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MASH – Work-Package 9
MASH EU Project 2007/209
Mass casualties and Health care following the
release of toxic chemicals or radioactive material
WP 9 – Seminar to discuss the final recommendations of the project.
(Deliverable D8)
6th – 7th of October 2010 At Lake Tegernsee in Germany
Bundeswehr Institute of radiobiology affiliated to the University of Ulm, InstRadBio Bw, Germany
Prof. Dr. Viktor Meineke
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Table of content Table of content..............................................................................................................................3 Letter of Invitation ...........................................................................................................................5
MASH Dissemination Work Shop ...............................................................................................5 Final Consortium meeting...............................................................................................................7
Agenda:.......................................................................................................................................7 Participants .................................................................................................................................8
Consensus opinion .........................................................................................................................9 Review of WP 9 – The Summary and Foresight, of the Mash project. ........................................9 Identification of the most significant results.................................................................................9
STRATEGIC AIMS: ...............................................................................................................10 KEY OBJECTIVES................................................................................................................10
Presentations from invited people.............................................................................................13 Discussion on optimal dissemination of results.........................................................................14
- Spin-off from MASH for additional activities (national or European)....................................14 - Spin-offs from MASH for additional EU projects..................................................................15
Clarification of the administrative procedures required to successfully conclude the project ....15
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Letter of Invitation
MASH Dissemination Work Shop
The MASH Project as a final work shop would like to invite Policy Makers, Health Planners and other Key Personalities within Emergency Medicine to discuss and promote the outcome of MASH. MASH or Mass-causalities and Healthcare following the release of toxic chemicals or radioactive materials is an EU project closing on the 15th of October this year. The project has been running for 30 months, financed by the DG Health of the European Commission. The project adheres to the idea expressed by the Commission, that generic preparedness planning and interoperability are key elements in mitigating the impact of mass emergencies. MASH has therefore performed a scenario based study of the medical competence and of organisational and technological preparedness throughout EU 27. The project includes an horizon scan and its deliveries includes several suggestions for an improved European preparedness. For more information about the MASH project please visit www.mashproject.com The preliminary program of the work shop includes the following topics:
- Review of project. - Identification of the most significant results. - Discussion on optimal dissemination of results - Spin-off from MASH for additional activities (national or European). - Spin-offs from MASH for additional EU projects.
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Final Consortium meeting 6th – 7th of October 2010
At Lake Tegernsee in Germany
MASH EU Project 2007/209
The program of the work shop includes the following topics:
Review of project.
Identification of the most significant results.
Discussion on optimal dissemination of results
To clarify the administrative procedures required to successfully conclude the project.
Spin‐off from MASH for additional activities (national or European).
Spin‐offs from MASH for additional EU projects.
Agenda: October 6th:
Time Issue
12.00‐13.00 Lunch
13.00 Welcome
13.15‐14.45 Presentation from invited people
14.45‐15.30 Presentation and discussing of the WP 9 report
15.30‐15.40 Coffee Break
16.00‐17.30 Discussion
17.30‐18.00 Foresight
18.00 Summary
19.00 Dinner
October 7th:
Time Issue
08.30‐10.00 Discussion on recommendations.
10.00‐10.30 Coffee break
10.30‐11.45 Administrative procedures/Future Dissemination Activities.
11.45‐12.30 Future activities / cooperation.
12.30‐13.00 Closure.
Presentation from invited people
Simon Clarke: “Mass Casualties and Health; the views of an emergency physician”
Geert Seynaeve: "Public Health aspects of HZM emergencies"
Axel Böttger: “New Trends in German Radiation Protection Legislation”
Merete Folmer Nielsen: “The CBRN Institute and its role in the Danish system”
Jürgen Dick: “NBC‐Scenarios – the Perspective of German Military Medicine”
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Participants
No Organization Name
1 European CBRNE center, Sweden Åke Sellström
2 HPA, Health Protection Agency, United Kingdom David Baker
3 HPA, Health Protection Agency, United Kingdom Shelly Mobbs
4 Consultant in Emergency Medicine, Frimley Park
Hospital, United Kingdom; Honorary Consultant, CRCE
(London), UK, HPA
Simon Clarke
5 FOI, Swedish defence research agency, CBRN safety and
security, Sweden
Gudrun Cassel
6 FOI, Swedish defence research agency, CBRN safety and
security, Sweden
Anders Bucht
7 FOI, Swedish defence research agency, CBRN safety and
security, Sweden
Sofia Jonasson
8 CMO‐EMS, Ministry of Health, Belgium
Geert Seynaeve
9 KI, Karolinska institutet, Sweden Leif Stenke
10 SoS, The National Board of Health and Welfare, Sweden Anders Eklund
11 CEIT, Centro de Estudios e Investigaciones Técnicas de
Gipuzkoa, Spain
Jon Legarda
12 Federal Ministry for the Environment, Nature
Conservation and Nuclear Safety, Germany
Axel Böttger
13 Bundeswehr Institute of radiobiology affiliated to the
University of Ulm, InstRadBio Bw, Germany
Viktor Meineke
14 Bundeswehr Institute of radiobiology affiliated to the
University of Ulm, InstRadBio Bw, Germany
Evelyn Schanbacher
15 Bundeswehr Institute of radiobiology affiliated to the
University of Ulm, InstRadBio Bw, Germany
Claudia Biendl
16 Bundeswehr Institute of radiobiology affiliated to the
University of Ulm, InstRadBio Bw, Germany
Dieter Gräßle
17 Head from the Federal Armed Forces Medical Office,
SanABw, Germany
Major General MC Jürgen Dick
18 The CBRN‐institute Denmark
Merete Folmer Nielsen
merete@cbrn‐institut.dk
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Consensus opinion
MASH EU Project 2007/209 Consortium Meeting
6th -7th October 2010 at Lake Tegernsee, Germany Following lunch and a short welcome address by Professors Meineke and Sellström, pointing out that this was the last meeting of Mash and dedicated to discussing the last WP. Especially the invited guests were welcomed.
Review of WP 9 – The Summary and Foresight, of the Mash project. David Baker started the report of Work Package 9 (see WP 9 Final Report: Foresight into Needs, Possibilities and Knowledge Gaps for the Future, David Baker, Samantha Watson, Sheila Holmes, Shelly Mobbs and Virginia Murray, HPA) stressing the substantial differences and needed balance between management of chemical and radiation casualties ( see reports on Work package no 5 and no 6) and emphasizing the need to combine two sections: chemical and radiation release scenarios on a European wide level . Although a large scale incident may stretch the resources of a single country or affect several countries there was no pan-European response to the questionnaire. The report describes the findings of work package 9, the foresight study conducted for the MASH project which draws on the findings of the other work packages.
Identification of the most significant results. Shelly Mobbs continued the report and presented a “roadmap” to improve the overall capacity in EU to provide effective pre-hospital care in such incidents. It was stressed that family physicians and primary care (walk ins) have to be included in pre-hospital care because it is difficult to predict where people would turn to in the case of an incident. The strategic aims included use of developments in information and communication technology as well as biotechnology in order to improve effectiveness of response and casualty management. It was stated that there is little motivation and interest from end users. Although politicians want emergency responders and clinicians to be prepared for such incidents in order to justify citizen’s trust in society, the overall view is: this will not happen, is unlikely. This situation is not yet politically emphasized. The applied for MASH II project emphasizes on improving this situation.
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The following points, i.e. the roadmap and its text were discussed in detail. Shelly Mobbs was leading this discussion. Text and formulations were discussed with particular respect given to the invited participants. Agreement was reached on all points.
STRATEGIC AIMS:
Effective links between key experts and organizations in each country
it was agreed to enhance “organizations” by “responsible institutions”
An agreed minimum level of competence in toxic chemicals and radioactive
compounds required for emergency responders and clinicians
An agreed minimum level of response preparedness across EU
“base line” instead of ”minimum level”, what do EU-commission and
EU-Member States expect?
Harmonised training material for emergency responders and clinicians across
EU
Expand “clinicians” (health professionals and other medical personnel
Improved effectiveness of response using modern ICT technology
ICT technology has to be accepted and user friendly (thus avoiding
non-use by “conservative” users)
Rapid diagnostic tools available for use in emergencies
Important, because generic tools are interlinked (diagnostic screening
tools)
It was discussed that it is unclear who is responsible for the risk assessment, eg the national poison centers are not trained for chemical incidents and in some European countries “emergency physician” is not a recognized speciality. This has to be highlighted more intensively.
KEY OBJECTIVES Within 3 yrs Establish and maintain an updated list of contacts for chemical and radiation
specialists and relevant expert organizations in each EU member state.
As the project already compiled a list it would be important to review and update it, have new organizations be found. It was agreed that the key list is still incomplete but moreover, it is a list that was created last year and problems to be addressed are
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Who keeps the list updated?
Should institutes/individuals be credited for being on the list?
Should it be European or national list, see REMPAN (although nor for chemical incidents)
Establish and support an EU network of researchers and emergency
responders and clinicians. The list of contacts can be a starting point.
It was agreed that a recommendation for list of contacts should be presented to the EU. It was indicated that already 12 platforms exist and therefore it was agreed to add “link with existing platforms
Establish a standardised minimum response across the EU to a mass casualty incident by convening an EU conference of specialist clinicians and researchers with this objective.
Hold regular special sessions at existing relevant conferences (or possibly initiate separate EU conferences if necessary), to enable key experts to meet to discuss issues, lessons learned from recent events and to identify practical needs.
part of dissemination (see above)
Develop a comprehensive publication on managing chemical incidents, equivalent to the TMT handbook for radiation incidents. Include comprehensive text on understanding and recognition of toxidromes (a characteristic collection of signs and symptoms).
It should be discussed what should be in the “handbook” which should be a somehow electronically updatable data collection. Toxidromes: instant or pre-operation?
Review and revise key guidance and documents eg the TMT handbook so that they remain up to date and include any lessons learned from real events.
It was added: collected from different countries (multilingual)
Identify suitable training materials for an EU wide training course.
Establish an agreed framework for the development and roll out of EU wide training courses and exercises for the response to mass casualty incidents, particularly those involving chemicals or radiation.
EU wide consulting training courses
Undertake a review of current responses and procedures for equality and diversity.
One of the key findings is: even different states within one country cannot be processed equally “so “guidelines” would be the best term
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Initiate a project to develop an agreed response to incidents involving both chemicals and radiation, particularly if physical trauma is also involved. This will involve emergency responders, clinicians and researchers.
instead of “emergency responders, clinicians and researchers” - this will involve the “entire health community”
Identify and support a group of clinicians and emergency responders to run small scale trials using modern ICT technology, in small incidents. Evaluate and identify promising technologies.
First step would be to “Evaluate outcomes of current projects and identify gaps”
Continue support of developments in bio-technology that will aid rapid diagnosis, for large numbers of people, and can be transported to the incident scene.
Continue support of and prepare infrastructure for developments in bio-technology that will aid rapid clinical diagnosis. It was agreed that diagnosis has to be done as quickly as possible in order to check “triggers to treat”.
Within 10 yrs
It was agreed that this time frame is too long: change to within 5 years)
Compatible modern ICT technology for use in incidents and disaster situations available across EU.
Rephrase: develop suitable ICT technology in partnership with industry (“create the market”).
Minimum level of response preparedness for mass emergencies achieved across EU
Agreed minimum competence in toxic chemicals and radioactive compounds for mass emergencies achieved across EU
across EU - plus treatment protocol for clinical management
Harmonised training materials for response to mass casualty situations in use across EU
“harmonised training curricula”, refers back to 3y
Development of rapid radiation dose assessment techniques using biotechnology that are transportable and hence can be used near the scene of the incident.
Identification of promising biotechnological techniques for chemicals and establishment of small scale trials.
Of promising biomarkers for chemical exposure and establishment ….
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Established mechanism to ensure periodic review and update of response, training and guidance materials.
Within 20 yrs - It was agreed to rephrase this time frame into “beyond 10 years. Development of improved diagnostic techniques for chemicals using
biotechnology.
Improved treatment of severe radiation injuries
Rephrase on the basis of Ake Sellström’s text on research and research evaluation. Draft will be sent to Shelly Mobbs
Presentations from invited people Geert Seynaeve, Ministry of Health, Belgium: see attached presentation "Public Health aspects of HZM emergencies". He agreed that it is difficult not to get stuck on terms and to include public health aspects. Especially triage and control have to be emphasized, take reactions into account (families may not want to be separated by triage ). The problem is that “guidelines” are often irritating and the scenario can never be foreseen in detail. With respect to evaluation he referred to EMA (Emergency Management in Australia) and the Böttstein approach. Following the meeting he further referred to publications which could be useful for project conclusions1. Simon Clarke: see presentation “Mass Casualties and Health; the views of an emergency physician”. He stressed that also the practicability of procedures has to be evaluated eg decontamination in tents (water pressure too low), treating victims lying on the floor and not in hospital beds etc. For both, emergency physicians and experts it is an extension of their daily work to prepare for an incident. Simon Clarke: see presentation “Mass Casualties and Health; the views of an emergency physician”. He stressed that also the practicability of procedures has to be evaluated eg decontamination in tents (water pressure too low), treating victims lying on the floor and not in hospital beds etc. For both, emergency physicians and experts it is an extension of their daily work to prepare for an incident.
1European policy paper on psychosocial support in mass emergency situations Portuguese, which also has been used for several EU 'train the trainer' sessions in various European countries as well as in the EU Final report of the EU Disaster Medicine program, sponsored by the Civil Protection Unit of DG Environment 1998-1999 & 2000-2004 (details & documents can be found at http://ec.europa.eu/echo/civil_protection/civil/prote/cpactiv/cpmaj03-01.htm and http://ec.europa.eu/echo/civil_protection/civil/prote/cpactiv/cpmaj03-02.htm "Issues Paper" on Disaster Medicine E&T of the Education Committee of WADEM, the report of the Brussels Consensus meeting on E&T as well as the slides of the 2006 Brisbane meeting. A lot of information can be found via WADEM & Prehospital & Disaster Medicine and the next World Conference: http://www.wadem.org/ 17th World Congress on Disaster and Emergency Medicine : 31 May - 3 June 2011, Beijing, China , http://www.wcdem2011.org
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Axel Böttger: “New Trends in German Radiation Protection Legislation” He referred to the governmental responsibility of the “Länder” in Germany (also, part of the hospitals are run by private companies), a coordination of the “Länder”-procedures should be considered. For a European-wide coordination the individual national approaches should be brought together. Whereas no money can be earned by preparing for an incident the governments should provide money for preparation of the entire medical personnel. A curriculum has to be harmonized with different national activities in order to create a global health initiative network as in RANET or REMPAN. Whereas different Directorates General are involved it is important to prevent double work. Merete Folmer Nielsen: see “The CBRN Institute and its role in the Danish system” Dr. Folmer Nielsen started to work for the new established CBRN Institute only in spring this year and is very interested in the outcomes of the project.
Discussion on optimal dissemination of results
- Spin-off from MASH for additional activities (national or European). Dr. Sellström voted for a targeted dissemination of the project publication to reach people within the European Commission. He proposed to compile a mailing list in order to distribute the executive summary and raod map. As HPA will be making the reports available on the website, link should be distributed and referred to. In order to reach DG Sanco and the Commission, an idea was to go to Luxemburg and propose a presentation in front of the Member States. Dr. Legarda informed about a French guest in San Sebastian, who volunteered to give info to DG Sanco. Dr. Baker will concentrate on the chemical issue and publish the essentials in journals. Dr. Meineke may publish in Deutsches Ärzteblatt and/or Environmental Biophysics. He will also give a presentation at the Defense Conference next May. It was proposed CEIT and FOI report on biotechnology. EU has to be acknowledged in all presentations. WP 4 Scenarios, is a FOI report WP 5 EU Chemical preparedness, published in JDM WP 6 EU Radiological preparedness, published in Deutsches Ärtzblatt (Environ Biophys) WP 7 Biotechnology, will become a FOI report and possibly a review article. WP 8 ICT, will become a CEIT report and possibly a review article WP 9 The Foresight, will become a HPA report and partly included in DB JDM article
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Another way for dissemination of results would be to reach out to emergency conferences, Dr. Sellström informed that the EU-Commission could be asked for financial support. There were several proposals for further dissemination, depending on whether it should be on a European or national level. The MASH concept should be expanded as discussed in Vancouver and to be discussed in May in Beijing. Already 12 platforms are existing, eg REMPAN (Radiation Emergency Medical Preparedness and Assistance Network), Civil protection unit, CBRN Task Force. Recommendations for a list (credited?) should be conveyed to the EU. As the results of the project should be disseminated to all individuals working in the context of an emergency, the results should be published in eg “Annals of Emergency Medicine, Ambulance Journals, Prehospital Emergency Journals, publications of the European Assoc. of Emergency Medicine but also of the Australian and American association to get the message distributed and to help identify end users as it is unknown how many people (blue light and emergency clinicians) might be involved. Whereas no representative from the EU could participate in the meeting, also due to restrictions on travel to attend project meetings it was agreed that one way to disseminate the project findings would be to visit responsible officers. The EU will act only in agreement with the Members States.
- Spin-offs from MASH for additional EU projects Dr. Sellström informed that in February 2011 a research project (30 Million Euro) will be launched by DG Sanco, deadline for application is supposed to be late April or early May 2011. Dr. Sellström proposed to use the existing project network and asked the partners to outline their ideas on 1 or 2 pages. As far as the application of the MASH II-project is concerned he has not yet received any information. Since the grant for MASH 2007/209 was received in the middle of October he awaits the decision within the next weeks.
Clarification of the administrative procedures required to successfully conclude the project Dr. Sellström informed the project partners that the administrative officers were informed by Carina Forsberg (Financial Office University of Umea) about the requirements concerning the financial documents from the participating organizations.
October 7, 2010 Bundeswehr Institute of Radiobiology
affiliated to the University of Ulm
