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In the age of globalization, the evolution of
epidemiological scene, the system of the communication routes and international
travels, the humanitarian crises, the new challenges represented by the climate
changes, underdevelopment, mass migration, with Complex Political Emergencies
(EPC) (rebellions and insurrections, wars of liberation,
separatist/anti-separatist wars, coups d'état, wars for ethnic and religious
dominance, “delegated” wars, wars of marginalized groups) and international
(bio) terrorism, are elements which influence the genesis of outbreaks of
emerging/re-emerging infectious diseases. In the system of prevention and
control of public health emergencies at national and international level, the
adequate surveillance and response systems with mechanisms of collaboration
among State and Non-state Actors, are crucial requirements, particularly in
order to face the biological risk related to migratory flows. In the Eu early
warning and response system for infectious diseases, Italian Red Cross Volunteer Military
Corps (ItRC VMC), auxiliary of Italian Armed Forces under the humanitarian
organization Italian Red Cross National Society, is a crucial national actor,
thanks to the “interoperability” of all resources in terms of personnel,
materials and procedures. In fact, with its “interoperability” capabilities,
ItRC VMC contributes to the efficiency of bio-risk prevention and response
national system, related to migratory flows, setting up biocontainment assets,
under Ministry of Health directives and according to the International Health
Regulations.
INTRODUCTION
In case of
transportation and management in high bio-containment of patients affected by
high infectious diseases, such as, in particular, 4th biological
agents risk group (highest pathogenic characteristics risk group in a biosafety
point of view, according to D.lgs. 81/2008, art. 268) or Category A (high
morbidity and mortality, according to CDC classification, in a biosecurity
point of view) such as Viral Hemorrhagic Fevers), the Ministry of Health
established a central management protocol for Suspected/Probable/Confirmed
(S/P/C) cases. Preparedness and response organization protocols and plans,
provide S/P/C case management at Central Level, with the involvement of Regions
and, where necessary, of other government Departments and/or Private Bodies,
and possible relocation at one of the National Reference Centres for the
clinical management of high contagious patients (INMI) “Lazzaro Spallanzani” in
Rome and “Azienda Ospedaliera L. Sacco” in Milan, in ways that will be
evaluated from time to time, under the Ministry of Health coordination. In case
of ships sailing to Italian territorial waters or flights within the National
airspace with suspected cases of infectious diseases on board, it will be
activated the normal international prophylaxis procedures by the USMAF, that
start contextually the central Protocol [10-12].
BIO-RISK IN MIGRATORY FLOWS CONTROL ACTIVITIES AND ItRC VMC
BIOCONTAINMENT MANAGEMENT
Through the
implementation of bio-containment and decontamination assets at Italian Naval
Base – Maristaeli (Catania) with the set-up of AMET-Bio, ItRC Volunteer Military Corps
contributed to the completion of Aeromedical Staging Unit-Bio function: the
aeromedical unit operating “transient patient” Suspected (“S” case) to be
affected by high contagious diseases, using specifically STI (Stretcher Transit
Isolator), ready to use in a few minutes, and equipped with a retaining
accessory for various kinds of fluids and transportable on aircraft and
helicopters. As to the measures considered in presence of a confirmed case, we
must refer to the Guidelines/Rules/Regulations of the Ministry of Health about
Biosafety and High Bio-Risk Patients Transportation. In particular, it is worth
mentioning the instructions presented in the Ministry of Health document n.
24349 issued on 16th October 2006 – “Viral Hemorrhagic Fevers: recommendations
and directions on the transport”, which indicates, for the clinical management
of cases, the possibility of admission both at INMI [14-17]. When it is not
possible to transport in a short time suspicious high disease cases to the
Referral hospitals, the patient is temporarily transferred to an insulation
tent, continuing health care (AMET-Bio Unit) until the time of transportation
to specialized medical facilities [18]. In case of long-duration transport from
MARISTAELI, Catania to the Specialist Hospitals of Rome and Milan, a technical
stop is required at the Biocontainment Unit at the Naval Base of Taranto -
MARISTANAV, following the same transport process used on the outward journey.
As far as it is possible, the patient's transfer activities should be kept to a
minimum.
CASE PRESENTATION: BIO-EMERGENCY ON BOARD THE “BOURBON ARGOS” VESSEL –
STRICT OF SICILY, 2015
As a case report,
the following pictures show the photographic documentation related to the
operating phases of AMET-bio intervention on Eritrean patient on board the MSF “Bourbon
Argos” vessel, located about 40 miles off the coast of the Lampedusa Island.
The operation took place in conjunction with the Italian Navy and the Italian
Coast Guard biocontainment units, demonstrating the “interoperability” of
biocontainment capabilities, a concept which will be specified in the following
paragraph.
08:10 a.m. –
Bio-Alarm! Operation Room (S.O.M.M.) of the Italian Navy MARISTAELI Helicopters
Station alerts ItRC VMC Team AMET-Bio;
10:05 a.m. –
AMET-Bio Team is projected by Italian Navy helicopter (EH-101 helicopter) with
destination: helicopter base in Lampedusa Island;
06:30 p.m. –
following the same transport process used on the outward journey, AMET-Bio Team
leaves Lampedusa Heliport to Catania, to transport the patient to the insulator
camera ISOARK located at MARISTAELI.
08.00 p.m. – the
Team reaches AMET-BIO facility by EH-101 helicopter, providing reception,
administration, processing, ground transportation, feeding and “limited”
medical care for patients entering and leaving the aeromedical evacuation
system to referral institute [18,20].
Like in this case
of transfer in the national territory, the Italian Health Ministry response
system provides obligations relating to the notification of suspected or
confirmed cases, and requires patient transportation in high biocontainment by
helicopter or boat, with a human stretcher isolator and an insulation tent set
up on board of a naval unit in the port area or at MARISTAELI biocontainment
and decontamination unit. The regulation provides bio-safety obligations: the
ItRC VMC team must be protected with appropriate personal protective
equipment (PPE) during transportation by helicopter or boat, to the naval unit
which hosts the potential patient in high biological risk [18,20].
DISCUSSION
The case report shows the “Interoperability Concept” of ItRC VMC, auxiliary of Italian Armed Forces, whose capabilities to participate to
the Ministry of Health and Italian Navy Biosafety activities and High Bio-Risk
patients transportation in Migratory Flows Control Operations, contribute to
the completion of Aeromedical Staging Unit-Bio function thanks to preparedness
in biocontainment and decontamination activities and response system, according
to Italian legislation. ItRC VMC personnel working in the transport unit in
high-bio containment must possess appropriate certification proving their
training in an “Interoperability” framework. In particular, after having passed
basic training course for CBRN Defense (one week, full time), the second level
of training is the “Enabling Course for CBRN Decontamination and Bio
containment Units Operator” (duration: 2 weeks, full time/recipient personnel:
lower Officers, NCOs and enlisted military personnel) which prepares attendees
for specialists tasks related to the Bio containment Standard Operative
Procedures (SOP) about treatment of CBRN contaminated people; setting up and
management of decontamination unit, ISOARK insulation tent, materials and
equipment; treatment of a hazard wastes, following NATO regulation and the
Italian Ministry of Health decrees. Under the Interoperability Concept,
AMET-Bio Team operates in different transport services (maritime, ambulance and
aeromedical services). In fact, the safe patient transportation in high
biocontainment is conducted in different transportation ways on the various
maritime, aircraft and land segments, thanks to the “interoperability” in terms
of personnel, materials and procedures (in particular Extra-hospital management
procedures). More in detail, the main aspect of the interoperability concept
regards High biocontainment transportation equipments and operational
procedures, which can be regarded during: the stretcher isolator transshipment
by ItRC VMC AMET-Bio operators (all qualified in biocontainment and CBRN
decontamination) from patrol boat to Lampedusa port facility; the preparation
of stretcher isolator loading activities on Ambulance stretcher set up by
Palermo Territorial Health Service Company Operators. ItRC Military Corps has
also implemented the concept of interoperability in the operational
coordination of response structures during healthcare/biocontainment operations
management and the rational and efficient and effective set up of all resources
[3,21].
CONCLUSION
1.
Marino M (2014) Biological risk - Technical and
operational procedures. HSF Conference, Rome.
2. Gismondo
MR (2015) Globalization, climate changes and infectious diseases. NATO
Biological Warfare Defense Awareness
Course - NATO School (Germany).
3. Rossetti P (2016) “Reversed engineered approach”
and “gap analysis” to evaluate CBRN training outcomes in Italian Red Cross
Military Corps bio containment response and Disaster Victim Management
activities, working in Migratory Flows Control operations - High/Medium
Biological Risk. International Master Course in Protection against CBRNe events
- 2nd LEVEL. Master Thesis AY 2015/2016 - Department of Industrial
Engineering, University of Rome “Tor Vergata”.
4. Bartels C (2015) Biopreparedness in the EU: A joint
perspective. NATO Biological Warfare Defense Awareness Course - NATO School
(Germany).
5. (2000) Biological agents at work. Directive E.U. No
2000/54/EC.
6. European Parliament and Council (2013) Serious
cross-border threats to health and repealing. Decision No. 1082/2013/EU.
7. http://www.who.int/csr/ihr/en/ (consulted on 9th July 2019).
8. Decree of the Minister of Health (2004) Discipline
of the organization and functioning of the National Center for Disease
Prevention and Control (CCM).
9. http://ecdc.europa.eu/ (consulted on 9th July 2019).
10. European Center for Disease Prevention and Control
(ECDC) (2019) Communicable disease threats report.
11. IRC, IOM, UNHCR, Save the Children - Italy,
Ministry of Interior (2012) Presidium Project: Recommendations and good
practices in the management of mixed migratory flows by sea.
12. Coker R, Atun R, McKee M (2008) Health systems and
the challenge of communicable disease. Experiences from Europe and Latin
America. European Observatory on Health Systems and Policies Series. McGraw
Hill.
13. https://www.cri.it/flex/cm/pages/ServeBLOB.php/L/IT/IDPagina/12156 (consulted on 9th July 2019).
14. Ministry of Health (2014) Circular no. 0026708 of
06/10/2014, Update and Errata Corrige circular note pr. 26377 of 10/01/2014
“Ebola Virus Disease (MVE) - Central protocol for case management and contacts
on the national territory”.
15. Ministry of Health (2015) Circular no. 35824 of
07/12/2015. Technical document on protection measures for health protection in
out-of-hospital transport and management operations of patients infected or
potentially infected with Class IV biological agents.
16. Ministry of Health (2006) Circular n. 24349 of
10/16/2006. “Viral Hemorrhagic Fevers (FEV) recommendations and indications for
transport”.
17. Pump MG, Vellucci L (2015) Ministerial directives,
communication flows, notification to the Ministry of Health. Directorate General
for Prevention - Ministry of Greeting. Proceedings of the Conference
“International Health Regulations (R.S.I.) of the WHO and the Operational
Outcomes on Regions and ASLs”.
18. Tripodi R, Valente M (2015) National Inspectorate
of the Military Corps of the Italian Red Cross. The Bio-Containment response to
the management of migration flows in biological emergency. 2nd
International CBRNe Workshop 2015 “CBRNe new Technologies, new strategies, new
approaches to reduce the risk” - Poster Session.
19. Ministry of Health (2006) Circular n. 24349 of
10/16/2006. Viral Hemorrhagic Fevers (FEV) recommendations and indications for
transport.
20. Gamberoni IP (2015) National Inspectorate of the
Military Corps of the Italian Red Cross. The competitions of the Military Corps
of the C.R.I. in operations to control migratory flows. Case Report.
21.
Lupini G, Tripodi R, Rossetti P (2017) The ItRC
volunteer military corps: Role of civil protection and civil defense in CBRN
Emergencies. Biomedicine & Prevention issues CBRNe safety Special issue
(PART 1), p: 118.
22.
Command in Chief of the Naval Team - Health Office
(2013) Guidelines for the management of biological risk on board the naval
units impregnated in the control of migration flows.
23.
Legislative Decree (2008) n. 81/2008 of 09/08/2008.
Implementation of Article 1 of the Law of 3 August 2007, n. 123, concerning the
protection of health and safety in the workplace.
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