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What if everyone needs help at the same time? The care process in the event of a disaster

The relief operation for a collective emergency situation or major federal crisis is coordinated from the National Crisis Centre, which is part of the FPS Home Affairs. However, the principles of management developed at a federal level are also applied at a provincial and municipal level for incidents of lesser importance.

Five disciplines

 

A disaster or collective emergency situation is tackled by various intervention services, whereby each discipline has a mono-disciplinary intervention plan that describes its own operation. Where multiple disciplines are deployed simultaneously, joint coordination is required, this is referred to as a multi-disciplinary deployment.[1]

“ 5 disciplines or intervention services can be called upon in the event of a disaster or crisis.“

 

Discipline 1: emergency rescue zones
Discipline 1 missions are carried out by fire brigades, which may be assisted by operational units from civil protection. Their duties include:

  • Managing the emergency situation and eliminating the associated risks;
  • Locating, freeing and rescuing people and protecting their property;
  • Recovering people and property.

 

Discipline 2: medical, sanitary and psychosocial services
Discipline 2 missions are performed by medical and psychosocial services (e.g. ambulance services, MUG/SMUR services, the Red Cross, psychosocial workers, the Federal Health Inspectorate, etc.). The most important missions in this discipline are discussed later on in this report.

 

Discipline 3: police at the scene of the emergency
Discipline 3 missions are performed by federal and local police and are as follows:

  • Maintaining and restoring public order;
  • Keeping access and evacuation routes clear;
  • Setting perimeters, physically defining them, signalling and controlling access to the area;
  • Evacuating the population and overseeing shelter;
  • Identifying fatalities;
  • Assisting in the judicial investigation.

 

Discipline 4: logistical support
Discipline 4 missions are performed by civil protection, the fire brigade and the army. Their duties include:

  • Providing reinforcements for personnel and equipment, as well as providing special rescue and relief equipment;
  • Organising the technical means for communication between the disciplines, the operational command post and the coordination committee;
  • Organising the supply of food and drinking water for the emergency services and the people affected.

 

 

Discipline 5: information to citizens
Discipline 5 missions are carried out by a communications manager and consist of:

  • Providing information and guidance to the public;
  • Providing information on measures for returning to normal.

 

Emergency planning

The purpose of emergency planning is to anticipate a disaster or crisis. A whole range of measures, procedures, tools and coordination mechanisms are put in place. In this way, the resources (both human and equipment) needed to manage the situation can be deployed quickly and efficiently. Depending on the nature of the incident, there are several different contingency plans.

  • Multi-disciplinary emergency plans are developed by different authorities. These emergency plans are intended for crisis management at a federal, provincial or municipal level. For example, this type of contingency plan was used during the terrorist attacks in Zaventem and Maelbeek and the COVID-19 crisis;
  • Mono-disciplinary intervention plans: these plans aim to develop the missions per discipline, so a discipline can start independently and act quickly. In addition, an emergency plan makes it possible to cooperate with other disciplines;
  • Internal emergency plans: these are plans drawn up at the level of an institution, e.g. a hospital.

To find out more about emergency plans:
National Crisis Centre - Contingency Plans

Below, we will examine the mono-disciplinary contingency plan for medical, sanitary and psychosocial assistance (discipline 2), for which the FPS Public Health is responsible in an emergency situation.

This emergency plan describes the following missions:

  • Initiating the medical chain;
  • Administering medical and psychosocial care to victims and people involved in the emergency situation;
  • Organising the transport of victims;
  • Taking measures to protect public health.

The Federal Health Inspector plays an important role in executing this contingency plan. This individual is the local representative of the FPS Public Health in relation to emergency medical assistance. They are in direct contact with the governor, the mayor, health professionals and citizens. The Federal Health Inspector is assisted by an expert incident and crisis manager (ICM), a psychosocial manager (PSM) and a 112 medical team. This team consists of a medical director, a deputy medical director and nurse regulators (see ‘Organisation’ section) for each 112 emergency centre. Together, they form a ‘Federal Health Inspectorate Cluster’.

The clusters are tasked with the following:

  • supervising the proper organisation of emergency medical assistance by inspecting the quality of the activities;
  • coordinating the medical component of emergency and contingency plans at a provincial and municipal level;
  • implementing federal disaster plans locally (nuclear plan, health plan, heat wave plan, etc.)
  • inspecting and applying possible sanctions for the standards in force within emergency medical assistance.

 

To find out more:
https://www.health.belgium.be

 

Three specific sub-plans that were developed as part of the above missions will now be discussed.

 

Medical care

  

 

Psychological Care

  

 

Public health
The Medical Contingency   The Psychosocial  

Risks and Demonstrations Plan
Plan   Intervention Plan  
MIP

   PSIP

  

RDP

 

The Medical Contingency Plan (MIP)

The first emergency services (police, ambulance service or fire brigade) on the scene can request the activation of a medical contingency plan (MIP)[2]. Only a few professionals are authorised to activate a MIP, namely:

  • the (deputy) medical director[3] ;
  • the first MUG/SMUR doctor at the scene;
  • a federal health inspector;
  • an incident and crisis management (ICM) expert;
  • Head of the Response Service of the Directorate-General for Health Emergency Preparedness and Response of the FPS Public Health.

The emergency centre with territorial jurisdiction will formally declare the MIP.

An MIP has different levels, with an increasing use of resources depending on the phase the MIP has reached. The (deputy) health inspector ((DEP)HI), (deputy) medical director ((DEP)DIRMED) and psychosocial manager (PSM) are always called. Depending on the phase, the Medical Emergency Group (MUG/SMUR), ambulances (AMB 112) and rapid intervention resources (RIR) are deployed.

The scaling up and down of plans is carried out by the 112 emergency centre on the basis of the information obtained from the people referred to above. When an MIP is scaled up, the 112 emergency centre in the affected province can call upon the resources of neighbouring provinces.

The Federal Minister of Public Health has an agreement with the Belgian Red Cross to provide support in the event of a (medical) emergency. This includes, among other things, providing the following:

  • Ambulances and paramedics.
  • Rapid Intervention Resources (RIR) for the establishment of the advanced medical post.
  • Liaison officers: these are people who establish contact during an emergency and ensure communication between the various partners involved.
  • Logistical support (sanitary kits, camp beds, blankets, etc.).
  • A deployment of “Emergency Social Intervention”: these are volunteers who provide emergency psychosocial support in large-scale relief operations during disasters or severe cases.

The Head of the Response Service of Directorate-General for Health Emergency Preparedness and Response, the federal health inspectors and the incident and crisis management expert coordinate emergency medical assistance during a crisis. When the crisis is of such a magnitude that major socio-economic consequences are feared, administrative control (mayor, governor) is also required.

For example, during a large industrial fire, a toxic cloud moves towards surrounding businesses. At that point, a decision must be made on whether to evacuate the factory for health reasons. This decision is made by the director of the operational command post or, in the administrative phase, by the mayor or governor. This decision has financial implications. Compensation may also need to be paid. The various disciplines have an advisory role at the municipal or provincial coordination centre (CC) at that point.

 

The Psychosocial Intervention Plan (PSIP)

A collective emergency could cause serious psychosocial harm to a large number of people. As a result, there may be a need for appropriate assistance for those directly involved and their loved ones. In order to address this need, a Psychosocial Manager (PSM) works alongside the Federal Health Inspector (FHI). The actions within psychosocial support are aimed at stimulating the resilience of those affected and are targeted at both the direct and indirect victims of the emergency situation. The federal government is responsible for psychosocial assistance in the acute phase. Psychosocial support in the aftermath of a disaster is a task for the communities.

The following basic tasks of a psychosocial manager are to be carried out in the acute phase of an emergency situation:

  • grouping the uninjured at or in the vicinity of the disaster area;
  • transporting the uninjured to a reception centre;
  • installing and developing a reception centre (RC) where psychosocial support and information can be provided to those involved;
  • installing and developing a Telephone Information Centre (TIC) for those directly affected and their relatives;
  • uniform registration: the accurate collection of information about those affected and its safe management;
  • processing the data to create victim lists at one central information point (CIP).

 

For example, during a fire at an assisted living facility, the family needs information about their family member. The psychosocial manager concerned will organise an information point at a nearby sports hall.

 

To find out more about the PSIP:
www.health.belgium.be

Risks and Demonstrations Plan (RDP)

When a large-scale activity is organised, it may be necessary to provide a medical aid station as a precautionary measure. Using the Risks and Demonstrations Plan (RDP) questionnaire, the federal health inspectors give advice based on a risk analysis. The competent authority (the mayor or governor concerned) is advised on the necessary medical resources.

International emergency assistance

When there is a disaster or incident abroad, one of the FPS Public Health’s missions is to provide aid and assistance to the affected country if it officially requests it. Below we have opted to focus on two projects that illustrate the international action of the FPS Public Health.

Belgian First Aid and Support Team
The Belgian First Aid and Support Team (B-FAST) is an inter-departmental federal structure that deploys Belgian emergency assistance abroad.

The FPS Public Health, which works with the Ministry of Defence, the FPS Home Affairs and the FPS Foreign Affairs under the B-FAST mission, is responsible for the operational maintenance of the following modules:

  • A water purification system module that includes the storage and distribution of purified water.
  • An emergency medical team type 2 will be included as an emergency response capacity in the European Union’s civil protection pool and form part of the Emergency Medical Team (EMT) initiative, a network of medical teams qualified, trained and prepared to provide immediate assistance in the event of an emergency.
  • A rapid response team for major burns and a specialist mother and baby unit will also be set up within the framework of the “rescEU EMT” consortium.
  • The FPS Public Health will also provide medical support to all team members during B-FAST missions.

B-Fast in action

B-FAST’s most recent major medical operation was the post-earthquake operation in Turkey in 2023. Our country responded alongside France, Spain and Italy, sending a team of 207 volunteers, medical equipment to set up a EMT-2 type field hospital and a water treatment unit.

Due to the work of these volunteers, the field hospital was able to stay open 24 hours a day, 7 days a week from 16 February to 6 March 2023. The hospital, which included an emergency ward, a general consultation ward, a radiology service, a pharmacy and an operating room was able to help no fewer than 2,389 adults and 1,114 children, 400 of whom were aged under 5.

Despite B-FAST’s assistance, living conditions were particularly difficult for the affected population. In total, 491 of the 3,503 patients stayed in shelters, 2,295 patients lived in tents and 63 were sleeping in the street. Many of these patients did not have access to drinking water, food or toilets.

B-FAST recorded the most common complaints and shared them with the international community to improve its preparedness for future operations. In Turkey, the most common symptoms were, in decreasing order, respiratory problems and flu symptoms, localised cuts and fractures, gastro-intestinal disorders, skin problems and pain. This breakdown is observed after nearly all types of disaster.

These actions would not be possible without our pool of volunteers. This currently stands at 670 professionals, including medical and logistics profiles, but also experts in water purification and technicians.

Want to learn more?
https://www.health.belgium.be/en/b-fast

 

RescEU: million euros of medical assistance for Ukraine.

In March 2022, the European Commission and the FPS Public Health set up a platform in Belgium to transport privately-donated medication and medical equipment to Ukraine. This partnership, launched under the European Commission’s RescEU programme, was initially planned for a period of six months. However, as the need for medical provisions in Ukraine has persisted and the platform has continued to receive donations, the project has been extended. The project was first extended for six months, then a year.

This partnership with the European Commission came at a crucial moment when the emergency situation in Ukraine required a united and coordinated response.

This critical phase of the operation was concluded in February 2024, bringing to an end the project financed by the EU which facilitated the delivery of medical aid to Ukraine. This partnership set up with the EU will continue and the FPS Public Health will be ready to intensify its operations at any time, if the situation demands.

Belgium will continue to support Ukraine with its own assistance and donations from third parties will be evaluated on a case-by-case basis. The European Commission will continue to transport private donations to Ukraine via its platform in Poland.

  

 

“ Over the last two years, these donations worth over 5 million euros have been transported on more than 600 pallets. “

 

Want to know more?
https://civil-protection-humanitarian-aid.ec.europa.eu/what/civil-protection/resceu_en

 

[1]Source: National Crisis Centre (s.d.) Organisation in an emergency. https://crisiscenter.be/en/what-do-authorities-do/crisis-management/organisation-emergency

[2]The structure of the MIP is defined in a ministerial circular.

[3]Within the MIP, this is a temporary function held by a doctor who is in operational charge of all medical, sanitary and psychosocial support services at the site. This doctor works under the administrative authority of the Federal Health Inspector.