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1st INTERIM REPORT FOR ETHREAT PROJECT June 2006

Agreement number: No 2004207 Contracting period: 01/05/2005 – 30/04/2008 Year: 2004 Country: EL Project duration: 36 months Title: European Training of Health Professionals on Rapid Responses to Health Threats Contractor: NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS Contractor's legal representative: M. DERMITZAKIS Period covered by the report From: 01/05/2005 – 30/04/2006 Contract amendments Yes No

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A. Summary of progress

The aim of this report is to describe the progress of the ETHREAT project: “European Training for Health Professionals on Rapid Responses to Health Threats” during the first period of its implementation (01/05/05 – 30/04/06). The project flow has generally been successful and most of the project’s aims for this period have been fulfilled. The deliverables for the first year have been completed and for those tasks where some difficulties and delays have been faced, we are in the final process of correction and finalization. In more detail, the management of the project has run relatively smoothly and the progress with the dissemination of the project (construction of website, scientific announcements, emailing lists and newsletter) has been satisfactory. In the same way quality assurance has been so far ensured for the main procedures and products of the project. With regards to the projects’ outcomes, we have concentrated our efforts on the development of the relevant methodologies. Two partner meetings have already taken place, the first in Athens (June 2005) and the second in Prague (March 2006) and have contributed towards the direction of a more efficient cooperation among the partners. At the same time the construction of a specific, partners’ area, and a project management area at the web-site have ensured the development of strong communication links among the partners. The actual project development has also progressed satisfactorily, however, with different paces than the ones foreseen. Nevertheless, all the products (deliverables) of the first project period have been completed within the first twelve months. Tables C.1.1 and C.2.1 provide a summary on the level of progress for each workpackage and its deliverables.

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B. Changes in the project - amendments No amendments are required.

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C. WORK PROGRAMME In Table C.1.1 and C.2.1 you can see the progress for the Work Packages examined in this interim report. (The following table includes only the workpackages that cover totally or partially the first year of the project). Table C.1.1 N° Title of Work package Start date

(dd/mm/yyyy) End date (dd/mm/yyyy)

Percentage of Progress (of the planned tasks for the completion of the project)

WP 1 Project Coordination, Management and Strategic Project Planning

01/05/2005 30/04/2008 50%

WP 2 Launch of technical/electronic tools 01/05/2005 30/04/2008 90% WP 3 Sampling of schools 01/06/2005 30/09/2005 100%

WP 4 Identification of sources of information 01/09/2005 30/12/2005 100% WP 5 Identification of training needs

(Questionnaire, Algorithm) 01/08/2005 30/05/2006 70%

WP 6 Design and development of the pilot training course

01/01/2006 31/10/2006 20%

WP 10 Dissemination 01/05/2005 30/04/2008 30%

WP 11 Quality assurance 01/05/2005 30/04/2008 30%

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Table C.2.1

No Deliverable Title Month COMPLETION

D1 1st partners’ meeting 2 COMPLETED List of education objectives for professionals targeted by the

project 2 COMPLETED

Flow diagrams describing the coordination of the activities and the role of each partner

2 COMPLETED

COMPLETED D2 Website with open and restricted areas providing information,

material and the outputs of the project 2 COMPLETED

Development of strong communication channels among the partners

2 COMPLETED

COMPLETED D3 List of schools where relevant curricula exist 5 COMPLETED Inventory of existing courses and available training material 5 COMPLETED

COMPLETED D4 Databank with identified sources of information 8 COMPLETED COMPLETED D5.3 Intrerim report 13 COMPLETED D5.4 2nd partners’ meeting 12 COMPLETED

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C.2. Work packages Description of progress and deliverables WP 1: Project coordination, management and strategic project planning Progress in this workpackage has been satisfactory and in accordance with the project provisions. The WP was divided into the following tasks TASK1.1 Title: Flow Diagrams Deadline: 30/09/05 Description: Design of flow diagrams describing the coordination of the activities and the role of each partner.. All partners were involved by providing their organizational chart concerning the implementation of the project and the role of individuals. The final structure of the diagrams has been implemented by the National and Kapodistrian University of Athens using the Microsoft Visio Program.

TASK1.2 Title: Communication Channels Deadline: 30/07/05 Partners: National and Kapodistrian University of Athens Description: Development of strong communication channels among the partners based on the construction of group e-mails and the uploading of the partners’ forum (WP2). TASK1.3 Title: 1st Partners’ Meeting Deadline: 24/06/05 Partners: All Description: The organization of the 1st partners’ meeting was the responsibility of the National and Kapodistrian University of Athens. A more detailed description of the meeting and its results can be found in the following section on the partners’ meetings (Please refer to part F1 of the Annex, p. 25). Moreover, regarding the internal organisation of the project coordinator’s work team can be outlined as following:

- the scientific coordinator: responsible for the project coordination and scientific supervision - the consultant: providing expert information and feedback - the supervising researcher: primarily responsible for the coordination of the research and the project

management, in constant cooperation with the researcher of the project. - the researcher: performing the main research under the guidance of the scientific supervisor, responsible

for the day to day communication with the partnership, and the management of the project’s website - the administrator: responsible for providing administrative assistance to the researchers - the financial administrator: responsible for managing the finances of the project

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From the part of the coordinator, the following people have worked on the project: The management of the project’s partnership has been based on the frequent communication with the partners through the project’s website (partners’ forum) or through emailing. Our initial goal was for all communication to be managed through the partners’ forum, however since responsiveness from the partners has varied we have continued to email partners on their regular email accounts, also to alert them on new items posted at the web forum. Furthermore, the partners have been encouraged to participate in all aspects of the project; making proposals, evaluating the methodology and products, and contributing to the ongoing research. Partners have also been encouraged to promote the dissemination of the project through contacts with experts in their own countries and other dissemination activities. The flow diagrams describing the organizational structure of the team working on the project in the organizations of the consortium are displayed below. Please note that these are the flow diagrams that were sent by partners during the first months of the project, as foreseen by the contract and changes concerning the names of individuals that work in the project might have occurred.

Name Function Dr Athena Linos scientific coordinator –

project head Ms Eirini Andriopoulou project manager Ms Evangelia Tavoulari researcher LtCol (MD) Ioannis Galatas

CBRN consultant

Dr Agoritsa Baka consultant Ms Chaido Peppa administrator Mr Ioannis Karamanis financial administrator Mr Koumantakis researcher

Scientific coordinator

Supervising researcher / Consultant

Researcher

Administrative support

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A: PUBLIC HEALTH RESEARCH ASSOCIATION SAXONY, MEDICAL FACULTY OF DRESDEN, UNIVERSITY OF TECHNOLOGY, DRESDEN, GERMANY

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B: NATIONAL INSTITUTE OF PUBLIC HEALTH PRAGUE, CZECH REPUBLIC

Flow diagram describing the role of each person in our organizationin ETHREAT project

Dr. Jan Kyncl (MD)

National Project Coordinator

Dr. Jitka Castkova(MD,Ph.D)

Scientific Manager, Researcher

Dr. Katerina Fabianova(MD)

Researcher

C: NOFER INSTITUTE OF OCCUPATIONAL MEDICINE, LODZ, POLAND

FLOW DIAGRAM DESCRIBING THE ROLE OF EACH PERSON IN OUR ORGANIZATION IN ETHREAT PROJECT

Nofer Institute of Occupational Medicine

FLOW DIAGRAM DESCRIBING THE ROLE OF EACH PERSON IN OUR ORGANIZATION IN ETHREAT PROJECT

Nofer Institute of Occupational Medicine

Dr Andrzej Marcinkiewicz MD

Researcher

Dr Jan Nosko Msc, PhD

Researcher

Dr Dorota Szosland MD, PhD

National Project Coordinator, Researcher

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D: PUBLIC AND ENVIRONMENTAL HEALTH RESEARCH UNIT (PEHRU), DEPARTMENT OF PUBLIC HEALTH AND POLICY, LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE (LSHTM) – UNITED KINGDOM

ETHREAT – UK TEAM FLOW DIAGRAM

E: FACULTY OF PUBLIC HEALTH, MEDICAL UNIVERSITY, SOFIA - BULGARIA No flow diagram was sent by the Medical University of Sofia.

Professor Jack Dowie

Lead for UK Team

Mr. Mike Ahern

Researcher for UK Team

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WP 2: Launch of Technical electronic tools 90% of the contents of this work package have been completed. This work package has been divided into five tasks: TASK2.1 Title: Web-site (Construction) Deadline: 24/06/05 Partners: National and Kapodistrian University of Athens, Institute of Preventive Medicine Environmental and Occupational Health “Prolepsis” Description: Design and construction of the web site that will include a) a forum for the communication with experts and the public, b) another forum for the communication among partners, c) a password protected area for the partners. The National and Kapodistrian University of Athens has been responsible for the construction of the website. TASK2.2 Title: Web-site (Contents) Deadline: Continuous Partners: All Description: All partners must contribute to the initial content and updates of the web-site by sending relevant material and links. Furthermore, apart from using the partners’ area, partners must contribute to the public forum and answer individuals’ questions. The number of visits to the web-site, as well as the mobility in the forum area, are considered as main criteria for assessing the project. TASK2.3 Title: Newsletters Deadline: Continuous Partners: All Description: As a part of WP2, newsletters must be sent to selected experts as well as to the individuals that have subscribed in the web-site. The role of the partners is to send a list of experts or other professionals in order to compile an extensive list of contacts who will receive newsletters with information on the project’s progress and its results. TASK2.4 Title: Subscription of the web-site’s address at search engines WP2 Deadline: 15/07/05 Partners: National and Kapodistrian University of Athens Description: Subscribe the web-site with the proper key word at search engines TASK2.5 Title: Web-site (Updates) WP2 Deadline: Continuous Partners: All Description: Often updates of the web-site are the responsibility of the National and Kapodistrian University of Athens , however all partners are requested to contribute with material.

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Tasks Implementation The development of the project’s website has been the most important output of this workpackage. The website can be found at www.ethreat.info and it should also be found as a direct link at the DG SANCO website. Moreover the website has been “posted” at the main world wide web search engines. The website comprises of 3 areas: - An unrestricted access area which comprises the following web pages providing general information on the project: “Home”, “The Project”, “Partnership”, “Objectives”, “Questionnaires”, “Contact us”. - A restricted access area, for members only, which comprises the forum and the library where questions and answers can be posted and shared files can be uploaded. - A restricted access area, only for the project partners. This area comprises a forum for partners’ communication and a forum for the communication of the coordinator with each partner. The website has been used mainly:

- for widely disseminating the project - for contacting experts and interested partners and inviting them through the forum to contribute to the

project - for internally managing in a more efficient way the project’s partnership

Please see Annex F2 (page 26) of the current report for a detailed description of the project’s web site. Another very important tool for the project’s dissemination is the newsletters. We have already sent newsletters to major organizations and individual experts and non-experts on CBRN issues, so as to provide some introductory information on the project and invite interested parties to visit the website. A second newsletter inviting individuals to participate at the project’s questionnaire survey was also sent. In total more than 300 e-mail addresses belonging to organizations or individuals receive the project’s newsletter. The two newsletters can be found in Annex F3 of the current report (page 28).

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WP 3: Sampling of schools This WP has been completed successfully. This work package has been divided into four tasks TASK3.1 Title: List of universities/organizations Deadline: 31/10/05 Partners: All Description: Create a list with all organizations (Universities, Public Health Schools, Other Educational Organizations, Health Institutes, Professional Associations, Health Authorities – national and regional- etc.), the curricula of which has been searched for courses related to bioterrorism. TASK3.2 Title: List of schools where relevant curricula exist Deadline: 30/11/05 Partners: All Description: Create a list with all organizations/schools where we found that there are courses taught related to bioterrorism. TASK3.3 Title: Production of a curricula inventory Deadline: 30/11/05 Partners: All Description: Produce an inventory of the relevant curricula, including information related to particular characteristics of the health educational and training systems in each country. TASK3.4 Title: Collect the syllabus/curricula Deadline: 30/11/05 Partners: All Description: Find the material – content of the courses (syllabus, lecture notes) that were identified in the previous tasks Tasks Implementation Not all the tasks of this WP were completed by the deadlines that are presented above. The major reason for the delay was poor response rate from the contacted schools and departments or being unable to locate a proper contact point in the specific Member State (MS), where the project team was unable to locate any information from the internet. However, the final product, the construction of an inventory including all the major courses that are taught in the EU on CBRN issues had been finalized in early March 2006. An inventory template was constructed by the coordinator so as to facilitate the collection of information. The organizations that were investigated were as many as possible (more than 300) and of all types (universities, public health schools, health authorities - regional & national-, health institutes, professional associations, other educational organizations, armed forces, civil protection authorities). Please refer to the CD-ROM accompanying the interim report to view the inventory.

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WP 4: Identification of sources of information This WP has been completed successfully. This work package has been divided into three tasks TASK4.1 Title: Examine the curricula Deadline: 31/12/05 Partners: All Description: Produce a report based on the material gathered in the previous work package. TASK4.2 Title: Literature review Deadline: 31/12/05 Partners: All Description: Examine other sources of information apart from European universities’ curricula and training material like:

o official reports o academic publications o WHO (World Health Organisation), EMEA (European Agency for the Evaluation of Medical

Products), APHA (American Public Health Association), EUPHA (European PHA) guidelines, CDC, etc.

o EU programmes, projets and reports o Syndromic surveillance systems o Public health authorities

TASK4.3 Title: Production of a databank Deadline: 31/01/06 Partners: All Description: Creation of a databank including all identified sources of information with the relevant electronic links (wherever available). Tasks Implementation In this WP the final databank with all the sources available on CBRN training issues world wide, has been constructed using the bibliographic software Endnote. The CD-Rom also includes short reports of the individual partners concerning the existing courses and material on CBRN issues and bioterrorism in the countries for which they were responsible for collecting data (For the assignment of countries among the partners please refer to the section concerning the decisions of the first partners’ meeting – Annex F1 page 25). The data bank for the trainees should contain basic information on the various aspects of CBRN terrorism and medical countermeasures. There is no use to try to encapsulate all the Internet knowledge on this subject since this is impossible and of no practical usage. Instead it will be extremely useful to provide health professionals with some on-line editions, manuals, field manuals and picture galleries from open sources on the Internet that will serve as a personal reference library for continuing medical education and in case of a real incident happened in the future. Considering the fact that native language is always more digestible that a foreign one, we made some effort to collect documents written in the languages of the EU member states that will act as introductory editions to the complexity of medical CBRN defense.

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WP 5: Identification of training needs (questionnaire and algorithm) This WP has not yet been completed (completion at approximately 70%) This work package has been divided into three tasks. TASK5.1 Title: Construction of questionnaires Deadline: 30/11/05 Partners: UK Description: construct two questionnaires addressed to public health experts and health professionals, especially front-line health professionals, so as to collect more information on the practical aspects of health professionals’ training needs on the issue. TASK5.2 Title: Questionnaire survey Deadline: 31/01/05 Partners: All Description: address the questionnaires to public health experts and health professionals, especially front-line health professionals through universities, conferences, professional associations etc. and collect the results. TASK5.3 Title: Algorithm guide Deadline: 20/02/06 Partners: All Description: develop an algorithm guide of actions to be undertaken in case of terrorist attacks. The algorithm guide will be released and distributed in large number of copies (both hard and electronic) and will be published on the web. TASK5.4 Title: Second partners meeting Deadline: 31/03/06 Partners: All Description:. the 2nd partners’ meeting was organised in Prague, Czech Republic in March 2006. Please see Annex F5 for all relevant information (page 41). TASK5.5 Title: Interim report Deadline: 31/05/06 Partners: Greece Description:. produce an interim report presenting the progress achieved and summarizing all the performed actions, their results and deliverables as well as the internal evaluation of the project up to that moment. Tasks Implementation The questionnaire survey that has been performed has targeted both the Front-line health professionals (FLHP) as well as experts on CBRN issues. The two questionnaires can be found in electronic versions at the project’s web-site www.ethreat.info/questionnaires or at Annex F4 (page 30) of this report. Due to delays in the response

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from health professionals and experts, the questionnaire survey run 2,5 months instead of 1 that was initially planned. Therefore, the results of the survey have not been fully analyzed yet. The aim of the the FLHP questionnaire is to investigate the gap of knowledge of front-line health professionals on CBRN issues and assess their training needs. The experts’ questionnaire works as complementary in reviewing what the experts think that the FLHP in their country know on CBRN issues and what they need to learn. The algorithm guide of actions as it is strongly linked with the results of the questionnaire survey has not been constructed yet. However, a cardinal Greek medical CBRN expert who was involved at the construction and editing of the CBRN Preparedness Plan of the Athens 2004 Olympic Games, has been employed as a consultant to work on the issue.

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WP 6: Design and development of the pilot training course This WP, as a time period, covers a small part of the first year. Thus only 20% of the provisioned tasks have been completed. The work package has been divided into the following tasks: TASK6.1 Title: Main course material Deadline: 28/02/2007 Partners: All Description: Prepare the main course material TASK6.2 Title: Develop the teaching methodology Deadline: 30/04/2007 Partners: All Description: Construct some cases studies and problem sets to be used as training methods + ppp presentations, CDs, etc TASK6.3 Title: Construct the electronic interface Deadline: 31/05/2007 Partners: Prolepsis Description: Construct a user and teaching friendly IT environment for the incorporation of the training material at the website Tasks Implementation Until now the project’s research team has been occupied only with the first of the above tasks “The development of the main course material”. The task has not yet been completed but the main sources of information (publications, syllabuses of other training courses, power point presentations, videos, methodologies etc.) have been identified during the implementation of the previous WP and the construction of the databank (page 15). Since the “CBRN Course for Front Line Health Professionals” would be the main product of this project it has to be as complete as possible taking into accounts that the audience are not experts and that this might be their first contact with this field of expertise. CBRN experts of the working group believe that the course should be both theoretical and practical. When you teach people about mass casualties due to chemical weapons attack a main part is dedicated to personal protective equipment. It is almost impossible to make trainees realize that adverse inner environment of a chemical suit unless they wear it and practice with it. If there is no hands-on experience during the final course, when they will try to enforce it in their own countries as a pilot course for their physicians and nurses they will realize all the difficulties and problems arising from the usage of this kind of equipment and this might compromise the whole effort. Medical people are not very willing to be involved in CBRN operations since this kind of training should be constant and continuous. Despite the fact that the inclusion of a practical part to the pilot course will increase its cost, we believe that it will make the course more complete and appealing. Therefore, we will look into the possibility of adding also a practical session to the program. A short overview of the content of the course that is estimated to take place at the last ten days of May 2007, is shown further down.

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ETHREAT PILOT CBRN COURSE [MAY 2007] FOR EU FRONT-LINE HEALTH PROFESSIONALS – DRAFT

DAY 0 [Tuesday]

Arrival of Participants (after 13.00) in Athens

DAY 1 [Wednesday] TIME TITLE SPEAKER (Country) 09.00-09.45 Introduction to ETHREAT initiative TBD 10.00-10.45 Is it possible to deal with a terrorist CBRN real

incident? TBD

11.00-11.45 History of chemical war TBD 12.00-12.45 Chemical warfare agents I TBD 12.45-14.00 LUNCH 14.00-14.45 Chemical warfare agents II TBD 15.00-15.45 Management of mass chemical casualties I TBD 16.00-16.45 Management of mass chemical casualties II TBD 17.00-17.45 Practical demonstration [medical dummies] of

chemical casualties management TBD

Visit to Acropolis

DAY 2 [Thursday] TIME TITLE SPEAKER (Country) 09.00-09.45 Toxic war (TICs) TBD 10.00-10.45 Chemical Weapons Convention [OPCW] TBD 11.00-11.45 History of biological war TBD 12.00-12.45 Bioterrorism: Prnciples & Practice TBD 12.45-14.00 LUNCH 14.00-14.45 Biological warfare agents I TBD 15.00-15.45 Biological warfare agents II TBD 16.00-16.45 Management of mass biological casualties TBD

Free afternoon DAY 3 [Friday] TIME TITLE SPEAKER (Country) 09.00-09.45 Introduction to medical radiology TBD 10.00-10.45 Major nuclear accidents and dirty bombs TBD 11.00-11.45 Management of radio-contaminated casualties TBD 12.00-12.45 Triage of mass CBRN casualties TBD 12.45-14.00 LUNCH 14.00-14.45 Decontamination of CBRN casualties TBD 15.00-15.45 Hospital-based CBRN defense & planning TBD 16.00-16.45 WMD-induced stress & desensitization TBD 16.45-17.30 Closing remarks – Graduation/Certificates TBD

Official Dinner

DAY 4 [Saturday] Departure of Participants (till 12.00) for their countries of origin

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All speakers will be of European origin and of known expertise in the field of medical defense, planning and medical management. All presentations will be included in a DVD, the whole course will be taken into video, there will be hand outs with the main points of each presentation, there will be an initial evaluation of the trainees and a final – after the course, evaluation (in order to measure the piercing of knowledge provided). Certain sources of information [mostly manuals and full reports] will also be included in the DVD for further reading and as reference material. It is one of these rare occasions that theoretical knowledge should be indissolubly connected with practical training in order the front line health care provider to be able to realize the magnitude of the problem and his/her position and responsibilities in this frightful potential. If we manage to inoculate to them the fact that “it can happen to us as well, today” then the course would be a success and its proliferation in all European countries will provide the first human line of defense against this horrifying threat. We are currently examining the profile of the trainers for the pilot course.

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WP 10: Dissemination The dissemination of the project has been a key interest in the first year of the project’s life and will be given even greater attention in the following months when the products/results of the project will be ready for dissemination. The development of the project’s website has been an important output of this work package. The website can be found at www.ethreat.info and it is also “posted” at the DG SANCO website. Moreover the website has been “posted” at World Wide Web search engines. The website comprises of 3 areas: - An unrestricted access area which comprises the following web pages providing general information on the project: “Home”, “The Project”, “Partnership”, “Objectives”, “Questionnaires”, “Contact us”. - A restricted access area, for members only, which comprises the forum and the library where questions and answers can be posted and shared files can be uploaded. - A restricted access area, only for the project partners. This area comprises a forum for partners’ communication and a forum for the communication of the coordinator with each partner. The website has been used mainly:

- for widely disseminating the project - for contacting experts and interested partners and inviting them through the forum to contribute to the

project - for internally managing in a more efficient way the project’s partnership

Please see Annex F2 (page 26) of the current report for a detailed description of the project’s web site. Another very important tool for the project’s dissemination is the newsletters. We have already sent newsletters to major organizations and individual experts and non-experts on CBRN issues, so as to provide some introductory information on the project and invite interested parties to visit the website. A second newsletter inviting individuals to participate at the project’s questionnaire survey has also been sent. The two newsletters can be found in Annex F3 (page 28) of the current report. We have also developed and published an information and advertising brochure for the project that has been distributed to major Greek conferences and other events. Please see the layout of the brochure at Annex F6 (page 44) of the current report. This can be used as a model of dissemination techniques that can be replicated by all partners in their countries. A “Greek experts meeting on issues of Bioterrorism” was organized in Athens in December 2005. Greek experts and key individuals from Universities, Ministries, Armed Forces, Civil Security Organizations, Schools of Public Health and other institutes and organizations were invited at the National and Kapodistrian University of Athens. The aim of the meeting was to present the project’s content and aims and to pilot test the two project questionnaires that would be used for the questionnaire survey (one addressed to Front-line Health Professionals and the other to EU experts). The agenda of the meeting in Greek can be seen at Annex F7 of the current report. Since Greece organised the 2004 Olympics, the representatives were familiar with the problem that revealed the necessity for the ETHREAT Project. During a terrorist CBRN incident only 20% of the victims remain on-site and these people are those found by the first responders. The rest of the crowd is overwhelming near by hospital and medical facilities and soon due to the worried well [ration 1:5] resulting in the collapse of the medical system. On the other hand, hospitals should alarm their CBRN defence units in order to avoid inner contamination of their premises. In order to do this, front line health care professionals should be aware of the various levels of the threat and the methodology of response that will help them take charge of the affected population. The first step in this direction is the product of the ETHREAT Project that is the CBRN Course for Front Line Health Care Professionals. With regards to scientific announcements and publications on the project, an abstract has already been submitted and accepted for oral presentation at the 16th International Congress of Agricultural Medicine and Rural Health (IAAMPH) that took place from June 18th to June 21st in Lodi, Italy and at the 2006 European Public Health Conference that will take place from November 16th to November 18th in Montreux, Switzerland.

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WP 11: Quality assurance Quality assurance has been an integral part of all project activities so far. We have developed specific methodologies and tools which have been used during the development of the project’s main products. In addition an informal quality assurance procedure has been running along with all project activities through the informal communication among the project’s researchers and other researchers and experts. The quality assurance procedure has been based on 3 different components:

- The frequent communication with the partners and the operation of the partners’ web forum ensuring that open discussion can take place on all issues related to the project (actions and strategies adopted, methodologies used, results and products of the project).

- As a more general monitoring tool we have developed an activities’ overview form which every partner

submits to the project coordinator every few months (please find attached in the Annex F8, page 46). External quality assurance has and will also be sought from external experts. Dr. Strauss (Austria) and Dr. Bork (Denmark), have participated as external experts in the 1st partners’ meeting. The same approach will be used more intensively as the project is getting into a phase where more products are being finalised, quality assurance will assume an even more central role. We therefore aim to discuss all products prior to their final development among the partners, by using evaluation forms. We will also request from external experts to evaluate the main project products for quality assurance purposes.

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D.– Partnership meetings FIRST PARTNERS MEETING Table D.1.1

Place N° Country code Town

Date (dd/mm/yyyy)

Purpose of the meeting

1 EL Athens 24/06/2005 1st partners’ meeting Table D.1.2 N° Partners attending 1 National and Kapodistrian University of Athens, Greece 2 Dresden Technological University, Germany 3 Faculty of Public Health, Medical University, Sofia 4 Public And Environmental Health Research Unit (Pehru), Department Of Public Health And Policy, London

School Of Hygiene And Tropical Medicine (LSHTM) – United Kingdom 5 Nofer Institute of Occupational Health, Poland 6 Institute of Preventive Medicine, Environmental and Occupational Health, Greece Table D.1.3 N° Key results (summary of the minutes): Please see Annex F9 for detailed minutes

1 Agreement on the assignment of countries 2 Agreement on the way the questionnaire survey will run 3 Agreement on the curricula review 4 Agreement on the next partners meeting to take place in Luxembourg (SANCO) in March 2006 5 Election of the project’s steering committee (Dr Strauss, Dr Bork, Dr Dowie, Dr Linos, Dr Kirch) Please refer to annex 9 (page 47) for the analytical agenda and minutes of the meeting.

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SECOND PARTNERS MEETING Table D.2.1

Place N° Country code Town

Date (dd/mm/yyyy)

Purpose of the meeting

1 EL Prague 17/03/2006 2nd partners’ meeting Table D.2.2 N° Partners attending 1 National and Kapodistrian University of Athens, Greece 2 Dresden Technological University, Germany 3 Faculty of Public Health, Medicla University, Sofia 4 Public And Environmental Health Research Unit (Pehru), Department Of Public Health And Policy, London

School Of Hygiene And Tropical Medicine (Lshtm) – United Kingdom 5 Nofer Institute of Occupational Health, Poland 6 National Institute Of Public Health Prague, Czech Republic Table D.2.3 N° Key results (summary of the minutes): Please see Annex F10 for detailed minutes 1 Agreement on the target group of the questionnaire survey and correction of questionnaires 2 Agreement on the databank details 3 Agreement on the algorithm details 4 Agreement on the month for the pilot course (June 2007) Please refer to annex 10 (page 51) for the analytical agenda and minutes of the meeting.

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E. RESULTS / PRODUCTS / PROCESSES

No Deliverable Title Month COMPLETION

D1 1st partners meeting 2 COMPLETED List of education objectives for professionals targeted by the

project 2 COMPLETED

Flow diagrams describing the coordination of the activities and the role of each partner

2 COMPLETED

COMPLETED D2 Website with open and restricted areas with all

documentation gathering through the project 2 COMPLETED

Development of strong communication channels among the partners

2 COMPLETED

COMPLETED D3 List of schools where relevant curricula exist 5 COMPLETED Inventory of existing courses and available training material 5 COMPLETED

COMPLETED D4 Databank with identified sources of information 8 COMPLETED COMPLETED D5.3 Intrerim report 13 COMPLETED D5.4 2nd partners meeting 12 COMPLETED

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F. ANNEX F1. First Partners Meeting Agenda

AGENDA OF 1st PARTNERS MEETING

NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS, 24th of June 2005, Athens

Venue

National and Kapodistrian University of Athens, Cultural Centre "Kostis Palamas"

Akadim ias 48 & Sina

AGENDA

9:00-9:15 W elcome Athena Linos Germain Thinus 9:15-9:30 Introducing People: W ho is who? Ioanna Kotsioni (+Participants) 9:30-13:00 The Layout of the Project Eirini Andriopoulou W ork-packages, Deliverables and Agoritsa Baka Tim efram e Coffee Break D iscussion of each work-package (+Participants) among partners 13:00-14:00 Lunch Election of Steering Com mittee 14:00-15:00 Presentation of the W ebsite and Eirini Andriopoulou Project’s M anagem ent Tools 15:00-16:00 ETHREAT’s Adm inistrative Ioannis Karamanis and Financial Issues Ioanna Kotsioni 16:00-17:00 Round Table Decisions Coordinator: Athena Linos

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F2. Detailed description of the web-site

Web-address: http://www.ethreat.info

Partners secure area: http://www.ethreat.info/project/index.php (password needed) Role of the Web-Site

1) Advertise the Project (subscription to search engines, group mail) and attract interest from public and experts

2) Disseminate the project’s results (preliminary and final educational package, algorithm, teaching methodology, case studies etc.)

3) Enhance the dialogue with the public (public forum) 4) Keep the subscribed experts updated (newsletters) 5) Host an electronic Library 6) Facilitate the implementation of survey through electronic questionnaire and feedback form (WP8) 7) Host the Project Management tool

Role of the Project Management Tool 1) Enhance the discussion and cooperation among the partners in the partners forum area 2) Facilitate coordination of work packages and the on time completion of deliverables (calendar,

announcements, project-flow board) 3) Assure an electronic archive through the project’s library 4) Facilitate the assessment of the project and the active role of each partner (statistics on posts, views etc.

generally on the participation)

Structure of the web-site The Ethreat’s Project Web-site has a structure of four levels. FIRST LEVEL The first level is for visitors who just want to read the project description, objectives and learn about the project partnership. SECOND LEVEL The second level is for the experts and public that have subscribed to the project’s web site (Users’ Area). These can enter the public’s general forum, project’s news as well as public’s library and links. The educational package, algorithm and other material will be uploaded on the “public” library. THIRD LEVEL The third level has been constructed in order to facilitate the project’s management and the communication among partners (Partners’ Area). It includes the following tools: - Announcements: The announcements are posted by the administrator and the partners can view them and they may also receive them by e-mail if the administrator has activated this option.

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- Library: The most important documents are uploaded by the administrator in the library. If the partners wish to post something in the library, they should send the material to the administrator. However, the partners can post the material on the partners’ forum or onto the project’s flow sub-forums. - Calendar: The administrator spots the important dates on the calendar like deadlines, meetings etc. - General Discussion: This is the forum for the discussion among partners. You can start new topics, reply to topics, upload documents, and ask to be notified by e-mail of any replies on a specific topic. - Project’s Flow: The administrator posts a task and creates sub-forums for every country that participates in the task. All partners can see the discussion in all forums, but they can write (start new topic, reply, upload documents) only to the general forum of the task or to their own. It also includes links for: - Profile: Here you can change your profile and add your personal details. - Search: You can search for topics and documents, using key words (it will be very useful after the first year). FOURTH LEVEL The fourth level concerns the administrators, moderator and the IT experts who support the forum (creation of new sub-forums, memberships etc)

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F3. Newsletters

1st NEWSLETTER March 2006

We would like to take this opportunity to introduce you to the project “European Training for Health Professionals on Rapid Response to Health Threats (ETHREAT)”, co-funded by the European Commission, DG for Health & Consumer Protection. This three year project was launched in May 2005. The new threats to health resulting from deliberate releases bring up new needs for the diffusion of existing knowledge. The training of health professionals stands out as a priority that should be coherently addressed at the European level as part of a long-term strategy to respond to the changing environment of public health threats. Our aim is to develop an educational package that will be used by training institutions, universities or public health authorities, in order to train front-line health professionals on the timely identification, management and response to events that might result from deliberate releases of biological, chemical and radiological agents. Emphasis will be placed on strategies for the diffusion of the relevant knowledge and the training of front-line healthcare providers for all 25 EU Member States. The project will take into account all developments in the field and will finally offer a revised educational content, which will enhance health policies and activities at the local, regional, national and pan-European level. For more details on the project please find attached the ETHREAT brochure or visit the project web-site at www.ethreat.info. Yours sincerely, Athena Linos Associate Professor, Athens Medical School on behalf of The ETHREAT Team PS. Please feel free to forward this email. If you want to be excluded from the mail list e-mail your request at the following e-mail address. Contact information: Eirini Andriopoulou (MSc) Department of Hygiene and Epidemiology Athens Medical School National and Kapodistrian University of Athens 75 Mikras Asias str., 11527, Athens, Greece Tel.: +30-210-7462059 / Fax.: +30-210-7462058 Email: contact@ethreat.info

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2nd NEWSLETTER May2006

Dear Colleague The ETHREAT (European Training for Health Professionals on Rapid Response to Health Threats) Project has entered the phase of Questionnaire Survey. The final aim of the ETHREAT Project is to form an educational package that will contain the knowledge and training material necessary to empower European health professionals, including armed forces health personnel, to rapidly recognise and adequately respond to new public health threats, in the form of attacks with chemical, biological, and radiological (CBR) agents. Before designing the training programme, the project team needs to address a number of important questions, including:

What is the existing knowledge of front-line health professional on bioterrorism and exposure to CBR agents? Have the front-line health professionals undergone any training during their career on CBR issues? What do the front-line health professionals need to know?

To enable us to address these, and other related questions we are conducting a web-based survey of relevant individuals in each of the 25 countries of the European Union. Please note that there are two questionnaires on the website, one targeted at Front-Line Health Professionals (e.g. doctors, nurses), and the other at Experts in this area. Completing either questionnaire should take no more than 10-15 minutes In order to participate at the Questionnaire Survey please press ctrl and click at the same time on the word QUESTIONNAIRES

or copy the following address into your web-browser http://www.ethreat.info/questionnaires.php If you have already participated in the survey, we would be much grateful if you could forward this email to your colleagues. Please find also attached the 1st ETHREAT Newsletter or visit the project web-site www.ethreat.info for more information on the project. Yours sincerely, Athena Linos Associate Professor, Athens Medical School on behalf of The ETHREAT Team PS. We apologize for any cross-posting. Please feel free to forward this email. If you want to be excluded from the mail list e-mail your request at the following e-mail address. Contact information: Eirini Andriopoulou (MSc) Department of Hygiene and Epidemiology Athens Medical School National and Kapodistrian University of Athens 75 Mikras Asias str., 11527, Athens, Greece Tel.: +30-210-7462059 / Fax.: +30-210-7462058 Email: contact@ethreat.info

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F4. Questionnaires

ETHREAT PROJECT

EXPERT QUESTIONNAIRE

(final VERSION)

INTRODUCTION

ETHREAT is a European Public Health Project launched in May 2005 funded by the European Commission. The aim of ETHREAT is to plan and develop an educational package containing the knowledge and training material necessary to empower European health professionals, including armed forces health personnel, to rapidly recognise and adequately respond to new public health threats, like attacks with biological, chemical and radiological agents. Further details are available at the project website www.ethreat.info. Before designing the training programme the project team needs to address a number of important questions, including:

What training programmes are currently available? Do these programmes meet the needs of attendees? What should be the educational objectives of a new training programme? What should be the content of a new training programme?

You have been identified as an individual with expert knowledge in this area, and we would be very grateful if you could take some time to complete this questionnaire, and assist us in addressing some (if not all) of these questions. We are primarily interested in learning about the experience of Front-Line Health Professionals (in your country), and their ability to deal with chemical, biological, and radiological incidents. We are also interested in your views on any training that may be available for FLHPs, which enables them to deal with such incidents. Completing the questionnaire should not take more than 10-15 minutes of your time. NOTE: a. All information that you provide here will be treated in the strictest confidence, and these

details will not be distributed to any individual or organisation, other than within the project team. We will be writing several reports for the European Commission, and these reports may at some point be available in the public domain. However, please note that these reports will contain only summary data. Your name will NOT appear in any report.

b. The working language of this project is English, so please ensure that answers are provided in English.

ETHREAT Project Coordinator: National and Kapodistrian University of Athens Athens Medical School Department of Hygiene and Epidemiology Mikras Asias 75 St, 115 27, Athens, Greece Tel: 0030 210 7462059, Fax: 0030 210 7462058, Email: alinou@cc.uoa.gr

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DEFINITIONS Front-Line Health Professional: for the purposes of the ETHREAT project we refer to medical practitioners and nursing staff in civilian or military facilities, especially those working in emergency departments or in primary healthcare, Public Health Officials especially at the local level and Emergency Medical Services personnel. CBRN: initials from the words Chemical, Biological, Radiological and Nuclear. Although the ETHREAT project does not address nuclear threats, the term is the one more constantly used in relation to incidents involving chemical, biological and radioactive agents especially used deliberately to harm. Deliberate: initiated by a person or group of persons with harmful intent; intentional, not natural. DEMOGRAPHIC CHARACTERISTICS Country:

Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, FYROM, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, The Netherlands, Turkey, United Kingdom

(circle one) Sex:

a. Male b. Female (circle one) Age:

a. 20-29 b. 30-39 c. 40-49 d. 50-59 e. 60-69 (circle one)

What is your highest degree? a. Undergraduate degree b. Postgraduate degree c. Doctoral degree

d. Other_____________________________________ (circle one or specify) What is your Occupation?

a. Physician b. Nurse c. Pharmacist d. Emergency Medical Service Personnel e. Public health officer f. Other_____________________ _____________________ (please specify)

(circle one) Type of organization, you work for:

a. Civilian b. Military (circle one)

a. University b. Public health authority c. Hospital d. Emergency Medical Services e. Ministry f. Private sector

g. EU institutions h. Other_____________________ _____________________(please specify)

(circle one) At what level does the organization, you work for operate?

a. local b. regional c. national/federal level (circle one)

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MAIN QUESTIONNAIRE Question 1 Are you aware of any CBRN training courses for Front-Line Health Professionals in your country at: a) Undergraduate level Yes_ No_ If yes, please list the agency/ies or institution/s responsible

1 _____________________ _____________________ 2 _____________________ _____________________ 3 _____________________ _____________________

b) Postgraduate level Yes_ No_ If yes, please list the agency/ies or institution/s responsible

1 _____________________ _____________________ 2 _____________________ _____________________ 3 _____________________ _____________________

c) Courses for practicing front-line health professionals

Yes_ No_ If yes, please list the agency/ies or institution/s responsible

1 _____________________ _____________________ 2 _____________________ _____________________ 3 _____________________ _____________________

d) Courses within a specific CBRN preparedness planning process Yes_ No_ If yes, please list the agency/ies or institution/s responsible

1 _____________________ _____________________ 2 _____________________ _____________________ 3 _____________________ _____________________

e) Other courses Yes_ No_ If yes, please list the agency/ies or institution/s responsible

1 _____________________ _____________________ 2 _____________________ _____________________ 3 _____________________ _____________________

(Tick yes/no and fill in, if you need more space pls use the back of this page) Question 2 In your opinion what proportion (approximately) of Front-Line Health Professionals in your country are adequately prepared to recognise and manage (as far as their role requires): a) biological incident

0-24% 25-49% 50-74% 75-100% Do not Know b) chemical incident

0-24% 25-49% 50-74% 75-100% Do not Know c) radiological incident

0-24% 25-49% 50-74% 75-100% Do not Know (circle one)

Question 3 In your opinion what proportion (approximately) of Front-Line Health Professionals in your country are able to discriminate between a man made and a natural

a) biological incident 0-24% 25-49% 50-74% 75-100% Do not Know b) chemical incident 0-24% 25-49% 50-74% 75-100% Do not Know c) radiological incident 0-24% 25-49% 50-74% 75-100% Do not Know

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(circle one) Question 4 Thinking about the statement ‘Most Front-Line Health Professionals in my country are better trained for natural rather than man-made CBR incidents’, indicate whether you agree or disagree with this statement for each type of incident indicated below. d) biological incident

Agree Disagree Do not Know e) chemical incident

0 Agree Disagree Do not Know f) radiological incident

Agree Disagree Do not Know (circle one)

Question 5

The agency/ministry coordinating the response to a CBRN incident in your country is:

a. Public Health Institute or similar institution pls fill in_______________________________________________________ b. Ministry pls fill in_______________________________________________________ c. Civil Protection Body or similar institution pls fill in_______________________________________________________ d. Other pls fill in_______________________________________________________ e. I do not know

(circle one or more options and specify as appropriate) Question 6 a) Are you aware of a plan for the coordination of response to an incident involving chemical,

biological agents or radiological agents in your country? Yes_ No__, if NO, please go to question 7

(tick one) b) At which level does this plan apply?

a. National/Federal b. Regional c. Local d. I do not know

(circle one or more options) c) Does this plan differ if the incident is defined as non-deliberate versus deliberate? Yes_ No_ I do not know_ (tick one) Question 7 In your opinion what proportion (approximately) of Front-Line Health Professionals in your country will be adequately familiar with this plan as far as their own roles are concerned?

0-24% 25-49% 50-74% 75-100% Do not Know (circle one)

Question 8

Where do the Front-Line Health Professionals who recognize or suspect a CBRN incident directly report?

a) a Chemical incident a. Police b. Public Health Agency c.Poison Center d.Emergency Medical Services e.Other _____________________________(please specify) f. I do not know

b) a Biological incident a. Police b. Public Health Agency c.Poison Center

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d.Emergency Medical Services e.Other _____________________________(please specify) f. I do not know

c) a Radiological incident a. Police b. Public Health Agency c.Poison Center d.Emergency Medical Services e.Other _____________________________(please specify) f. I do not know

(circle one) Question 9 Does the reporting differ if FLHPs suspect the incident to be deliberate or possibly deliberate? Yes__ No__ I do not know__ (tick one) If YES, please specify (otherwise go to q11) for:

a) Chemical incident a. Police b. Public Health Agency c.Poison Center d.Emergency Medical Services e.Other _____________________________(please specify) f. I do not know

b) Biological incident a. Police b. Public Health Agency c.Poison Center d.Emergency Medical Services e.Other _____________________________(please specify) f. I do not know

c) Radiological incident a a. Police b. Public Health Agency c.Poison Center d.Emergency Medical Services e.Other _____________________________(please specify) f. I do not know

(circle one)

Question 10 In your opinion what proportion (approximately) of Front-Line Health Professionals in your country need specific training or re-training with regards to their role and as it concerns the:

a) recognition of symptoms of CBRN incidents 0-24% 25-49% 50-74% 75-100% Do not Know

b) awareness of national plan for CBRN response 0-24% 25-49% 50-74% 75-100% Do not Know

c) coordination of response at hospital level 0-24% 25-49% 50-74% 75-100% Do not Know

d) coordination of response at regional level 0-24% 25-49% 50-74% 75-100% Do not Know

e) coordination of response at national/federal level 0-24% 25-49% 50-74% 75-100% Do not Know

f) decontamination 0-24% 25-49% 50-74% 75-100% Do not Know

g) use and principles of personal protective equipment 0-24% 25-49% 50-74% 75-100% Do not Know

h) first aid and management of exposed/ill 0-24% 25-49% 50-74% 75-100% Do not Know

i) other_____________________________________________ (please specify) 0-24% 25-49% 50-74% 75-100% Do not Know

(circle one for all a to i subquestions)

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Question 11 We may need to contact you to clarify any responses that you have provided. If this is necessary, do you agree to be contacted by a member of our team?

Yes_ No_ If YES, please fill in

Name: ___________________ Surname:_____________________________ Email: __________________ Tel: _________________________________ Comments:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS QUESTIONNAIRE THE ETHREAT PROJECT TEAM

PLEASE RETURN THE QUESTIONNAIRE TO: Eirini Andriopoulou (MSc) Department of Hygiene and Epidemiology Athens Medical School National and Kapodistrian University of Athens 75 Mikras Asias str., 115 27, Athens, Greece Tel.: +30-210-7462059 / Fax.: +30-210-7462058 Email: contact@ethreat.info

36

ETHREAT PROJECT

FRONT-LINE HEALTH PROFESSIONALS QUESTIONNAIRE

(final VERSION)

INTRODUCTION

ETHREAT is a European Public Health Project launched in May 2005 funded by the European Commission. The aim of ETHREAT is to plan and develop an educational package containing the knowledge and training material necessary to empower European health professionals, including armed forces health personnel, to rapidly recognise and adequately respond to new public health threats, like attacks with biological, chemical and radiological agents. Further details are available at the project website www.ethreat.info. Before designing the training programme the project team needs to address a number of important questions, including:

What training programmes are currently available? Do these programmes meet the needs of attendees? What should be the educational objectives of a new training programme? What should be the content of a new training programme?

To address these, and other related questions we would be very grateful if you could take some time to complete this questionnaire. We are primarily interested in learning about your own personal experience in terms of being able to deal with chemical, biological, and radiological incidents. Completing the questionnaire should not take more than 10-15 minutes of your time. NOTE: c. All information that you provide here will be treated in the strictest confidence, and these

details will not be distributed to any individual or organisation, other than within the project team. We will be writing several reports for the European Commission, and these reports may at some point be available in the public domain. However, please note that these reports will contain only summary data. Your name will NOT appear in any report.

d. The working language of this project is English, so please ensure that answers are provided in English.

ETHREAT Project Coordinator: National and Kapodistrian University of Athens Athens Medical School Department of Hygiene and Epidemiology Mikras Asias 75 St, 115 27, Athens, Greece Tel: +30-210 746 2059, Fax: +30-210 746 2058, Email: alinou@cc.uoa.gr

37

DEFINITIONS Front-Line Health Professional: for the purposes of the ETHREAT project we refer to medical practitioners and nursing staff in civilian or military facilities, especially those working in emergency departments or in primary healthcare, Public Health Officials especially at the local level and Emergency Medical Services personnel. CBRN: initials from the words Chemical, Biological, Radiological and Nuclear. Although the ETHREAT project does not address nuclear threats, the term is the one more constantly used in relation to incidents involving chemical, biological and radiological agents especially used deliberately to harm. Deliberate: initiated by a person or group of persons with harmful intent; intentional, not natural. DEMOGRAPHIC CHARACTERISTICS Country:

Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, FYROM, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, The Netherlands, Turkey, United Kingdom

(circle one) Sex:

a. Male b. Female (circle one) Age:

a. 20-29 b. 30-39 c. 40-49 d. 50-59 e. 60-69 (circle one)

What is your highest degree? a. Undergraduate degree b. Postgraduate degree c. Doctoral degree

d. Other_____________________________________ (circle one or specify) What is your Occupation?

a. Physician b. Nurse c. Pharmacist d. Emergency Medical Service Personnel e. Public health officer f. Other_____________________ _____________________ (please specify)

(circle one) Type of organization, you work for:

a. Civilian b. Military (circle one)

a. University b. Public health authority c. Hospital d. Emergency Medical Services e. Ministry f. Private sector

g. EU institutions h. Other_____________________ _____________________(please specify)

(circle one) At what level does the organization, you work for operate?

a. local b. regional c. national/federal level (circle one)

38

MAIN QUESTIONNAIRE

Question 1

g) How well prepared do you currently feel in dealing with an incident involving chemical agents?

Very well Well Poorly Very poorly Do not Know h) How well prepared do you currently feel in dealing with an incident involving biological

agents? Very well Well Poorly Very poorly Do not Know i) How well prepared do you currently feel in dealing with an incident involving radioactive

agents? Very well Well Poorly Very poorly Do not Know

(circle one)

Question 2

How confident are you currently that you can discriminate between a natural versus a man-made CBRN incident?

1 Very High Confidence 2 3 4 Very Low Do not Know (circle one)

Question 3

How important do you feel it is that you should be able to discriminate between a natural and a deliberate incident involving chemical, biological or radioactive agents?

1 Very High Importance 2 3 4 Very Low Do not Know (circle one)

Question 4

How well informed are you regarding the symptoms involved in the following diseases or caused by agents considered high threat for use in a CBRN incident?

a. Anthrax __ b. Smallpox __ c. Plague __ d. Tularaemia __ e. Viral hemorrhagic fevers __ f. Viral encephalitis __ g. Botulism __ h. Nerve agents __ i. Vesicants (e.g. mustard gas) __ j. Pulmonary/choking agent or asphyxiant __ k. Toxins (e.g. ricin, tetrodotoxin, etc) __

(enter a number in the range 0 to 4 alongside each term, Where 0=Do not Know, 1 = very well informed and 4 = very poorly informed)

Question 5

How well prepared do you feel concerning the management (in terms of decontamination and medical treatment) of patients involved in a CBRN incident arising from the following agents/sources?

a. Anthrax __ b. Smallpox __ c. Plague __ d. Tularaemia __ e. Viral hemorrhagic fevers __ f. Botulism __ g. Nerve agents __

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h. Vesicants (e.g. mustard gas) __ i. Pulmonary/choking agent or asphyxiant __ j. Toxins (e.g. ricin, tetrodotoxin etc) __

(enter a number in the range 1 to 4 alongside each term, where 0=Do not Know, 1 = very well informed and 4 = very poorly informed)

Question 6

a) In the event of you noticing a high number of cases of gastroenteritis or flu-like illness, do you know to whom should you immediately report?

Yes_ No_ (tick one)

If yes, to whom/where?__________________________________________________ (fill in)

b) In the event of you judging an incident to be possibly deliberate, do you know to whom should you immediately report?

Yes_ No_ (tick one)

If yes, to whom/where?__________________________________________________ (fill in)

Question 7a

Thinking about a potential CBRN incident, how would you grade your level of confidence, in terms of the procedures to be undertaken by you in order to prevent the spread of the agent of suspicion and minimise any secondary effects?

1 Very High Confidence 2 3 4 Very Low Do not Know (circle one)

Question 7b

Do you have access to specific Personal Protective Equipment (PPE) at your workplace? Yes_ No_ IF NO, GO TO QUESTION 8 (tick one)

Question 7c

How confident are you that in the event of a CBRN incident, you would be able to access your personal protective equipment at your workplace?

1 Very High Confidence 2 3 4 Very Low Do not Know (circle one)

How confident are you that in the event of a CBRN incident, you would be able to properly use your personal protective equipment?

1 Very High Confidence 2 3 4 Very Low Do not Know

(circle one)

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Question 8

The agency/ministry coordinating the response to a CBRN incident in your country is: f. Public Health Institute or similar institution pls fill in_______________________________________________________ g. Ministry pls fill in_______________________________________________________ h. Civil Protection Body or similar institution pls fill in_______________________________________________________ i. Other pls fill in_______________________________________________________ j. I do not know

(circle one or more options and specify as appropriate)

Question 9

c) Are you aware of a plan for the coordination of response to a deliberate CBRN incident in your country?

Yes_ No__, if NO, please go to question 10 (tick one)

d) Do you or your organization have a defined role in this plan? Yes_ No_ I do not know_

(tick one) e) at which level does this plan apply?

e. National/Federal f. Regional g. Local h. I do not know

(circle one or more options)

Question 10

Did you receive any CBRN training? During your: a. undergraduate studies Yes_ No_ b. postgraduate studies Yes_ No_ c. specialization/residency Yes_ No_ d. professional training Yes_ No_ e. training for the purpose of a specific preparedness plan Yes_ No_ f. self-training Yes_ No_

(tick yes/no throughout questions a. to f.)

Question 11

How long ago was your most recent training specifically related to CBRN incidents? a. In the last 6 months b. 1 year ago c. 2 years ago d. 3 years ago e. More than 4 years ago f. Never had such training

(circle one option)

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Question 12

We may need to contact you to clarify any responses that you have provided. If this is necessary, do you agree to be contacted by a member of our team?

Yes_ No_ If YES, please fill in

Name: ___________________ Surname:_____________________________ Email: __________________ Tel: _________________________________ Comments:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS QUESTIONNAIRE

THE ETHREAT PROJECT TEAM

PLEASE RETURN THE QUESTIONNAIRE TO: Eirini Andriopoulou (MSc) Department of Hygiene and Epidemiology Athens Medical School National and Kapodistrian University of Athens 75 Mikras Asias str., 115 27, Athens, Greece

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F5. Second Partners Meeting Agenda

ETHREAT PROJECT

AGENDA OF 2nd PARTNERS MEETING

NATIONAL INSTITUTE OF PUBLIC HEALTH 17th of March 2006, Prague

Exact address of the meeting is: Contact person: Státní zdravotní ústav (NIPH) Dr. Jan Kyncl Šrobárova 48 tel.: +420 267 082 891 Praha 10 e-mail: jkyncl@szu.cz

mobile: +420 602 525 098

AGENDA

10:00-10:10 Welcome Jan Kyncl

Athena Linos

10:10-10:50 Course perspective through Athens 2004 Olympic Games ExperienceIoannis Galatas

10:50-11:00 Questions – Discussion 11:00-11:40 Results of WP3 and WP4: Courses Inventory and National Sources (Summary of reports, 10 minutes each + 10 minutes discussion)

Andreas FuchsAlexander Zhekov

Czech Republic Coffee Break 12:00-12:40 Results of WP3 and WP4: Courses Inventory and National Sources (Summary of reports, 10 minutes each + 10 minutes discussion)

Dorota SzoslandEuaggelia Tavoulari

Mike Ahern 12:40-13:00 ETHREAT Progress: what has been achieved and what’s next

Eirini Andriopoulou

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12:40-13:00 ETHREAT Progress: what has been achieved and what’s next

Eirini Andriopoulou Lunch Break 14:00-14:20 ETHREAT questionnaires and questionnaire survey

Agoritsa Baka 14:20-14:40 ETHREAT algorithm

Jack Dowie 14:40-15:00 ETHREAT databank

Andreas Fuchs Coffee Break 15:15-16:45 Discussion 16:45-17:00 Summary of decisions and technical guidelines

Athena Linos – Eirini Andriopoulou

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F6. ETHREAT Brochure

45

F7. Greek Experts Meeting Agenda

ΣΥΝΑΝΤΗΣΗ ΕΛΛΗΝΩΝ ΕΙ∆ΙΚΩΝ ΣΕ ΘΕΜΑΤΑ

«ΒΙΟΤΡΟΜΟΚΡΑΤΙΑΣ»

ΕΘΝΙΚΟ ΚΑΙ ΚΑΠΟ∆ΙΣΤΡΙΑΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΑΘΗΝΩΝ ∆ευτέρα, 5 ∆εκεµβρίου 2005, Αθήνα

Πολιτιστικό Κέντρο «Κωστής Παλαµάς»

Aκαδηµίας 48 & Σίνα

AGENDA

13:30-14:30 Γεύµα 14:30-14:40 Χαιρετισµός

Αναπ. Καθ. Αθηνά Λινού (M.D., M.P.H, PhD) Επικεφαλής Ερευνητικής Οµάδος

14:40-15:00 Παρουσίαση του Ερευνητικού Προγράµµατος

Ειρήνη Ανδριοπούλου (MSc)Υπεύθυνη ∆ιαχείρισης Προγράµµατος -Ερευνήτρια

15:00-15:15 Παρουσίαση Ερωτηµατολογίων

∆ρ. Αγορίτσα Μπάκα (M.D.)Ερευνητική Σύµβουλος ΚΕΕΛΠΝΟ

15:15-15:30 Συµπλήρωση Ερωτηµατολογίων 15:30-17:00 Ανοιχτή Συζήτηση – Προτάσεις συµµετεχόντων

46

F8. Overview of activities form

Name of person working on the project Function / Tasks

Overview of Activities

Project:

Organisation:

no. of hours

Person completing the overview form:

Date:

Activities undertaken

47

F9. Minutes of the 1st Partners Meeting

ETHREAT PROJECT

MINUTES OF 1st PARTNERS MEETING

NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS, 24th of June 2005, Athens

Venue National and Kapodistrian University of Athens,

Cultural Centre "Kostis Palamas" Akadimias 48 & Sina

PARTICIPANTS Austria: Strauss R. Bulgaria: Koytcheva V. Czech Republic: Bencko V. Denmark: Bork K. Germany: Kirch W., Fuchs A. Greece: Linos A., Baka A., Andriopoulou E., Kotsioni I., Karamanis I. Poland: Szosland D. UK: Dowie J. EU: Thinus G.

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AGENDA

9:00-9:15 Welcome Athena Linos Germain Thinus 9:15-9:30 Introducing People: Who is who? Ioanna Kotsioni (+Participants) 9:30-13:00 The Layout of the Project Eirini Andriopoulou Work-packages, Deliverables and Agoritsa Baka Timeframe Coffee Break Discussion of each work-package (+Participants) among partners 13:00-14:00 Lunch Election of Steering Committee 14:00-15:00 Presentation of the Website and Eirini Andriopoulou Project’s Management Tools 15:00-16:00 ETHREAT’s Administrative Ioannis Karamanis and Financial Issues Ioanna Kotsioni 16:00-17:00 Round Table Decisions Coordinator: Athena Linos

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DECISIONS A: Countries Division Austria: Austria Bulgaria: Bulgaria, Romania (if possible) Czech Republic: Czech Republic, Slovakia, Hungary Denmark: Denmark, Sweden, Finland, Norway Germany: Germany, Croatia (if possible), Slovenia, Spain, Italy, Belgium Greece: Greece, Cyprus, Luxembourg, Malta, Portugal, Turkey (if possible) Poland: Poland, Estonia, Latvia, Lithuania UK: UK, Ireland, Netherlands, France B: Next Meeting Possibly March 2006 in Luxembourg (SANCO will host the event, on EU expenses). From each of the 25 countries one expert will be invited. Need to identify early who will be invited from each country and thus cooperate with throughout the project. C: Questionnaire(s)

1) Make a list of what we need from national countries. 2) Find out if in every country there is a need to pass the questionnaire through an ethics

committee. 3) Contact professional associations to ask them if we can give the questionnaire to them for

completion (perhaps they can also pass it on to their members).

4) Issue of translation: in which countries there is a need to translate questionnaire in local languages.

5) Two questionnaires? One addressed to experts. One addressed to front line health

professionals.

6) We don’t really worry for number of response, sample size, we only need a minimum number of completed questionnaires per country to support our needs assessment part of the study more in a qualitative than a quantitative way. Need to agree on categories of people questioned that we need represented (i.e., % of nurses, women, etc).

7) Concerning the 2nd questionnaire which experts are we going to contact in each country?

Use one as a contact point. Invite him/her at the meeting in Luxembourg?

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8) Hand the questionnaire for completion on the occasion of professional meetings, address it also

to SANCO committees (Mr. Thinus agreed on this). D: Curricula review Make a list of all universities/schools we want to search their curricula for relevant courses. Each partner should construct this for all the countries he/she is responsible for. E: Issue of the public forum No clear decision was made on whether we should answer or not the questions of the public and whether we should enhance the participation of public to the website F: Election of the Steering Committee Dr Strauss, Dr Bork, Dr Dowie, Dr Linos, Dr Kirch

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F10. Minutes of the 2nd Partners Meeting

ETHREAT PROJECT

MINUTES OF 2nd PARTNERS MEETING

NATIONAL INSTITUTE OF PUBLIC HEALTH 17th of March 2006, Prague

PARTICIPANTS Bulgaria: Alexander Zhekov Czech Republic: Jan Kyncl, Katerina Fabianova, Jitka Castkova Germany: Andreas Fuchs Greece: Athena Linos, Agoritsa Baka, Eirini Andriopoulou, Evangelia Tavoulari, Ioannis Galatas Poland: Dorota Szosland UK: Jack Dowie, Mike Ahern

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AGENDA

10:00-10:10 Welcome Jan Kyncl

Athena Linos

10:10-10:50 Course perspective through Athens 2004 Olympic Games Experience Ioannis Galatas

10:50-11:00 Questions – Discussion 11:00-11:40 Results of WP3 and WP4: Courses Inventory and National Sources (Summary of reports, 10 minutes each + 10 minutes discussion)

Andreas Fuchs Alexander Zhekov

Katerina Fabionova Coffee Break 12:00-12:40 Results of WP3 and WP4: Courses Inventory and National Sources (Summary of reports, 10 minutes each + 10 minutes discussion)

Dorota Szosland Euaggelia Tavoulari

Mike Ahern 12:40-13:00 ETHREAT Progress: what has been achieved and what’s next

Eirini Andriopoulou Lunch Break 14:00-14:20 ETHREAT questionnaires and questionnaire survey

Agoritsa Baka 14:20-14:40 ETHREAT algorithm

Jack Dowie 14:40-15:00 ETHREAT databank

Andreas Fuchs Coffee Break 15:15-16:45 Discussion 16:45-17:00 Summary of decisions and technical guidelines

Athena Linos – Eirini Andriopoulou

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IMPORTANT POINTS OF DISCUSSION - DECISIONS

Target group of the survey: the issue of definition of the project target group was raised by the UK-

team. We concluded that the front-line health professionals, which belong to the target group of the

project, are mainly medical doctors and nurses. Public health officers at the local level are concerned

and can profit from the educational package that will be produced by the project to the extent that they

lack the same knowledge as the FLHP on CBRN issues.

Course: the issue of having a practical/skill teaching part at the pilot course was discussed. Dr Galatas

gave specific examples of exercises that could take place. Most partners tend to think that the practical

part may be too difficult to implement and hence no final decision was made. With regards to the

course implementation data, it was decided that it is better to organize the pilot course in June 2007

and not January 2007, as it was initially planned. Particular effort will be made so as to disseminate

the course at medical schools with final aim to promote it as an optional course at the last year of

medical studies.

Inventory: the inventory of courses has been almost complete. There are two exceptions:

A. Bulgaria that will deliver the inventory (at least the institutions that were investigated) by mid

April and

B. the UK that will perform the courses collection along with the questionnaire survey.

Questionnaires:

1. Make sure that the completion is not more than 10-15 minutes

2. Correct low proportion to specific percentages %

3. Place “Do not know” at the end of the questionnaire

4. Delete information on medical specialty

5. Secure a “secure” connections to the questionnaires

6. Add all European Countries in the list

7. Try to complete the survey until the end of April

Databank: following the presentation of Andreas Fuchs, the partners suggested to cut down the

keyword list or use combination of keywords. In order to avoid duplication of work, it was decided

that the literature search will be the responsibility of Dr Galatas, Dr Fuchs and Dr Tavoulari. The

software Endnote© will be used for creating the literature index and an electronic version will be

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available on the project’s web-site. The databank must be ready by the end of May to accompany the

interim report to the Commission.

Algorithm: following the presentation of Prof. Dowie, it was first decided that the algorithm for which

the UK team is responsible will have nothing to do with the medical management of the particular

symptoms caused by CBRN agents. What we need to construct is two tables/diagrams resembling

slides 4 and 7 of Prof. Dowie’s presentation with an extension to higher levels of hierarchy. The main

need for this is that although the project concerns the actions of FLHP, it is very useful as a part of the

course to teach the complete algorithm of actions, so that FLHP know that there is an organized

system of actions that will follow after them reporting a suspicious incident.

Interim report: the partners were informed that the interim report needs to be completed by mid-June

2006. Therefore, by the end of May 2006, they should send all the deliverables that have a settled

deadline before that date, as well as the relevant invoices, financial and activities forms. Moreover,

they should have completed a small report commenting on the work (inventory, questionnaire survey

etc,) that will have completed up to that point.

Next meeting: Make another effort for having the meeting hosted by SANCO in Luxembourg along

with an EU experts meeting in November

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IMPORTANT DEADLINES Undeliverable deliverables: Mid April 2006 Small report: End April 2006 Questionnaire survey: End of April 2006 Databank: End of May 2006 Deliver information on Algorithm to the UK: End of May 2006 Algorithm (final): End of August 2006 Survey report: End of June 2006 Next partners meeting: Nov 2006 (possibly) Course content: End of February 2007 Course material: May 2007 Pilot Course: June 2007

This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of thecontractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarilyrepresent the view of the Commission or the Directorate General for Health and Consumer Protection. The EuropeanCommission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use madethereof.