PLENARY SESSION 2 - IS IT POSSIBLE THAT NATURAL EVENTS AND NATURAL DISASTERS CAN ACT AS TRIGGERS FOR CBRNe EMERGENCIES?

9.00 a.m. - 11.30 a.m.

Room "Giorgio Mazzini" (Aula Magna)

Building B - Floor 3

WELCOME ADDRESSES

 Pref. Laura LEGA

HEAD OF THE DEPARTMENT OF FIREFIGHTERS, PUBLIC RESCUE AND CIVIL DEFENCE

Italian Ministry of Interior

(ITALY) 

Ing. Carlo DALL'OPPIO

HEAD OF THE NATIONAL CORP OF THE ITALIAN FIREFIGHTERS

Italian Ministry of Interior

(ITALY) 

Prof. Nathan LEVIALDI GHIRON

RECTOR

University of Rome Tor Vergata

(ITALY) 

Dr.Danilo ARAGNO

National Federation of Chemists and Physicists

(ITALY) 

Chairperson PLENARY SESSION 2

Dr. Dieter ROTHBACHER

CBRN Protection

(AUSTRIA)

ORAL CONTRIBUTIONS

8.PL2. LECTIO MAGISTRALIS

Natural risks as the byproduct of physical gradients.

Prof. Carlo DOGLIONI

1. Sapienza University, Rome, Italy

2. President of the Istituto Nazionale di Geofisica e Vulcanologia (INGV), Rome, Italy

Any process on Earth is generated by a physical or chemical gradient. The higher the gradient, the larger the energy involved. The surface of the planet is featured by complex geological patterns produced by both endogenous and exogenous gradients. Any gradient may generate natural risks such as earthquakes, volcanism, landslides, floodings, hurricanes, Earth’s degassing, etc. Therefore, a cascade of chemical, physical, and electromagnetic gradients dictates Earth’s geodynamics and evolution. The lack of direct investigations still makes the Earth’s interior poorly understood and prevents complete clarification of the deep gradients and the mechanisms ruling the Earth’s vitality. We still don’t know what move tectonic plates, hence most of the Earth’s phenomena controlled by geodynamics, both internal and astronomical processes. Most gradients are natural, but some may be anthropogenic. The earthquakes are the dissipation of elastic or gravitational pressure gradients, and they have been and always will be an unavoidable ingredient of our life. The same is for volcanic eruptions, which are determined by pressure gradients in the magma chamber, where the rock melting is generated by thermal and compositional gradients in the Earth’s mantle. Anthropogenic degassing in the atmosphere generated a perturbing gradient determining climate warming, producing relevant risks that we must face. The knowledge of gradients is the key for valuable structural and non-structural prevention.

9.PL2. Navigating the Australian Black Summer Bushfires – A Personal Perspective on Australia's Response and Recovery.

Prof. Anthony M. HOOKER

Centre for Radiation Research, Education, and Innovation, The University of Adelaide, Adelaide, South Australia, Australia

The 2019-2020 Australian bushfires, known as the "Black Summer," caused significant devastation. They resulted in over 30 deaths, destroyed thousands of homes and structures, decimated wildlife, and habitats, and led to hazardous air quality due to smoke. The fires had a catastrophic impact on Australia's unique ecosystems. It's estimated that over 18 million hectares (44.5 million acres) of land were burned across the country. This led to significant habitat loss, endangering numerous plant and animal species, some of which are found nowhere else on Earth.

The Australian Incident Information Management System (AIIMS) played a crucial role in managing the emergency response during the bushfires. AIIMS is a standardized framework that ensures a coordinated approach among various agencies, such as fire services, police, and medical teams. It facilitated real-time information sharing, clear communication, resource allocation, and decision-making. AIIMS enabled responders to effectively manage logistics, implement evacuation plans, and provide timely public information. The disaster highlighted the need for improved preparedness, response coordination, climate change awareness, and community resilience.

As expected, the response to the bushfires was a massive and coordinated effort and involved thousands of firefighters, international assistance, evacuations, and community support. Evacuations were executed to ensure public safety, and evacuation centres provided shelter and support. Emergency management agencies collaborated to allocate resources, manage logistics, and coordinate response efforts. The establishment of the National Bushfire Recovery Agency focused on long-term recovery. Community support and donations played a vital role, reflecting the collective determination to address the disaster's impact. The response highlighted the importance of efficient communication, collaboration, and preparedness in managing such catastrophic events.

This presentation will give an overview of the response from a personal perspective as someone who lived in area affected by the bushfires. 

10.PL2. Unveiling Disaster: Exploring Dam Failures and CBRNe Events in Brazil and Beyond.

Prof. Susana DE SOUZA LALIC(1,2,4), Elí Cristina Caçador(2,3), Veridiana Teixeira de Souza Martins(3), Francesco d’Errico(1,2,4,5)

1 Physics Department - Federal University of Sergipe - São Cristóvão, SE, Brazil

2 CBRNe Program, University of Rome - Tor Vergata, Rome, Italy

3 Instituto de Geociências, Universidade de São Paulo - São Paulo, SP, Brazil

4 Scuola di Ingegneria - Università di Pisa (UNIPI) - Pisa, Italy

5 Yale Center for Emergency Preparedness and Disaster Response – Yale University - New Haven, CT, USA

Over the past six years, Brazil has witnessed two significant CBRNe events resulting from unforeseen and unintentional releases of mining tailings. These incidents have led to a cascade of social, environmental, and financial consequences, posing formidable challenges for both first responders and decision-makers in their efforts to restore equilibrium and effectively manage the aftermath. One of these pivotal occurrences took place on November 5, 2015, when the catastrophic breach of the Fundão dam in Mariana unleashed a colossal wave of sludge. The accident claimed 19 lives and became Brazil's most extensive environmental catastrophe involving chemical and biological aspects. Just a few years later, on January 25, 2019, Brumadinho fell victim to yet another dam breach, resulting in a staggering death toll of 270 individuals. This lecture aims to delve into the mechanics of these dam failures within Brazil, providing an analysis of their unfolding. Additionally, it will spotlight analogous global incidents, elucidating their reverberating impacts and consequent detriments. Focusing on the Brazilian context, the discourse will expound upon the measures instituted to minimize the repercussions and it will highlight the legislative amendments that followed these calamities. A comparative exploration of emergency protocols for dam failures and other CBRNe-related emergencies will also be undertaken, shedding light on their distinct attributes and commonalities.

11.PL2. Lessons learned from responding to the nuclear disaster - Feedback to natural disaster response on information/communication, wide-area evacuation and training/education.

Prof. Nakahiro YASUDA

1 The research institute of nuclear engineering, University of Fukui, Fukui, Japan

2 The Great East Japan Earthquake and Nuclear Disaster Memorial Museum, Fukushima, Japan

A massive earthquake of magnitude 9.0 occurred off the Sanriku coast in 2011. According to the Reconstruction Agency in Japan, 19,759 people have died so far, including disaster-related deaths, 2,553 people are still missing, and 122,006 houses have been completely destroyed. Twelve years later, 31,438 people are still living as evacuees. The project for housing reconstruction and community development is almost complete. Existing and new roads are being developed and the JR Joban Line is fully open. Production facilities in the three affected prefectures (Iwate, Miyagi, and Fukushima) have mostly been restored. Looking at the agriculture and fisheries industries, it is possible to resume farming in 95% of the tsunami damage records. The seafood processing industry in the three affected prefectures resumed operations at 98% of the facilities that requested reopening. Due to the release and diffusion of radioactive materials caused by the accident at the TEPCO Fukushima Daiichi Nuclear Power Station, some of the six towns and villages around the nuclear power plant are still designated as evacuation zones. Japan's disaster management system covers all stages of disaster prevention, mitigation, preparedness and emergency response, recovery and reconstruction. It also defines the roles and responsibilities of national and local governments and involves public and private stakeholders. This approach has allowed us to quickly and effectively recruit personnel from various organizations in a wide range of areas outside the disaster area even during the disaster. In order to prepare for possible mega-disasters in the future, regional disaster prevention plans have been reviewed and new measures have been proposed. This presentation will provide information from the following three perspectives: 1) Issues in information and communication under disasters, 2) Issues in wide-area evacuation plans in the event of a severe disaster, and 3) Development of disaster prevention personnel training and nuclear disaster prevention in school education. For the information and communication, it will address the lack of real-time information about local conditions and coordination among stakeholders, and the loss of critical public records critical to recovery. The wide-area evacuation plan that spans administrative districts is being considered, assuming hundreds of thousands of evacuees. Especially in recent years, disaster prevention plans are being considered not only for nuclear disasters, but also for Tokyo inland earthquake, Mount Fuji eruption and flood damage in various cities. The estimation of evacuation time to improve the efficiency of evacuation of residents is advancing its own evolution in consideration under these disasters. Lastly, training on radiation countermeasures for disaster prevention personnel (administrator, medical personnel, and firefighters) and nuclear disaster prevention in school education will be mentioned.

12.PL2. The DISASTER paradigm for responding to chemical, biological, radiological, nuclear and trauma/burn mass casualty incidents.

Prof. Francesco d'ERRICO(1,2,3), Vasilis Vasiliou(2), James Paturas(3), Joseph Albanese(3,4)

1. Scuola di Ingegneria, Università di Pisa, and Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy 

2. Yale School of Public Health, New Haven, Connecticut, USA 

3. Yale Center for Emergency Preparedness and Disaster Response, New Haven, Connecticut, USA 

4. Yale School of Medicine New Haven, Connecticut, USA

This presentation outlines how the DISASTER paradigm was utilized to formulate a series of clinical directives aimed at aiding hospitals in their readiness efforts to manage incidents involving chemical, biological, radiological, nuclear events, or explosive devices that lead to trauma/burn mass casualty incidents (MCIs), as well as their initial response to such occurrences. The DISASTER paradigm, crafted by the National Disaster Life Support Education Foundation (NDLSEC), serves as a blueprint for out-of-hospital emergency response, encompassing the following components: (1) Detection; (2) Incident command system; (3) Security and safety; (4) Assessment; (5) Support; (6) Triage and treatment; (7) Evacuation; and (8) Recovery. The acronym 'DISASTER' is formed from the initial letters of these crucial emergency response elements, serving as a memory aid. Descriptive insights were gathered from project-related observations and records. The expertise provided by a team of disaster medicine specialists at the Yale New Haven Health System Center for Emergency Preparedness and Disaster Response (YNHHS-CEPDR) was harnessed to draft the clinical guidelines. Analogous to NDLSEC's approach for on-site activities, the YNHHS-CEPDR clinical guidelines employ the letters in the term 'disaster' as a mnemonic to recollect the principal components necessary for managing MCIs within the hospital's emergency department.

13.PL2. An AI-powered patient triage platform for future viral outbreaks using COVID-19 as a disease model.

Georgia Charkoftaki(1), Reza Aalizadeh(2), Alvaro Santos-Neto(3), Wan Ying Tan(1,4†), Emily A. Davidson(1,5), Varvara Nikolopoulou(2), Yewei Wang(1), Brian Thompson(1), Tristan Furnary(1,6†), Ying Chen(1), Elsio Wunder(7), Andreas Coppi(8), Wade Schulz(8,9), Akiko Iwasaki(10,11), Richard W. Pierce(12), Charles S. Dela Cruz(13), Gary V. Desir(14), Naftali Kaminski(13), Shelli Farhadian(15,16,17), Kirill Veselkov(1,18), Rupak Datta(19,20), Melissa Campbell(15), Nikolaos S. Thomaidis(2), Albert I. Ko(7,21,22) Yale IMPACT Study Team, David C. Thompson(1), Prof. Vasilis VASILIOU(1) 

1. Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA 

2. Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Greece 

3. São Carlos Institute of Chemistry, University of São Paulo, São Carlos 13566-590, SP, Brazil 

4. Internal Medicine Residency Program, Department of Internal Medicine, Norwalk Hospital, CT, USA 

5. Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA 

6. Harvard Medical School, Harvard University, Boston, MA, USA 

7. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA 

8. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA 

9. Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA 

10. Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA 

11. Howard Hughes Medical Institute, Chevy Chase, MD, USA 

12. Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA 

13. Section of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, Yale University, New Haven, CT, USA 

14. Department of Internal Medicine, Section of Nephrology, Yale School of Medicine - New Haven, CT, USA 

15. Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA 

16. Department of Neurology, Yale School of Medicine, New Haven, CT, USA 

17. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA 

18. Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK 

19. Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA 

20. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA 

21. Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

22. Institute Gonçalo Moniz, Fundação Oswaldo Cruz, Brazilian Ministry of Health, Salvador, Brazil 

† Current address

Throughout the past century, outbreaks and pandemics have surfaced at unsettlingly regular intervals, underscoring the importance of proactive readiness and well-coordinated responses. In this context, we have developed an advanced predictive machine learning model for gauging the severity of diseases and the duration of hospital stays in COVID-19 cases. This model lays the groundwork for addressing potential future viral outbreaks. Our methodology involved amalgamating untargeted metabolomics data extracted from plasma samples of COVID-19 patients (n=111) during their hospitalization, alongside samples from healthy controls (n=342). Coupled with clinical and comorbidity data (n=508), we have established a patient assessment framework comprising three key components: Clinical Decision Tree: Among a range of biomarkers, our clinical decision tree pinpointed elevated eosinophil levels as a potent prognostic indicator of disease severity. This discovery presents a potential novel biomarker with remarkable accuracy (AUC=0.974). Hospitalization Duration Estimation: Our model accurately predicts the duration of patient hospitalization with a minimal margin of error (±5 days) (R2=0.9765). Severity Prediction and Intensive Care Unit Transfer: We’ve also created a mechanism for forecasting disease severity and determining the necessity of transferring patients to the intensive care unit. Notably, patients requiring positive airway pressure oxygen and/or intubation exhibited significantly diminished serotonin levels. Additionally, our research revealed elevated levels of metabolites like 5-hydroxy tryptophan, allantoin, and glucuronic acid in COVID-19 patients, collectively offering predictive potential for disease progression. The significance of swiftly identifying patients at risk of life-threatening illness cannot be overstated. Such early identification enables optimized allocation of medical resources and the implementation of highly effective interventions. We strongly advocate that this same methodology holds promise for guiding hospital triage procedures during future viral outbreaks. By doing so, hospitals can enhance patient outcomes, ensure resource efficiency, and effectively address the challenges posed by emergent infectious diseases.

14.PL2. Emilia Romagna Flood – Main activity and intervention of National Fire and Rescue Service and related CBRN risk.

Arch. Sergio SCHIAROLI(1), Damiano Zurlo(1) 

1. National Fire and Rescue Service - Central Directorate of Emergency, Rome, Italy

The purpose of this work is to illustrate the intervention work of the National Fire and Rescue Service during the recent natural disaster that involved Emilia Romagna, in particular by analyzing the direct and collateral interventions, including CBRN ones. In the first days of May, in a few hours, part of the Region was affected by exceptional rainfall causing the overflowing and breaking of the banks of numerous rivers, canals and streams, resulting in mud and debris flow, flooding of anthropized areas, basin of stagnant water and sewers overflow. Collaterally, the flood caused chemical and biological risks to the primary scenarios, this significantly influenced the choice of PPE. On the biological and sanitary side, contamination by sewage water, the movement of abandoned waste and the putrefaction of animal carcasses were found, elements which could have favored the transmission of pathogenic microorganisms. Although no epidemics have been recorded, the Romagna Health Authority has nevertheless set up field vaccination centers for Tetanus and Hepatitis A. The flood scenario has also caused chemical risks due to environmental contamination in those industrial plants that produce and/or use chemical additives or that generate biogas through the processing and transformation of food waste for the production of energy. In this context, sampling and detection were carried out on the water deposited near the industrial areas affected by the floods. Furthermore, always on the chemical side, where there were LPG tanks, above ground or underground, due to hydrostatic pressure they were uprooted or re-emerged by floating, numerous breakages of the pipes occurred with consequent loss of LPG. The chemical risk also occurred a few weeks after the calamitous event, when lithium batteries present in landfills and piles of waste caught fire from a chemical reaction. The concurrence of interventions to face aquatic risk with the rescue of people and goods and interventions to face CBRN risk has made the management of this natural disaster more complex and challenging.