilities in CBRN including modelling DSTO is a lead agency in the CWALN providing definitive analysis of samples containing chemical warfare agents

Emergency

An event actual or imminent which endangers or threatens to endanger life property or the environment and which requires a significant or coordinated response

Environmental Health Committee (enHealth)

A standing-committee of the AHPPC that provides nationally agreed Health policy advice coordinates research information and practical resources on environmental Health matters

Hazard A potential or existing condition that may cause harm to people or damage to property or the environment

HAZMAT Hazardous materials

International Atomic Energy Agency (IAEA)

IAEA is the global focal point for preparedness event reporting and response to nuclear and radiological incidents They have established a global Response Assistance Network (RANET) of teams qualified to respond rapidly to nuclear and radiological emergencies

CBRNINC PLAN VERSION 1

Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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Page | 57

International Health Regulations (IHRs)

An international legal instrument binding on 194 countries across the globe including all the Member States of the WHO The aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHRs require countries to report certain disease outbreaks and public health events to the WHO

Liaison Officer (LO)

A person nominated or appointed by an organisation or functional area to represent that organisation or functional area at a control centre emergency operations centre coordination centre or site control point A liaison officer maintains communications with and conveys directions requests to their organisation or functional area and provides advice on the status capabilities actions and requirements of their organisation or functional area

Logistics

The range of operational activities concerned with supply handling transportation and distribution of materials Also applicable to the transportation and support of people

Medical Assessment Element

A team which attends a Mass Casualty Incident (MCI) as soon as possible to gather health and logistics intelligence and provides focused timely and accurate communication back to jurisdictions

National Crisis Committee (NCC)

The primary forum for coordinating whole-of-government response to an incident of national significance including consolidation of information and coordination of information exchange advice to ministers and coordination of ministerial decisions across the Federal State and Territory governments

National Health Emergency Management Subcommittee (NHEMS)

A standing-committee of the AHPPC that addresses the operational aspects of disaster medicine and health emergency management in an all hazards context

National Health Emergency Response Arrangements (NatHealth Arrangements)

The principle response document of the AHPPC that outlines the strategic authorities responsibilities arrangements and the mechanisms that enable a coordinated national health sector response to emergencies of national consequence

CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

CBRNINC PLAN VERSION 1

Page | 59

Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

CBRNINC PLAN VERSION 1

Page | 60

Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

Page | 58

National Incident Room (NIR)

An operational response capability located within Health The NIR acts a conduit for national coordination of response and recovery operations within Health and between state and territory health authorities other Commonwealth operations centres and the international Health community

National Medical Stockpile (NMS)

Is a strategic reserve of drugs vaccines antidotes and medical equipment that can be used in a national response to a public health emergency such as a CBRN incident The NMS established in 2002 is managed by Health and items from the stockpile are released on the authority of the CMO The NMS is held in various locations around Australia to facilitate rapid distribution in an emergency The contents of the NMS are determined by health on the basis of expert medical and public health advice

Non-Government Organisation (NGO)

Non-profit making organisation operating at local national or international levels with no statutory ties with national government

Nuclear Safety Committee (NSC)

Established under the ARPANS Act 1998 to advise on nuclear safety and the safety and security of controlled facilities including the reactor at ANSTO

Preparedness

Arrangements to ensure that should an emergency occur all those resources and services which are needed to cope with the effects can be efficiently mobilised and

deployed In relation to an emergency includes arrangements or plans to deal with an emergency or the effects of an emergency (Source AGCMF) This may include establishing the plans training exercises and resources necessary to achieve readiness for all hazards including a MCI from trauma

Prevention

Measures to eliminate or reduce the incidence or severity of emergencies by preventing events from occurring or where this is not possible by putting in place arrangements to mitigate their effects

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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Public Health Laboratory Network (PHLN)

A standing-committee of the AHPPC A collaborative group of laboratories which have expertise and provide services in public health microbiology including veterinary microbiology with a human health impact Develop nationally consistent guidelines for the detection and monitoring of notifiable infectious diseases

Radiation Emergency Medical Preparedness Assistance Network (REMPAN)

World Health Organization (WHO) network of collaborating centres for practical assistance and advice to countries in case of overexposure to radiation or for radiation related public health advice ARPANSA and Peter MacCallum Cancer Centre (PMCC) Melbourne together are one of 13 WHO Collaborating Centres The role of PMCC is to provide medical advice for Australian REMPAN activities Expert radiation medicine advice is obtainable in all states from local radiation oncology centres

Radiation Health and Safety Advisory Council

Advises the ARPANSA CEO on radiation protection and nuclear safety emerging issues community concerns recommendations policies codes and standards

Radiation Health Committee (RHC)

Provides advice on radiation policy including draft standards to the ARPANSA CEO and the Radiation Health and Safety Committee

Recovery

In relation to an emergency In relation to an emergency the coordinated process of supporting emergency affected communities in reconstruction of the physical infrastructure and restoration of emotional social economic and physical wellbeing In this document refers to all types of emergency actions dedicated to the continued protection of the public or promoting the resumption of normal activities in the affected area

Response

In relation to an emergency the coordinated process of supporting crisis-affected communities through the reconstruction of physical infrastructure and restoration of psychological social economic environmental and physical wellbeing Executing the plan and resources identified to perform those duties and services to preserve and protect life and property

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care

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CBRNINC PLAN VERSION 1

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Risk A concept used to describe the likelihood of harmful consequences arising from the interaction of hazards communities and the environment

Risk Assessment

The process used to determine risk management priorities by evaluating and comparing the level of risk against predetermined standards target risk levels or other criteria

Risk Management The systematic application of management policies procedures and practices to the tasks of identifying analysing evaluating treating and monitoring risk

Security Sensitive Biological Agent (SSBA) Regulatory Scheme

The SSBA Regulatory Scheme is administered by Health The Scheme aims to limit opportunities for acts of bioterrorism or biocrime to occur using harmful biological agents It also provides standards for the handling and transport of samples from affected animals or persons The Scheme builds on Australias obligations under the Biological and Toxins Weapons Convention and UN Security Council Resolution 1540

Standing Operating Procedures

Internal response procedures that document operational and administrative procedures to be followed during activation of emergency plans

StateTerritory Control Centre A dedicated (health) control facility from which a stateterritory response will be coordinated

Supporting Jurisdiction A state or territory able to provide support to an affected jurisdiction

Triage The process by which casualties are sorted and prioritised according to their need for first-aid resuscitation and emergency transportation and definitive care