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PHARMACEUTICAL SUPPLY CHAIN
INITIATIVE (PSCI) WEBINAR:
Emergency Preparedness and Response
PSCI
PSCI @PSCInitiative
EMERGENCY PREPAREDNESS AND RESPONSE
Aaron Duff, CFPS
Johnson & Johnson
Global Director of EHS Process Excellence and
Standardization
SPEAKER
2
AGENDA
THIS WEBINAR WILL PROVIDE:
• Overview of questions related to emergency
preparedness & response in the PSCI audit checklist.
• Prepare an emergency response plan, assessing and
Planning
• Preventing and Responding to emergencies
• Basic elements to be considered when performing
an impact assessment from neighboring industries.
PSCI
PSCI @PSCInitiative
Explosion in China Factory
killed 19
Sugar Explosion in
Georgia Factory killed 14
Japan
earthquake
(Fukushima)
NFPA reports 37,000 industrial fire 2009-2013 (USA)
58 Hurricanes between 2010-2017
Increased severe weather winters, water shortages, floods
Sydney announces water
restrictions for business
50% increase in flood events
EMERGENCY PREPAREDNESS AND RESPONSE 4
PSCI
PSCI @PSCInitiative
THE AGENDA AND HOW IT ALL TIES TOGETHER
EMERGENCY PREPAREDNESS AND RESPONSE 5
PSCI
PSCI @PSCInitiative
QUESTIONS FROM SELF-ASSESSMENT QUESTIONNAIRE
Q.No Question Guidance
85 Is the facility emergency response equipment (fire extinguisher, fire pumps, sprinkler systems) visually inspected monthly,
comprehensively inspected annually, and documentation maintained for all inspections?
Describe if the relevant emergency scenarios been
addressed in the emergency response plan
• Natural: Earthquake, flood, tornado, hurricane,
drought, etc.
• Chemical: Spill, fire, wastewater treatment plant
upset,
• Human: Evacuation, first aid, medical
emergency, civil unrest, active shooter/security
threat,
Does the facility have a communication system to
alert the local community of impacts in the event of
major emergency?
86 Is the fire alarm system monitored 24 hours a day (including weekends and holidays) with prompt notification to
emergency services (within 5 minutes)?
87 Does the facility ensure that an adequate amount of fire water is maintained for fire protection?
88 Are emergency exits and evacuation routes clearly marked, kept free of obstructions (unlocked)?
Are emergency exit signs illuminated with emergency backup power?
89 Are regular emergency evacuation drills conducted, and what is the frequency?
90 Are emergency response plans in place?
Please explain the key points of the emergency response plan:
Indicate when the plan was last revised:
91 Does the site have an on-site emergency response team that is trained for fire or other emergencies?
78 Has the facility evaluated the impact of its operation on the community?
Has the facility evaluated the impact from the activities of neighboring businesses?
Why are these questions important?
EMERGENCY PREPAREDNESS AND RESPONSE 6
PREPARING AN EMERGENCY RESPONSE PLAN
ASSESSING AND PLANNING
PSCI
PSCI @PSCInitiative
ASSESSING AND PLANNING FOR EMERGENCY RESPONSE
§ What are your Government regulation? Seveso, Community Right to know, SPCC, PSM, Safety Reg.
§ Assessing your risk starts with Inventorying potential risks and severity at your locations.
• Natural Hazards; Storms, Flood, Earthquake, Drought
• Chemical; Fire, Spills, Airborne Release
• Human; First-Aid, Confined Space, Work Place Violence
§ What response capability do you have in your city and what are the response times
• Transportation- will road be cleared, alternate routes people/goods
• Emergency response for Fire, Chemical, Medical, unique risks
• Communications- how is emergency information communicated to businesses/ residence
§ What are the reliability of your utilities services
• Water
• Electricity
• Waste Water (Fire Water Waste?)
What are your Managements expectations?
What are your customers expectations?
EMERGENCY PREPAREDNESS AND RESPONSE 8
PSCI
PSCI @PSCInitiative
ASSESSING: WHAT ARE YOUR POTENTIAL EMERGENCIES
§ Fire/Explosion
§ Chemical Delivery / Transportation
§ Civil Chemical Spills/Releases
§ Disturbances/Site Strikes/Protestors
§ Utility Loss (Power Loss)
§ Bomb Threats
§ Medical Emergencies
§ Sabotage
§ Elevator Entrapment
§ Workplace Violence
§ Chemical Release
§ Parcel / Letter
§ Severe Weather - Winter
§ Severe Weather – Severe Thunderstorm / Tornado
§ Hurricane
§ Biohazardous Materials
§ Media Relations
§ Unexploded Munitions/Ordnance (UXO)
§ Confined Space
§ Compressed Gasses
§ Earthquake
§ Nuclear Event
EMERGENCY PREPAREDNESS AND RESPONSE 9
PSCI
PSCI @PSCInitiative
ASSESSING EMERGENCY RISK
Potential
Emergency
Risk
Rating
Gover.
Response
Gover. Resources Management/
Customer
Expectation
Site Engineering
Controls
Site Administrative
Controls
Gaps/ actions plan
Fire
(example A)
High 20 min. from
notification
1 truck 4 Fire Fighters,
mutual aid 20 additional
mins
Fire immediately
controlled, no more
than 48 hours delay in
production
Offices have sprinklers
Manuf. has no sprinklers
Site has fire detection
Trained employee for fire
handheld fire
extinguishers
Create site fire brigade
Training and
equipment needed
Create Crisis Mgmt
Team
Fire
(example B)
High 4 min from
notification
3 truck, 12 Fire fighters,
Pre-planned response,
annual facility walk
through, 3 mutual aid
cities 7 min response
Fire immediately
controlled, no more
than 48 hours delay in
production
Site is fully Sprinklered
Site has full fire detection
Site CMT
Inspect, Maint., Testing
SOP
Drills- with Gov.
responders
None
Confined
Space
Med No trained
responders
NA No fatalities Hazards identified with
Sign
Work Permits
Employees trained
Rescue equipment and
training
None
EMERGENCY PREPAREDNESS AND RESPONSE 10
PSCI
PSCI @PSCInitiative
RISK-TOOLS
EXAMPLE ONLY
EMERGENCY PREPAREDNESS AND RESPONSE 11
PSCI
PSCI @PSCInitiative
PLANNING
§ Objective of Emergency Plan
§ What are we protecting: describe facilities, operations, maps, neighbors, utilities
§ Applicable regulations
§ Defining Emergency: Many sites have 3 levels
- Can be handled by department
- Can be handled by site Emergency Response Team
- Government support needed
§ Crisis Management Team: Formal SOP describing roles and responsibilities (who does what)
§ Emergency Equipment: What, How much, Where is it (Inspect, Test, Maintain)
§ Specific written action plans for high impact risk events: immediate action to be taken to reduce impact of
risk
§ Training/ Drills: ERT and site management (consideration include government responders)
§ Recovery Plans: specific plans on business resumption
EMERGENCY PREPAREDNESS AND RESPONSE 12
PREVENTING AND RESPONDING TO
EMERGENCIES
PREVENTION AND RESPONSE
PSCI
PSCI @PSCInitiative
PREVENTION
§ Physically Engineered Facility:
- Fire Suppression 97% of fires controlled with 1-3 sprinklers
- Fire Detection early detection/ early response
- Spill containment protect environment/ controlled clean-up
- Spill Detection early response / minimizes risk
- Fail Safe Designs WHAT IF
- Fire Rated Walls Contains /minimizes site wide impact
- Fire DoorsStop fire spread
- Guards Stop injuries from occurring
- Flood Barriers Stop flood damage
The BEST most effective emergency response plan is one never needed
§ Management Procedures:
§ Work Permits
§ Inspections, Testing, Maintenance
§ Routine/Non-routine work SOPs
§ Pre-startup safety reviews (PSSR)
§ Emergency Shut down
§ Hazard awareness (identified and
integrated into operating SOPs)
EMERGENCY PREPAREDNESS AND RESPONSE 14
PSCI
PSCI @PSCInitiative
EMERGENCY RESPONSE
We know emergencies will happen, most emergencies will not happen exactly as planned for.
The best emergency response plans allow for flexibility
§ When an emergency occurs
1. Responders show up to designed area, and one person is designed in charge (Incident Command) and a team of support
2. Determine type of emergency and have the response plan available (grow or reduce size of team based on emergency)
3. Establish goals and limits of response
4. Who is impacted by emergency, do you need to communicate and to who. (employees, management, neighbors, government)
5. Establish accountability; who do you need leading elements of response plan, and who will support leads, leads need to know who,
and where their people are, and what they are doing.
6. Incident Commander; needs to know when you need help, who to call for help, and ensure the risk to responders is acceptable.
7. Frequency of communication updates should be established
8. If Government responds (fire department) during an emergency is not the time to be introduced. Most external response
organizations will take control of your facility, may not want to talk company employees, and may not allow your people to help.
9. If emergencies go on for time, you need to have plans for feeding and resting your teams
EMERGENCY PREPAREDNESS AND RESPONSE 15
PREVENTING AND RESPONDING TO
EMERGENCIES
EVALUATING IMPACT OF NEIGHBORS
PSCI
PSCI @PSCInitiative
IMPACT OF NEIGHBORS
When assessing your neighbors risks and impacts what should we consider?
§ Do they have bulk chemicals, fire explosion risks, fumes?
§ What kind of work do they do, does it pose a risk? Fireworks warehouse?
§ Do they have good house keeping?
§ Are they upwind of your facility?
§ Do you share utilities (can you)?
§ Is their building protected by Fire Suppression?
§ Do they have security?
§ What direction does their stormwater run? Floods/ spills/ Fire Water
§ Do you pose a risk to them / or them to you?
Know your neighbors. Understanding their hazards allows you to make your emergency plans
Can your neighbor help you during an emergency? Equipment, Resources, Communications
(industrial mutual aid agreements)
EMERGENCY PREPAREDNESS AND RESPONSE 17
Emergency Plan
Example
Microsoft Word
Document
Microsoft Word
Document
Crisis Mgmt Plan
Example
EXAMPLES
PSCI
PSCI @PSCInitiative
PSCI Secretariat
Carnstone Partners LLP
Durham House
Durham House Street
London
WC2N 6HG
info@pscinitiative.org
+55 (11) 94486 6315
About the Secretariat
Carnstone Partners Ltd is an independent management consultancy,
specialising in corporate responsibility and sustainability, with a long
track record in running industry groups.
For more information about the PSCI please contact:
pscinitiative.org info@pscinitiative.org Annabel Buchan:
+55 (11) 94486 6315
PSCI @PSCInitiative
CONTACT
EMERGENCY PREPAREDNESS AND RESPONSE 20
PSCI
PSCI @PSCInitiative
BACK-UP Slides
EMERGENCY PREPAREDNESS AND RESPONSE 21
PSCI
PSCI @PSCInitiative
Potential
Chaos
Fire
Police
Managers
Employees
Medical
EHS
Security
Media
WHO RESPONDS VS. HOW TO THEY RESPOND?
What happened?
What caused it?
Was anybody hurt?
How bad is it?
Who should be notified?
Do we need to enact
contingency plans?
FACILITY SCENE Senior Leaders
Potential
Chaos
Fire
Police
Managers
Employees
Medical
EHS
Security
Media
What’s the emergency?
Who’s in charge?
What do we need to do?
Did everybody evacuate?
What happened?
What caused it?
Was anybody hurt?
How bad is it?
Who should be notified?
Do we need to enact
contingency plans?
FACILITY SCENE Senior Leaders
EMERGENCY PREPAREDNESS AND RESPONSE 22
PSCI
PSCI @PSCInitiative
Incident Command Structure for Emergencies
Span of Control:
Any one person in
charge can handle
between 2-7 direct
reports.
Incident Command
needs to be
comfortable with
delegation
EMERGENCY PREPAREDNESS AND RESPONSE 23
PSCI
PSCI @PSCInitiative
Emergency
Response Team
Site Crisis
Management Team
(site Emergency Operations Center)
Corp Crisis
Management
Team
Communication
Communication
Corp Crisis Leader –
Maintains
primary contact with the facility
CMT leader
Assesses broad company impacts,
significant media communication,
Companywide communications,
implements contingencies,
maintains contact with Incident
Commander
On-scene coordination led by a
scene leader – established by
“Incident Commander”
Deals with evacuations, fire fighting,
responders, safety zones, activates
site Crisis Management Team
A pre-determined “CMT Leader”
becomes the manager of the overall
event as it escalates
Considers broad site impacts, off-site
impacts, sustained supplies, manages
media, considers agency notifications,
deals with logistics, must notify BU
Crisis Management Leader
Primary focus on safety
and incident containment
Primary focus on impact of
event that could last
several days
Primary focus on
stakeholders, broad impacts,
and business continuity
Example: ICS Major Crisis
EMERGENCY PREPAREDNESS AND RESPONSE 24
PSCI
PSCI @PSCInitiative
Example Crisis Management Team:
Each member of Team should
have specific roles and
responsibilities defined,
including any tools or
templates to support their
responsibilities
EMERGENCY PREPAREDNESS AND RESPONSE 25

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Emergency Preparedness & Response plan.pdf

  • 1. PHARMACEUTICAL SUPPLY CHAIN INITIATIVE (PSCI) WEBINAR: Emergency Preparedness and Response
  • 2. PSCI PSCI @PSCInitiative EMERGENCY PREPAREDNESS AND RESPONSE Aaron Duff, CFPS Johnson & Johnson Global Director of EHS Process Excellence and Standardization SPEAKER 2
  • 3. AGENDA THIS WEBINAR WILL PROVIDE: • Overview of questions related to emergency preparedness & response in the PSCI audit checklist. • Prepare an emergency response plan, assessing and Planning • Preventing and Responding to emergencies • Basic elements to be considered when performing an impact assessment from neighboring industries.
  • 4. PSCI PSCI @PSCInitiative Explosion in China Factory killed 19 Sugar Explosion in Georgia Factory killed 14 Japan earthquake (Fukushima) NFPA reports 37,000 industrial fire 2009-2013 (USA) 58 Hurricanes between 2010-2017 Increased severe weather winters, water shortages, floods Sydney announces water restrictions for business 50% increase in flood events EMERGENCY PREPAREDNESS AND RESPONSE 4
  • 5. PSCI PSCI @PSCInitiative THE AGENDA AND HOW IT ALL TIES TOGETHER EMERGENCY PREPAREDNESS AND RESPONSE 5
  • 6. PSCI PSCI @PSCInitiative QUESTIONS FROM SELF-ASSESSMENT QUESTIONNAIRE Q.No Question Guidance 85 Is the facility emergency response equipment (fire extinguisher, fire pumps, sprinkler systems) visually inspected monthly, comprehensively inspected annually, and documentation maintained for all inspections? Describe if the relevant emergency scenarios been addressed in the emergency response plan • Natural: Earthquake, flood, tornado, hurricane, drought, etc. • Chemical: Spill, fire, wastewater treatment plant upset, • Human: Evacuation, first aid, medical emergency, civil unrest, active shooter/security threat, Does the facility have a communication system to alert the local community of impacts in the event of major emergency? 86 Is the fire alarm system monitored 24 hours a day (including weekends and holidays) with prompt notification to emergency services (within 5 minutes)? 87 Does the facility ensure that an adequate amount of fire water is maintained for fire protection? 88 Are emergency exits and evacuation routes clearly marked, kept free of obstructions (unlocked)? Are emergency exit signs illuminated with emergency backup power? 89 Are regular emergency evacuation drills conducted, and what is the frequency? 90 Are emergency response plans in place? Please explain the key points of the emergency response plan: Indicate when the plan was last revised: 91 Does the site have an on-site emergency response team that is trained for fire or other emergencies? 78 Has the facility evaluated the impact of its operation on the community? Has the facility evaluated the impact from the activities of neighboring businesses? Why are these questions important? EMERGENCY PREPAREDNESS AND RESPONSE 6
  • 7. PREPARING AN EMERGENCY RESPONSE PLAN ASSESSING AND PLANNING
  • 8. PSCI PSCI @PSCInitiative ASSESSING AND PLANNING FOR EMERGENCY RESPONSE § What are your Government regulation? Seveso, Community Right to know, SPCC, PSM, Safety Reg. § Assessing your risk starts with Inventorying potential risks and severity at your locations. • Natural Hazards; Storms, Flood, Earthquake, Drought • Chemical; Fire, Spills, Airborne Release • Human; First-Aid, Confined Space, Work Place Violence § What response capability do you have in your city and what are the response times • Transportation- will road be cleared, alternate routes people/goods • Emergency response for Fire, Chemical, Medical, unique risks • Communications- how is emergency information communicated to businesses/ residence § What are the reliability of your utilities services • Water • Electricity • Waste Water (Fire Water Waste?) What are your Managements expectations? What are your customers expectations? EMERGENCY PREPAREDNESS AND RESPONSE 8
  • 9. PSCI PSCI @PSCInitiative ASSESSING: WHAT ARE YOUR POTENTIAL EMERGENCIES § Fire/Explosion § Chemical Delivery / Transportation § Civil Chemical Spills/Releases § Disturbances/Site Strikes/Protestors § Utility Loss (Power Loss) § Bomb Threats § Medical Emergencies § Sabotage § Elevator Entrapment § Workplace Violence § Chemical Release § Parcel / Letter § Severe Weather - Winter § Severe Weather – Severe Thunderstorm / Tornado § Hurricane § Biohazardous Materials § Media Relations § Unexploded Munitions/Ordnance (UXO) § Confined Space § Compressed Gasses § Earthquake § Nuclear Event EMERGENCY PREPAREDNESS AND RESPONSE 9
  • 10. PSCI PSCI @PSCInitiative ASSESSING EMERGENCY RISK Potential Emergency Risk Rating Gover. Response Gover. Resources Management/ Customer Expectation Site Engineering Controls Site Administrative Controls Gaps/ actions plan Fire (example A) High 20 min. from notification 1 truck 4 Fire Fighters, mutual aid 20 additional mins Fire immediately controlled, no more than 48 hours delay in production Offices have sprinklers Manuf. has no sprinklers Site has fire detection Trained employee for fire handheld fire extinguishers Create site fire brigade Training and equipment needed Create Crisis Mgmt Team Fire (example B) High 4 min from notification 3 truck, 12 Fire fighters, Pre-planned response, annual facility walk through, 3 mutual aid cities 7 min response Fire immediately controlled, no more than 48 hours delay in production Site is fully Sprinklered Site has full fire detection Site CMT Inspect, Maint., Testing SOP Drills- with Gov. responders None Confined Space Med No trained responders NA No fatalities Hazards identified with Sign Work Permits Employees trained Rescue equipment and training None EMERGENCY PREPAREDNESS AND RESPONSE 10
  • 12. PSCI PSCI @PSCInitiative PLANNING § Objective of Emergency Plan § What are we protecting: describe facilities, operations, maps, neighbors, utilities § Applicable regulations § Defining Emergency: Many sites have 3 levels - Can be handled by department - Can be handled by site Emergency Response Team - Government support needed § Crisis Management Team: Formal SOP describing roles and responsibilities (who does what) § Emergency Equipment: What, How much, Where is it (Inspect, Test, Maintain) § Specific written action plans for high impact risk events: immediate action to be taken to reduce impact of risk § Training/ Drills: ERT and site management (consideration include government responders) § Recovery Plans: specific plans on business resumption EMERGENCY PREPAREDNESS AND RESPONSE 12
  • 13. PREVENTING AND RESPONDING TO EMERGENCIES PREVENTION AND RESPONSE
  • 14. PSCI PSCI @PSCInitiative PREVENTION § Physically Engineered Facility: - Fire Suppression 97% of fires controlled with 1-3 sprinklers - Fire Detection early detection/ early response - Spill containment protect environment/ controlled clean-up - Spill Detection early response / minimizes risk - Fail Safe Designs WHAT IF - Fire Rated Walls Contains /minimizes site wide impact - Fire DoorsStop fire spread - Guards Stop injuries from occurring - Flood Barriers Stop flood damage The BEST most effective emergency response plan is one never needed § Management Procedures: § Work Permits § Inspections, Testing, Maintenance § Routine/Non-routine work SOPs § Pre-startup safety reviews (PSSR) § Emergency Shut down § Hazard awareness (identified and integrated into operating SOPs) EMERGENCY PREPAREDNESS AND RESPONSE 14
  • 15. PSCI PSCI @PSCInitiative EMERGENCY RESPONSE We know emergencies will happen, most emergencies will not happen exactly as planned for. The best emergency response plans allow for flexibility § When an emergency occurs 1. Responders show up to designed area, and one person is designed in charge (Incident Command) and a team of support 2. Determine type of emergency and have the response plan available (grow or reduce size of team based on emergency) 3. Establish goals and limits of response 4. Who is impacted by emergency, do you need to communicate and to who. (employees, management, neighbors, government) 5. Establish accountability; who do you need leading elements of response plan, and who will support leads, leads need to know who, and where their people are, and what they are doing. 6. Incident Commander; needs to know when you need help, who to call for help, and ensure the risk to responders is acceptable. 7. Frequency of communication updates should be established 8. If Government responds (fire department) during an emergency is not the time to be introduced. Most external response organizations will take control of your facility, may not want to talk company employees, and may not allow your people to help. 9. If emergencies go on for time, you need to have plans for feeding and resting your teams EMERGENCY PREPAREDNESS AND RESPONSE 15
  • 16. PREVENTING AND RESPONDING TO EMERGENCIES EVALUATING IMPACT OF NEIGHBORS
  • 17. PSCI PSCI @PSCInitiative IMPACT OF NEIGHBORS When assessing your neighbors risks and impacts what should we consider? § Do they have bulk chemicals, fire explosion risks, fumes? § What kind of work do they do, does it pose a risk? Fireworks warehouse? § Do they have good house keeping? § Are they upwind of your facility? § Do you share utilities (can you)? § Is their building protected by Fire Suppression? § Do they have security? § What direction does their stormwater run? Floods/ spills/ Fire Water § Do you pose a risk to them / or them to you? Know your neighbors. Understanding their hazards allows you to make your emergency plans Can your neighbor help you during an emergency? Equipment, Resources, Communications (industrial mutual aid agreements) EMERGENCY PREPAREDNESS AND RESPONSE 17
  • 18. Emergency Plan Example Microsoft Word Document Microsoft Word Document Crisis Mgmt Plan Example EXAMPLES
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  • 20. PSCI PSCI @PSCInitiative PSCI Secretariat Carnstone Partners LLP Durham House Durham House Street London WC2N 6HG info@pscinitiative.org +55 (11) 94486 6315 About the Secretariat Carnstone Partners Ltd is an independent management consultancy, specialising in corporate responsibility and sustainability, with a long track record in running industry groups. For more information about the PSCI please contact: pscinitiative.org info@pscinitiative.org Annabel Buchan: +55 (11) 94486 6315 PSCI @PSCInitiative CONTACT EMERGENCY PREPAREDNESS AND RESPONSE 20
  • 22. PSCI PSCI @PSCInitiative Potential Chaos Fire Police Managers Employees Medical EHS Security Media WHO RESPONDS VS. HOW TO THEY RESPOND? What happened? What caused it? Was anybody hurt? How bad is it? Who should be notified? Do we need to enact contingency plans? FACILITY SCENE Senior Leaders Potential Chaos Fire Police Managers Employees Medical EHS Security Media What’s the emergency? Who’s in charge? What do we need to do? Did everybody evacuate? What happened? What caused it? Was anybody hurt? How bad is it? Who should be notified? Do we need to enact contingency plans? FACILITY SCENE Senior Leaders EMERGENCY PREPAREDNESS AND RESPONSE 22
  • 23. PSCI PSCI @PSCInitiative Incident Command Structure for Emergencies Span of Control: Any one person in charge can handle between 2-7 direct reports. Incident Command needs to be comfortable with delegation EMERGENCY PREPAREDNESS AND RESPONSE 23
  • 24. PSCI PSCI @PSCInitiative Emergency Response Team Site Crisis Management Team (site Emergency Operations Center) Corp Crisis Management Team Communication Communication Corp Crisis Leader – Maintains primary contact with the facility CMT leader Assesses broad company impacts, significant media communication, Companywide communications, implements contingencies, maintains contact with Incident Commander On-scene coordination led by a scene leader – established by “Incident Commander” Deals with evacuations, fire fighting, responders, safety zones, activates site Crisis Management Team A pre-determined “CMT Leader” becomes the manager of the overall event as it escalates Considers broad site impacts, off-site impacts, sustained supplies, manages media, considers agency notifications, deals with logistics, must notify BU Crisis Management Leader Primary focus on safety and incident containment Primary focus on impact of event that could last several days Primary focus on stakeholders, broad impacts, and business continuity Example: ICS Major Crisis EMERGENCY PREPAREDNESS AND RESPONSE 24
  • 25. PSCI PSCI @PSCInitiative Example Crisis Management Team: Each member of Team should have specific roles and responsibilities defined, including any tools or templates to support their responsibilities EMERGENCY PREPAREDNESS AND RESPONSE 25