Ministry of Health and Long-Term Care Hazard Identification and Risk Assessment
Ministry of Health and Long-Term Care Emergency Management Unit 2007
Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment
Sample Risk Assessment Excerpt from the MOHLTC Emergency Response Plan Note: This is provided as a reference to illustrate how the Ministry of Health and Long-Term Care carried out the hazard identification and risk assessment process for the hazards it is responsible assessing, as identified under the Emergency Management and Civil Protection Act (EMCPA). The risk assessment has been modified for use in the support manual and does not include the results of the risk assessment as these remain confidential.
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Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment
CONSIDERATIONS AND METHODOLOGY
ii) List of natural hazards 1. 0
Hazard Identification
Emergency Management Ontario (EMO) has compiled a comprehensive list of thirtyseven (37) potential hazards that are grouped according to three categories: natural, technological, and human-caused hazards. The MOHLTC Hazard Identification and Risk Assessment is based on those hazards. Based on its geography, climate and predominant industry, Ontario can be divided into four (4) regions. These four regions are: • • • •
Northern Ontario Central Ontario Eastern Ontario South-Western Ontario
Since the same hazard can have different probability and consequence for different regions, a separate Hazard Identification and Risk Assessment was conducted for each of the four regions.
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Agriculture and Food Emergencies (Plant Disease and Pest Infestations, Food Emergencies, Animal Disease) Atmospheric Hazards (Severe Weather) o Extreme Heat/Cold o Fog o Hailstorms o Hurricanes/Tropical Storms o Ice/Sleet Storms o Lightning Storms o Snowstorms and Blizzards o Tornadoes o Windstorms Forest Fires (Wildfires) Geological Hazards o Earthquakes o Landslides o Land Subsidence Human Health Emergencies and Epidemics Hydrological Hazards o Drought/Low Water o Erosion o Flooding (Storm Surges, River Flooding, Great lakes Flooding) o Water Quality Emergencies
1.1 Natural Hazards
1.2 Technological Hazards
i) Characteristics
i) Characteristics
Natural hazards are unexpected or uncontrollable natural events which affect a group of people by disrupting their activities and potentially causing loss of life. Given Ontario’s size, location and geographical and climatic diversity, we are faced with a wide range of natural hazards. Some of the most common natural hazards in Ontario include: ice storms/freezing rains, blizzards, extreme temperatures, earthquakes, floods, and forest fires.
Technological hazards refer to a wide range of conditions emanating from the manufacture, transportation, and the use of modern technology and substances such as chemicals, explosives, flammables, and radioactive materials. Given Ontario’s level of industrial development and the complexity of our interdependent critical infrastructure, we are faced with a multitude of unpredictable technological hazards. Some of the most common technological hazards in Ontario include: transportation
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Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment emergencies, building /structural collapse, hazardous material incident, etc. ii) List of technological hazards • • • • • • • • • •
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Building/Structural Collapse Critical Infrastructure Failures Dam Failures Energy Emergencies (Supply) Explosions/Fires Hazardous Materials – Fixed Site Incident Hazardous Materials – Transportation Incident (road, rail, air, marine) Mine Emergencies (Operating / Abandoned) Nuclear Facility Emergencies Oil, Natural Gas Emergencies – Pipeline, Oil/Natural Gas Wells, Storage/Distribution Systems Radiological Emergencies Space Object Crash Transportation Emergencies (Air, Marine, Rail, Road)
1.3 Human-Caused Hazards i) Characteristics Human-caused hazards are threats having an element of human intent, negligence, or error or involving a failure of a system. Various types of civil disorders, such as demonstrations and strikes, are considered some of the common human-caused hazards in Ontario. ii) List of human-caused hazards • • • • •
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Civil Disorders Sabotage Special Events Terrorism War and International Emergencies Risk Assessment
2.1 Risk Assessment Scoring Risk assessment is based on the probability (likelihood of occurrence) and consequence (impact on health services). The ministry
scored the hazards identified above on a scale of 1-4. The scale is shown below: Probability / Likelihood: Low • Moderate • High • Extreme
The probability scale is based on the level at which a hazard may occur within the province, its ability to overwhelm local resources and require provincial coordination from the MOHLTC.
Consequence/Impact: Minor • Severe • Extensive • Catastrophic
The consequence scale is based on potential casualties and societal disruption as well as the level and nature of provincial involvement, including information sharing, resource coordination and funding.
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2.2 Risk Assessment Factors The ministry considered the following factors when assessing probability and consequence for health services during an emergency: 2.2.1 Probability
Historical Occurrence The history of occurrence is an important determinant of risk for a variety of hazards. Getting a sense of how often various events have occurred in the past can lead us to an informed assessment of the likelihood they will occur in the future. There are three (3) questions that are important to consider in assessing risk based on history of occurrence: • Has it happened before? • What is the frequency with which it has occurred?; and • How long since the last occurrence?
Seasonal The likelihood of occurrence of various hazards can be contingent on seasonal variation. Different seasons have different climates, trigger different patterns of behaviour and have other unique features that contribute to making different events more or less prevalent. Questions to ask include: Does the particular event occur more frequently during one or two seasons? Is there a seasonal variation?
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Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment Hazard Identification and Risk Assessments conducted by various municipalities were also considered in determining hazards probability. 2.2.2 Consequences
Health care facility damage, loss or failure During an emergency, health care facilities may experience various direct or indirect infrastructure damage, loss or failure. Things to consider include: •
Physical Damage • Partial Damage • Total Loss (i.e. facility destruction)
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Technological Failure • Information Technology sabotage (e.g. virus)
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Utilities Loss • Electricity • Water
Closure or evacuation is also a form of health care facility damage, loss or failure.
Health care facility capacity overload Capacity overload occurs due to mass casualties. Questions to ask include: Does the particular event have the potential to cause mass casualties due to large-scale injuries, large-scale sickness/infection, and/or large-scale contamination? Shortage or inadequacy of medical supplies Depending on the type and the magnitude of the event, health care facilities may experience a shortage or inadequacy of medical supplies. Supplies to consider include: personal protective equipment, decontamination equipment, pharmaceuticals/drugs, etc. Shortage of health human resources Shortage of health human resources is another serious consequence of various events. Questions to ask include: Are healthcare workers unable to report to work/cut off from work due to event? Are healthcare workers affected by a communicable disease due to event?
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Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment
HAZARD DESCRIPTION
NATURAL HAZARDS Extreme Cold: Extreme cold is a weather condition where a minimum temperature falls to -30ºC or colder and maximum temperature does not exceed -20ºC. Extreme cold tends to be associated with other hazards such as snow and ice storms.
Probability: Extreme cold periods occur, on average, five to six times per season, depending on location. They are most likely to occur between December and February, with most extreme cold periods occurring in January. Most extreme cold periods are accompanied by windchill – a measurement of the rate at which the heat is lost from an exposed object. Consequence: Extreme cold can have various impacts on health care facilities. Health care settings may experience a higher than usual number of patients, seeking medical attention due to hypothermia, frostbite injuries and various chronic medical conditions. Extreme cold can also lead to physical damage such as frozen/burst pipes resulting in utilities loss. Extreme cold also has the potential to cause a shortage of health human resources and medical supplies, mainly due to the impact on transportation. TECHNOLOGICAL HAZARDS Energy Emergencies (Supply): An energy emergency may involve any one or more of various types of energy resources. It may involve natural gas, heating oil, gasoline, coal, or electricity. An energy emergency occurs when there is an inability to produce or to transfer sufficient quantities of the resource at an acceptable cost to businesses, industry, and the public that
creates the emergency. This is especially true during periods of inclement weather where heating is necessary for individual safety. A power failure is also included as an energy emergency. Power failure is defined as any interruption or loss of electrical service due to disruption of power generation or transmission. These interruptions can last anywhere from few seconds to several days.
Probability: Ontario is a major industry hub and home to a large population. As such, its energy demands are high, and often exceed the supply, which can lead to an energy emergency. In August 2003, Ontario was hit by the largest blackout in North America's history. Electricity was cut to 50 million people. Streetlights went out, subway trains stopped midtunnel and refrigeration equipment went dead. Consequence: Health care facilities loss and may experience utilities technological failures. There is also a potential for capacity overload; however, not necessarily related to health needs. Individuals may come to a health care facility to escape the extreme weather conditions (cold or hot). Shortage of medical supplies and health human resources may ensue. HUMAN-CAUSED HAZARDS Terrorism: Terrorism is the unlawful use of force or violence against persons or property to intimidate or coerce a government or civilian population, in furtherance of political or social objectives.
Probability: Terrorism is unpredictable however; certain cities may be targeted based upon population and location etc.
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Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment
Consequence: Depending on the magnitude of a terrorist attack, the impact on health care facilities could be severe. Health care facility could experience physical damage, utilities loss and technological failure. Capacity overload and the shortage of medical supplies and health human resources would all likely occur as well. Droplet/Contact Spread Diseases Contact transmission is the most common mode of transmission for infectious disease. Contact transmission can be either direct or indirect. Direct transmission involves direct physical contact between two people or close droplet contact, where sneezing, coughing or talking contaminates the air with droplets. Indirect transmission occurs when an infected person spreads the infection to an inanimate object, and a noninfected person touches or otherwise comes into contact with the infected object. Individuals become infected by shaking hands with infected persons or touching contaminated surfaces and transferring the virus by touching their own eyes, nose or mouth.
Human Influenza: Every "flu" season – there are a hundreds of confirmed influenza outbreaks in institutions reported to the MOHLTC. Ontario offers free flu vaccine every year (the Universal Influenza Immunization Program) free of charge to all Ontarians aged 6 months and older. The Health Protection and Promotion Act requires that all new sporadic cases of Influenza and outbreaks of respiratory infections (including Influenza) in institutions be reported to the local Medical Officer of Health (MOH). However, given that influenza is most often diagnosed clinically, without laboratory confirmation, it is likely that the number of cases is an underestimate of the actual number of cases in the province.
Although no one can Probability: predict when the next influenza pandemic will occur, public health officials have warned that a global influenza pandemic is inevitable. The 20th century saw three influenza pandemics. The most deadly, the "Spanish Flu" of 1918-19, killed an estimated 20 million people worldwide. As a result, public health officials estimate that an influenza pandemic in Ontario, depending on the number of people infected, could result in between 22,000 and 52,000 hospitalizations, 980,000 and 2.25 million outpatient visits, and 5,000 to 12,000 deaths. Consequence: An Influenza pandemic will have severe impacts on public health and security. Mortality and morbidity rates will be high, for example Ontario could see between 1.8 and 4.2 million outpatient visits, between 7,500 and 65,000 hospitalizations, and between 2,900 and 19,700 deaths from influenza. Airborne Diseases Airborne diseases are transmitted from person to person by aerosol and droplets exhaled from the nose and mouth. Droplets that are sneezed, coughed or otherwise sprayed into the air evaporate but the residue remains in the air for long periods of time. Airborne dust particles pick up some of these bacteria or other disease causing organisms and air currents help to spread them over a wide area. The disease-causing organisms then are inhaled by or come to rest on a susceptible person who is subsequently infected. Airborne particles are smaller than those in contact/droplet, as a result, diseases caused by airborne can spread further and more insidiously.
Tuberculosis: Tuberculosis (TB) is a serious disease that usually attacks the lungs, but can also affect other parts of the body, including the brain, the lymph nodes, and bones. TB is not as contagious as many other diseases, including the measles and chickenpox. To become infected, a person
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Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment
usually has to have frequent exposure to someone with active TB. Most people who are exposed to TB bacteria do not develop TB disease. In some cases, the person's immune system is able to kill the TB germs. When this doesn't happen, the bacteria can remain alive but inactive in the body, and this is called latent TB infection. A person with latent TB infection has no symptoms, is not sick, and poses no risk of spreading the bacteria. TB infection may become TB disease if the infected person's immune system cannot stop the TB bacteria from growing. The risk of developing TB disease is highest in the first two years after someone is infected. About 10% of infected adults will develop TB disease at some point in their lives. In addition, for those co-infected with HIV, the risk is 10% per year. TB is completely curable with antibiotics over a 6-12 month period. However, despite the availability of highly effective drug regimens, TB cure rates are often not satisfactory. TB incidence has undergone an overall decline between 1945 and 2001.
Probability: People living in overcrowded and poor living conditions are at greater risk of developing TB. As a result, the likelihood of occurrence remains high in these populations. While TB is curable, TB cure rates are unsatisfactory which means that those who are infected with the active form of TB continue to spread the disease to unsuspecting individuals. In addition, drugresistant TB has been reported in Canada for decades. In most cases, the TB organism was resistant to a single drug. However, a few of these reports describe cases of multiple drug-resistant TB. The most common reason for development of drug-resistant TB strains is poor management of TB control programs followed by patient non-compliance.
Consequence: All of the diseases pose a burden on the health care system. For example, the resurgence of TB and the phenomenon of the drug-resistant therapy create a host of public health issues. Foodborne/Waterborne Diseases Foodborne and Waterborne diseases are caused by consuming food or drink that has been contaminated with microbes and toxic substances. There are more then 250 known foodborne diseases. Most of the diseases are infectious, and are caused by bacteria, viruses, and parasites. Other foodborne diseases are essentially poisonings caused by toxins and chemicals contaminating the food. Foodborne diseases can be prevented with proper hand washing, and food handling practices. Foodborne diseases are usually self-limiting and may not require treatment. Many microbes can spread in more than one way. For example, infections with Escherichia coli O157:H7 (E. coli O157:H7) can be acquired through contaminated food, contaminated drinking water, contaminated swimming water, or from person to person at a day care center. Depending on which means of spread caused a case, the control measures range from removing contaminated food from stores, chlorinating a swimming pool, or closing a child day care center.
Campylobacter: Campylobacter is the most common bacterial cause of diarrheal illness in the world. The bacteria live in the intestines of healthy birds, and most raw poultry meat has Campylobacter on it. Eating undercooked chicken or other food that has been contaminated with juices dripping from raw chicken is the most frequent source of this infection. Aside from diarrhea, common symptoms include causes fever, diarrhea, and abdominal cramps.
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Ministry of Health & Long-Term Care
Hazard Identification and Risk Assessment
Probability: While there are high numbers of confirmed laboratory cases of foodborne and waterborne diseases every year, there are control strategies that are in place by the local health units to monitor and respond to these diseases. Sporadic enteric diseases events have annual incidence rates that are predictable to a certain degree in Ontario. As with any passive reporting system, under-reporting of disease events occurs. Outbreaks of enteric illness are also predictable in that they occur, however, predicting their occurrence, beyond saying that they will occur, is difficult.
Consequence:Foodborne and Waterborne diseases continue to be reported in high numbers every year. As a result, these diseases will continue to be a public health burden. Health-related and economic impacts include number and cost of lost work days, doctor’s visit, and hospitalization. In sever cases, death can occur. Although most individuals recover, foodborne diseases can result in chronic health problems in 2 to 3% of cases. Outbreaks of enteric disease occur annually. The government response to both of these risks has been present at every level of government for decades.
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