2012

Lisanne van der Schors I6008557 Bachelor European Public Health Faculty of Health, Medicine and Life Sciences Maastricht university Supervisor: Matt Commers Second grader: Peter Schröder-bäck Placement: EMRIC+ Placement supervisor: Marian Ramakers Placement supervisor content: Cindy Gielkens

[HAZMAT disaster management in the

Netherlands and Belgium] Bachelor Thesis European Public Health

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Outline

Introduction ............................................................................................................................................. 4

Euregio Meuse-Rhine ...................................................................................................................... 4

Background .......................................................................................................................................... 5

EMRIC+ ............................................................................................................................................ 5

Cross border collaboration of emergency services in the EMR ...................................................... 5

Madrid Convention .......................................................................................................................... 5

Benelux treaty ................................................................................................................................. 6

Anholt treaty ................................................................................................................................... 6

Treaty of Mainz................................................................................................................................ 6

Agreements of mutual assistance in case of disasters .................................................................... 7

Research question and goals ........................................................................................................... 7

Methods .............................................................................................................................................. 8

HAZMAT in the Netherlands ................................................................................................................... 9

GRIP structure ..................................................................................................................................... 9

Safety regions .................................................................................................................................... 11

HAZMAT defense at national level .................................................................................................... 11

Areas of disaster management ......................................................................................................... 12

Health in disaster management ........................................................................................................ 12

GHOR ............................................................................................................................................. 12

GGD ............................................................................................................................................... 15

RIVM .............................................................................................................................................. 16

HAZMAT in Belgium ............................................................................................................................... 17

Municipal phase ................................................................................................................................ 17

Provincial phase ................................................................................................................................. 17

National phase ................................................................................................................................... 17

Multidisciplinary plans .................................................................................................................. 18

Monodiscilinary plans.................................................................................................................... 18

Discipline 2 – medical, sanitary and psychosocial assistance ....................................................... 19

Internal emergency plans .............................................................................................................. 21

Alerting hospital services............................................................................................................... 21

Decontamination ........................................................................................................................... 21

The Netherlands and Belgium working together .................................................................................. 22

Discussion .............................................................................................................................................. 23

3

Conclusion ............................................................................................................................................. 25

Recommendations ................................................................................................................................ 26

References ............................................................................................................................................. 28

Appendix ................................................................................................................................................ 33

Appendix 1 – Transcript interview doctor Lucien Bodson ................................................................ 33

Appendix 2 – transcript interview Michel Moors .............................................................................. 51

Appendix 3 – transcript interview Cindy Gielkens ............................................................................ 65

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Introduction

On the 11th of March in 2011, there was a nuclear disaster with the Fukushima nuclear power plant

in Japan caused by a tsunami. The area around the plant is exposed to a high level of radiation and

scientists fear that this will cause a huge amount of cancer cases and other adverse health outcomes

among the exposed people. This time the nuclear disaster happened in Asia, but these things can

also happen in Europe. (World Nuclear Association, 2012)

In Europe, 25 years earlier than the Fukushima incident, on April 26th, 1986, there was an accident in

a nuclear power plant in Chernobyl, Ukraine. This resulted in a radiological contamination not only in

Ukraine itself, but also in surrounding countries and even beyond the surrounding countries. This

incident lead to many major adverse health effects varying from an increased cancer rate (4000 extra

cancer deaths in the highest exposed cancer groups and 5000 extra cancer deaths in the surrounding

countries (WHO, 2006) ) to deformed newborns and reactivation of viral infections. Some people are

still suffering from the consequences of this accident (Morley, 2012 ). Incidents with hazardous

materials (HAZMAT incidents) can happen anywhere in the world and, as you can see in the examples

of Fukushima and Chernobyl, can have huge impacts on health. Therefore it is important to include

HAZMAT incidents in health policy to be prepared for any HAZMAT disaster.

As said, CBRN incidents do not always limit themselves to the country they happen in. This is also

seen after the Chernobyl disaster. Not only Ukraine had radioactive pollution after the incident, a

high rate of pollution was also found in the surrounding countries Russia and Belarus. There was

even pollution found in Scandinavian countries (IAEA, 2012). It is therefore not only very important

to have a good HAZMAT disaster management, but also to have a good cooperation with border

countries on this area to minimize the victims of such a disaster and to make sure that the disasters

are under control as quick as possible.

Euregio Meuse-Rhine

One of the border regions where more work could be done on HAZMAT disaster management is the

Euregio Meuse-Rhine (EMR). The EMR is a non-profit foundation that concerns the cooperation of

five regions within three countries. The countries are Belgium, the Netherlands and Germany and the

regions within these countries are the southern part of the province of Limburg (the Netherlands),

the province of Limburg which is Dutch speaking (Belgium), the province of Liege which is French

speaking (Belgium), the German speaking community of Belgium and the Region of Aachen

(Germany) (EMR, 2012). The EMR is a high density area with about 4 million inhabitants on 11,000

km².(AEBR, 2012)There has been cross border cooperation within this region for over 30 years

already. Within the EMR there is a large diversity. Not only are there three different languages

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spoken in the three different countries, but even within Belgium there are different languages.

Having to deal with this diversity means dealing with differences in culture, but also in laws and ways

people deal with things. This also means that there are different ways of dealing with disasters and in

this case dealing with HAZMAT disasters. Since HAZMAT incidents and their consequences can cross

borders, it is very important that there is an overview of what kind of procedures on HAZMAT

disasters exist in the EMR. This is important because when you know the procedures, you know what

you can expect from the other countries and you can establish a cooperation that is effective in

containing the disaster and keeping the adverse effects to a minimum. The diversity in the EMR

might on one hand be seen as a barrier for a good cooperation, this can mean that the process of

establishing an effective collaboration requires great effort, time, expertise and willingness to adapt

to other cultures. On the other hand it might also be seen as a chance to get other points of view and

to develop new, improved ways of HAZMAT disaster management. (Ramakers & Bindels, 2006).

Background

EMRIC+

EMRIC+ stands for Euregio Meuse-Rhine Intervention in case of Crisis. EMRIC+ is the follow up of the

Interreg project EMRIC which ended in 2008. The goal of EMRIC was to make previous agreements

and results available on internet and secure the agreements and results by developing a concept of

collaboration. This is done to make sure that people do not try to create solutions that are already

there (EMR-IC, 2006). EMRIC+ wants to continue the implementation of this development and add a

focus to innovation and scientific research (GHOR Zuid Limburg, 2008). In the first news letter of

EMRIC+, the project is defined as a project which facilitates, coordinates and broadens the

cooperation of emergency services like fire departments and ambulances in the EMR (EMRIC+, 2010).

Cross border collaboration of emergency services in the EMR

Before there was any cooperation between countries in the EMR, emergency services of one country

could not provide their services to another country (EMRIC+, 2010). In some cases this was very

inefficient, for example when someone had an accident in the Netherlands, but a hospital in Belgium

would be closer, the ambulance still had to go to the hospital that was in the Netherlands but further

away. This would often cost a lot of time, which can be essential in severe cases. Nowadays there is

collaboration in the EMR on the area of emergency services. There are several treaties, conventions

and agreements on these collaborations on European and international level.

Madrid Convention

One of the first European conventions on cross border cooperation is the European Outline

Convention on Transfrontier Co-operation between Territorial Communities or Authorities, signed on

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21st of May, 1980 by the Council of Europe, also called the Madrid convention (Council of Europe,

1980). Member states of the European Union that ratified the convention, declare that they will

commit themselves to improve cross border collaboration. The convention also makes it possible for

bordering member states to set up treaties on cross border collaboration. Resulting from the Madrid

convention, there were three treaties important for the countries of the EMR developed (Ramakers,

Bindels, & wellding, 2007).

Benelux treaty

The first treaty was the Benelux treaty regarding cross border collaboration between territorial

communities or authorities. This treaty was signed on the 12th of September in 1986 and entered

into force on April first, 1991 (Denters, Schobben, & van der Veen, 1999). The Benelux treaty makes

it possible for decentralized authorities (like municipalities and provinces) to set up a cross border

collaboration with other decentralized authorities. The treaty mentions three ways of cooperation.

Administrative agreements are the lightest form of cross border cooperation. This can be an

agreement on delivery of service or resources. A second way of cooperation is a shared cross border

organ. A shared cross border organ does not have any legal power and does not have any financial

resources. This can be a good base for cross border cooperation and can later on be expanded to a

public cross border body. The third and most intensive form of cross border cooperation is a public

cross border body. This body does have legal power and can therefore make binding decisions. These

decisions have to be in accordance with national law (Benelux, 2012).

Anholt treaty

Secondly, on the 23rd of may, 1991, the treaty of Isselburg-Anholt (also called the Anholt treaty) was

signed. This is a treaty concerning Germany and the Netherlands. The treaty offers a framework for

cross border cooperation of decentralized authorities of Germany and the Netherlands. The goal of

the treaty is to stimulate cross border cooperation between Germany and the Netherlands. With this

treaty as a base, public agreements can be made by the governing bodies of Germany and the

Netherlands. This treaty is also a very good base for cross border emergency service delivery

agreements. One example of these agreements is the public agreement on cross border neighbor-

ambulance aid. The Anholt treaty uses the same three forms of cooperation as the Benelux treaty

(Ramakers & Bindels, 2006).

Treaty of Mainz

Finally, the treaty of Mainz was signed on March 8, 1996. The treaty makes cross-border cooperation

possible between Belgium and Germany. It is comparable with the Benelux treaty and the Anholt

treaty and states the same three ways of cooperation (Ramakers & Bindels, 2006).

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Agreements of mutual assistance in case of disasters

Besides these treaties, there are agreements between Belgium and the Netherlands, Germany and

the Netherlands and Belgium and Germany on mutual assistance in case of disasters. All these

agreements have a similar content. Assistance is only given if it is in accordance with the possibilities

of the country that is asked for assistance. In these agreements, procedures of asking for assistance

and giving assistance are described. If assistance is eventually given, the commander of an

emergency service unit has to submit to the authority on the site of the disaster. The commander

steers his or her own unit. The countries need to pay the costs that they make by sending their units,

but for air transportation separate arrangements can be made. The country that receives assistance,

pays for the stay of the assisting units. If damages are made, the country that receives the assistance

will have to pay for these damages. This also applies when there is an exercise, unless stated

otherwise (Ramakers, Bindels, & wellding, 2007).

Research question and goals

Cooperation in the field of emergency services in the EMR is already visible. However, this

cooperation focuses mostly on general emergency services and there is no specific focus on HAZMAT

incidents yet. Cooperation in general emergency services will not be enough when dealing with a

HAZMAT disaster. There is a need for specialized collaboration when dealing with HAZMAT disasters.

EMRIC+ expresses that there is need for a clear overview of what the countries of the EMR are doing

on the area of HAZMAT disaster management. Such an overview is needed to be able to handle and

cooperate quick and effectively in case of a HAZMAT incident without losing precious time on having

to look for all regulations and procedures before being able to act. Creating an overview might also

give opportunity to find best practices, which might eventually be a base in creating a general

protocol for the EMR. A general protocol on HAZMAT disaster management can prevent confusion

and promote a better cooperation between emergency service units from different countries, which

will help containing the disaster as quick as possible and getting the least amount of adverse effects.

Therefore the research questions will be:

What are protocols, laws, treaties and agreements in Belgium and the Netherlands on the

acute phase of HAZMAT disasters on the area of health?

What are parts of the HAZMAT disaster management on the area of health in these countries

that are good and what can be improved?

What would be recommendations for both countries and for the cooperation in the EMR on

the area of HAZMAT disasters on the area of health?

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The focus in the paper will especially be on Belgium and the Netherlands, another research paper

with a focus on Germany and the Netherlands will be released by Judith Brehm. The goals of the

paper are to give an overview of protocols, laws, treaties and agreements on disaster management in

the acute phase of HAZMAT disasters in Belgium and the Netherlands, to compare the two countries

and look for best practices, to see what is already done in the EMR and to give recommendations for

cooperation in the EMR.

Methods

To answer the research questions, there was made use of several different ways to gather

information. One way is a literature research, this was done in databases with scientific papers like

Pubmed and Google Scholar and on relevant websites of organizations that were important for

disaster management in their country. The literature research was in the first place to gather basic

knowledge on HAZMAT disaster management. After finding literature, it was analyzed on its

relevance by looking at the content, but also at the year it was published and the writers and their

possible interests in the matter. Another way in which information was gathered is by an internship

at the project EMRIC+. This project is very relevant to the topic of the paper. In the internship,

information from EMRIC+ was be gathered, and the colleagues of the project helped getting relevant

knowledge and useful websites. The contacts of EMRIC+ were used to get more information on

HAZMAT disaster management in Belgium and the Netherlands. There were three interviews done

(transcripts can be found in the appendix) with Mister Bodson (clinical supervisor, Emergency

department emergency plans, Chemical, biological, radiologic and nuclear supervisor), mister Moors

(civil protection expert) and Miss Gielkens (Health advisor HAZMAT) Especially the Belgian interviews

were very useful on getting a clear picture of the Belgian system. Miss Gielkens joined in all the

interviews, she first gave a presentation about the Dutch system and about EMRIC+, after this I asked

my questions. There were questions asked about how the disaster management structure was, if

there were ever problems with the system, good things about the system, problems with

international cooperation and what could be done better in the future. After the interviews, another

literature research was done to support the outcomes of the interviews and to be able to elaborate

more on the outcomes of the interviews. When there was enough information gathered on a part of

the paper, the information was analyzed, written down and compared. In the end of the paper some

recommendations were done for the Dutch system, the Belgian system and the cooperation of the

two systems. Some of these recommendations were based on the opinions of the people that were

interviewed.

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HAZMAT in the Netherlands

GRIP structure

In the Netherlands you have the GRIP structure, GRIP stands for coordinated regional disaster

management procedure. GRIP is the procedure of upscaling or downscaling that happens in case of

disasters and incidents. The GRIP stages go from GRIP 0 to GRIP 4 where GRIP 0 can be a mild

incident and GRIP 4 can be a large disaster. The main characteristics of the different stages are

explained in table 1. All GRIP procedures are in principle the same in all safety regions (explained in

‘safety regions’), but the safety regions do focus their plans on specific risks in their area. For

example the area around the Meuse would take into account that the river could flood.

Table 1.

GRIP 0 Daily process

GRIP 1 Source control

GRIP 2 Source and effect control

GRIP 3 Threat to the public

GRIP 4 Incident involving multiple municipalities.

GRIP 0

The status of GRIP 0 is for incidents that do not interrupt the daily process of emergency services.

GRIP 1

When an incident is local and the effects limit themselves to the incident site, but a multidisciplinary

alignment between services is needed to manage the incident, the incident gets the status of GRIP 1.

To control the operational processes, a command center is placed on the incident site. The command

center leads the deployed emergency services. In the command center the operational leader is

appointed. The operational leader is most of the time the officer on duty from the fire brigade, but

the mayor can also appoint someone from other emergency services. The operational leader leads

the command center on site and keeps the mayor updated. The people that are usually present in

the command center on site are the officer on duty of the fire brigade, the police officer on duty, the

GHOR officer on duty, the officer of public discipline and safety and the information manager. The

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command center can also call different specialists, depending on the nature of the incident, to advice

them.

GRIP 2

When the effects of the incident exceed the incident site, it is upscaled to GRIP 2. In GRIP 2 a regional

operational team is started, this team focuses on the management of the environment around the

incident site. The regional operational team is the highest you can upscale in the operational area.

The tasks of the command center on site stay the same, but the leader of the regional operational

team becomes the operational leader. In most cases this will be the regional commander on duty of

the fire brigade. The people that are usually present in the regional operational team are the regional

commander on duty of the fire brigade, the commissioner of the police, the head of the GHOR, the

liaison of the municipality in which the source of the incident is, the information manager of the

safety region. Like in the command center on site, the regional operational team can also call in

professionals. Besides the regional operational team the core of the municipal policy team gets called

together to support the mayor.

GRIP 3

The status of GRIP 3 is given to incidents that may cause profound impact on the society. This impact

can be on health, but also on the environment or materials like essential infrastructure. Because

complex decisions need to be made, the municipal policy team gets called together. This team leads

the regional operational team, although the leader of the regional operational team stays

operational leader. The people that are usually present in the municipal policy team are the mayor,

the commander on duty of the fire brigade, the district police chief, the regional medical officer, the

municipal secretary, the officer of public discipline and safety, the public prosecution and the

information manager. The municipal policy team can also call in professionals for advice.

GRIP 4

If the incidents exceeds the municipal borders, it gets the highest GRIP status; GRIP 4. In this case

more municipalities are involved and these municipalities need a high degree of alignment. To get

this degree of alignment, the regional policy team gets called into action. The people that are usually

present in the regional policy team are the coordinating mayor (often the mayor of the biggest

municipality in the region), the general director of the safety region, the commander on duty of the

fire brigade, the police chief, the regional medical officer, the chief prosecutor, the involved mayors

(only if possible and desirable) and the information manager. In this stage the operational leadership

goes to the general director of the safety region. (Vogels, 2011)

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Safety regions

In the Netherlands there are several institutions that play a role in disaster management. Since the

GRIP system goes from small to large areas, it is logical to start with the sub national safety regions,

veiligheidsregio’s in Dutch. These safety regions are created under the law safety regions (LSR). The

LSR was accepted begin 2010 and replaced the fire brigade law of 1985, the law of medical help in

case of disasters and incidents and the law on disasters and major incidents. The main goal of the LSR

is to get the assistance of services like the fire brigade, medical assistance and other emergency

services organized in case of a disaster. A reason for instating these safety regions is that emergency

situations were often already handled at a very local level, but municipalities and other local

authorities regularly did not have the means to be prepared for a bigger disaster. Another reason is

that disasters are often not confined to a municipality, disasters can affect the near surroundings of a

municipality, but also a whole country. (Rijksoverheid I, 2012) (Ministerie van Binnenlandse Zaken en

Koninkrijksrelaties, 2009)

There are 25 safety regions in the Netherlands. In these regions the police, fire department and

medical help in case of disasters and incidents (GHOR) work together to be prepared for disasters

and to manage them effectively. The municipalities and emergency services work together with so

called crisis partners. Examples of these crisis partners are public prosecution, and the regional

military. Besides these crisis partners, there are other private organizations with whom the

municipalities work together during a crisis. These organizations are organizations like hospitals,

organizations that are responsible for the public transport, energy and chemical companies. Because

of their expertise and capacities they can play an important role in crisis management. (Rijksoverheid

II, 2012) (Ministerie van Binnenlandse Zaken en Koninkrijksrelaties, 2009)

HAZMAT defense at national level

On Governmental level you have the National Crisis Center (NCC). The NCC makes sure that there is a

consistency in decision making during a crisis or during the threat of a crisis. The NCC distinguishes

three different situations: Cold, lukewarm and warm. Whenever there is a cold situation, there is no

crisis or threat. When the situation is lukewarm, there is a crisis threat and extra attention should be

paid to that particular situation. When the situation is warm, there is a crisis or a very large crisis

threat. (Ministerie van veiligheid en justitie I, 2012) However, the NCC is not only active during

lukewarm or warm situations, when there is a cold situation, the NCC wants to make sure that crisis

professionals and organizations are constantly trained and kept upto date so they are more able to

handle potential disasters. To train these professional and organizations, the NCC has its own

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institute, the NCC academy. (ministerie van veiligheid en Justitie II, 2012) During cold situations, the

NCC also wants to improve the area of crisis communication by advicing authorities and helping them

with the policymaking on this area. Developing a good method of crisis communication will help

contain a disaster as fast as possible and informing people in case of a disaster. (Ministerie van

veiligheid en justitie III, 2012)

Areas of disaster management

Disaster management in the Netherlands is divided into four areas:

1. Military; in this area one can think of things like a bomb squad

2. Emergency services; police, fire and rescue services fall under this area

3. Health; regional health services, GHOR and RIVM are in this area

4. Environmental protection; emergency planning and advisory unit, national laboratory

network

From now on the focus is going to be specifically on health.

Health in disaster management

GHOR

GHOR stands for medical assistance organization in the region (Geneeskunige

hulpverleningsorganisatie in de regio). Each safety region has a regional GHOR bureau, these bureaus

are responsible for medical assistance in disasters or large incidents in the region where the bureau

is situated. The help GHOR offers is divided into three disaster management processes: Medical

assistance, psychosocial assistance and preventive public health. (GHOR I, 2012)

Medical assistance

One of the processes in a disaster is taking care of wounded victims, this is done based on the

upscaling from daily care. The upscaling from daily care is making organizations that are responsible

for daily incidents responsible for the care in disaster situations. In case of disasters these

organizations need to be deployed to the incident site at a large scale. To make this large

deployment possible, agreements are made. (GHOR II, 2012)

One of the emergency services that go to the incident site is ambulances, the ambulances are sent by

the Central Ambulance Post (CPA), which received the emergency number call. From the call the CPA

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paints a picture for the ambulances. After this, the CPA keeps communicating with the ambulances,

hospitals, medical workers and GHOR officials. The ambulance first to arrive at the incident site has

to explore the site and make a report for the CPA. The crew has to set op triage. Triage is a often

used system in which the gravity of the injuries of victims is identified. After this the victims are

categorized in order of the gravity of the injuries and helped in order of priority. (Vermeersch &

Verborgh, 2005) The crew keeps coordinating the medical emergency services that come in until the

medical officer on duty takes over. Ambulances from border regions can also be called by the CPA,

they meet op at an easy place and will be guided to the incident site so they do not get lost. If the

incident is too large for the CPA to handle, the CPA sends a transport coordinator to the site to

coordinate it from there. (GHOR III, 2012)

Another medical emergency service that goes to the incident site is a medical combination. A medical

combination is a team that can treat injured victims on the incident site, the main goal is to get

victims ready for transport to a hospital. The team consist of three parts, an ambuteam, a mobile

medical team and a rapidly deployable group for medical assistance. The ambuteam consists of an

ambulance nurse with a driver and performs triage and provides the most necessary treatment to

protect or recover vital organs. The ambuteam does not transport victims. The mobile medical team

stabilizes victims and prepares them for transport. The rapidly deployable group for medical

assistance is a group of volunteers with a special education from the red cross. The group assists

professionals in the field and they can set up a tent for a ‘nest’ of wounded people that are placed

together after the triage. The group can also staff a treatment center for lightly injured people

together with a nurse and a doctor. (GHOR IV, 2012) When the victims are stable, they can be

transported to hospitals, in the agreement of treatment and coordination of the injured, the GHOR

states that the victims need to be spread over different hospitals as much as possible to take the

pressure of the hospitals so they can focus on treating the victims that they have. (GHOR V, 2012)

Psychosocial assistance

GHOR wants to give victims psychosocial support directly after an incident if they need it to prevent

long term psychological problems like the post traumatic stress syndrome. The GHOR wants to

provide psychological assistance to both direct victims (victims that experienced the incident) and

indirect victims (victims that are in a way related to direct victims). Next to taking care of the victims,

the psychosocial workers also need to register the victims. The staff from the psychosocial team can

come from more organizations like the GGD, mental health care and general social work. (GHOR VI,

2012)

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Preventive public health care

In the process of preventive public health care there is a focus on the protection of public health in

disasters that compose a danger to humans or the environment. The GHOR states that public health

is at risk in the following kinds of disasters: HAZMAT disasters, terrorism and other environmental

related disasters like floods or extreme weather. (GHOR VII, 2012)

The preventive public health care process wants to protect public health in the different stadia of

disaster management. The different stadia are prevention, preparation, combating and aftercare. In

the prevention phase the GHOR takes care of giving advice to the municipalities in licensing activities

with hazardous materials and giving advice to the public administration, as well as charting risks and

giving advice and educating on risks and prevention measures. In the preparation stadium the GHOR

delivers well educated and trained GHOR officers, protocols for different kinds of incidents and

disaster management plans. During this stadium the GHOR also gives advice about the self reliance

and the use of safety equipment of civilians, and it preventively staffs and equips for example large

events. (GHOR VIII, 2012)

When an incident takes place, the medical advisor hazardous materials (GAGS in Dutch) together

with other experts of the GHOR look at the health risks and give information on the incident.

The GAGS plays a very important role in HAZMAT disasters. When there is a HAZMAT incident, the

GAGS looks at which substances there are released, what complaints are usually experienced with

the substances and what complaints are experienced. From this information the GAGS advices on

which measures people need to take to prevent or minimize the adverse health effects and what

needs to be done to treat the complaints of victims. Sometimes the health complaints do not match

the complaints people should be having from the released substance, in this case the GAGS will

notice it and warn the people at the incident site, because there might me another hazardous

material released that did not show up on the measuring systems of the fire brigade. The GAGS is an

important spider in the web, connecting the medical side to the side of the fire brigade. (Gielkens,

2012)

After an incident happened, the stadium of aftercare takes place. In this stadium the GHOR helps

with looking for the cause of the incident and estimates the after effects on public health of the

incident. (GHOR VIII, 2012)

15

GGD

The GGD is the municipal or regional health service, Gemeentelijke/gemeenschappelijke

Gezondheidsdienst in Dutch. The task of the GGD is to protect, guard and improve public health.

(GGD I, 2012) There are 28 different GGDs in the Netherlands. (GGD II, 2012) All these GGDs are

connected by GGD Nederland, the umbrella organization. In GGD Nederland, knowledge and

information are being actively gathered and exchanged. In the management of disasters with

hazardous materials, the GGD is more responsible for the aftercare and the prevention, while the

GHOR is responsible for the acute medical care. The GGD and the GHOR work closely together and

this connection is still growing, in some safety regions the GHOR is even part of the GGD. GGD

Nederland expresses the importance of the connection between GGD and GHOR in the bullet points

of the policy area of care and safety for 2012, where strengthening the cooperation between GHOR

and GGD is a bullet point. In this bullet point the GGD stresses that this cooperation will be beneficial

for the public health and coordination in disasters and that it will create new opportunities to make

new agreements for the cooperation between hospitals, general practitioners, trauma centers and

ambulance services. One of the bullet points is that the GGD wants to map health risks like chemical

plants before anything goes wrong. They want to do this so the municipalities or provinces can look

for alternatives before it is too late. In prevention the GGD has a large focus on the environment. The

GGD has a department of environmental health, this department has environmental medical doctors

that often double as medical advisor hazardous materials. (Drijver & Henk, 2009) The task of

environmental health is conducted by community and health doctors, social nurses and

environmental health doctors that often double as medical advisor hazardous materials with the

support of epidemiologists. When there are complex issues, the GGD get advice from a supra-

regional environmental health doctors. (NVMM, 2012) The department of environmental health also

develops guidelines for environmental factors that can form health risks. These guidelines can differ

from guidelines on noise and smell to guidelines on hazardous materials in the air, soil and water.

(RIVM I, 2012)

GGD Zuid Limburg

The GGD that is responsible for the Dutch part in the EMR is GGD Zuid-Limburg (GGD-ZL). This region

is one of the regions where the GHOR is a department of the GGD. GGD-ZL has 16 subjects it focuses

on, one of these subjects is disaster management. Since Zuid-Limburg is a part of the EMR and is

surrounded by other countries, the importance of international cooperation is emphasized in this

subject. The important role of the GHOR is also stressed in the subject of disaster management.

(GGD-ZL, 2012)

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RIVM

The RIVM is the national institute for public health and the environment. A part of the RIVM is the

center for health and environment. This center supports the GGD and the GHOR with their tasks in

environmental health with advice in normal situations and on the aftercare of incidents. During an

incident the center does health research as a part of the aftercare; after a disaster the center gives a

comprehensive, independent, expert contribution to the decision making on health research in

disasters. Next to health research, the aftercare the center delivers also consists of psychosocial help.

The center for health and environment has a team of environmental health that supports the

environmental health professionals at the GGD and the GHOR in projects, educating the public and

making guidelines and information flyers. The environmental health team also organizes information

meetings, and facilitates the uniform registration of environmental health complaints. The

environmental health team also does research to develop new measuring methods, models and

instruments. Besides this, the team creates working plans based on the need of GGDs.(RIVM II, 2012)

(RIVM III, 2012)

Another part of the RIVM is the environmental accidents service. The environmental accidents

service is available 24/7 and can be called when there is an incident with chemical or biological

substances. In such an incident, the service can support the fire brigade with a team of people with

protective suits and making risk estimates about the effects of the incident on health and the

environment. These estimates are based on measurements they make of hazardous materials in the

air, soil and water. The environmental accidents service has advanced measurement instruments and

a team of experts available for the measurements and analysis. The service gets support from the

national intoxication information center for medical toxicological knowledge. (RIVM IV, 2012)

In case of large incidents, the environmental accidents service is supported by the policy support

team for environmental incidents (BOT-mi). this team consists of the environmental departments of

the RIVM and other organizations that can play a role in environmental incidents, like the national

meteorological institute (KNMI) and the national institute of food safety (RIKILT). Together they

monitor the development of the incident and collect information about the possible dangers to

public health and the environment, and they develop advices and intervention measures to prevent

the adverse effects as much as possible. (RIVM V, 2007) (RIVM VI, 2012)

17

HAZMAT in Belgium

Since the royal decision on emergency and intervention plans of February 16th, 2006, Belgium has a

phasing system to manage disasters. This system consists of three phases; the municipal phase, the

provincial phase and the national phase.

Municipal phase

The municipal phase is in action when the size of the incident is so big that the mayor needs to

coordinate the emergency services. When the municipal stage comes into action, the mayor needs to

notify the governor of the province. There used to be a phase before this phase which was limited

action and coordination on municipal level without the mayor, but in the royal decision of 2006, this

phase was removed. (Federale Overheidsdienst Binnenlandse Zaken, 2003)

Provincial phase

There is a provincial phase when either the emergency situation is so severe that it requires the

management of the governor or when the incident surpasses the borders of the municipality. The

governor is the authority in this phase and needs to notify the minister of internal affairs and the

minister that concerns medical, sanitary and psychosocial assistance. (service public federal interieur,

2006)

National phase

The national phase can be started because of upscaling from the provincial phase, or straight away if

the incident seems severe enough. The incident has to have some characteristics in order to start the

national phase; the incident must involve two or more provinces, the province does not have enough

or the right resources to combat the incident adequately, numerous people are either in danger or

already wounded or dead, the incident has a large influence on the environment or the essential

needs of the citizens (e.g. on the food supply of the country), there is a need for coordination of

different ministries or federal institutions and there is a need to inform the entire country. (Federale

Overheidsdienst Binnenlandse Zaken, 2003)

Each area in each phase has to have an emergency and intervention plan, this plan consists of

multidisciplinary plans, monodisciplinar plans and internal plans. (Bodson, 2012)

18

Multidisciplinary plans

The multidisciplinary plans are the plans in which the disciplines of the monodisciplinar plans work

together to manage disasters.

The multidisciplinary plans consist of a general emergency and intervention plan and a particular

emergency and intervention plan.

General emergency and intervention plan

The general emergency and intervention plan consists of general information and guidelines of the

concerning area, like a inventory of risks, a list of the functions involved in disaster management in

that area, a list of services and their available resources and a general disaster plan. The goal of this

plan is to alarm the involved persons and services, and to set up coordination of assistance as quick

as possible. In this plan there are agreements on the coordination and cooperation between

different disciplines. (Gemeente Torhout, 2008) (service public federal interieur, 2006)

Particular emergency and intervention plan

The particular emergency and intervention plan complements the general emergency and

intervention plan. The particular plan consists of a description of all specific risks, for example a

company that works with hazardous materials (this is called a seveso industry in Belgium) in a certain

area, the possible intervention methods, the people involved in the specific risks, disaster scenarios

and the ways to inform the public about a certain disaster. The particular plan also includes the

geographical situation of the risk and the general information about the risk, the responsible people

of the company that forms a risk and the materials of the risk company itself. (service public federal

interieur, 2006)

Monodiscilinary plans

Next to the multidisciplinary plans, you also have monodisciplinary plans. These plans are

intervention plans per discipline, the plans are in accordance with the existing emergency

intervention plan. Every discipline has its own operational leader. In case of a disaster, all these

operational leaders come together in an operational command post lead (CP-OPS in Dutch and PC-

OPS in French) by the director of command post operations. There are 5 disciplines; (IBZ, 2007)

1. fire department and civil protection

2. medical, sanitary and psychosocial assistance

3. police department

4. logistical support

5. information

19

again, only the medical part will be covered, in this case that will be discipline 2. (Bodson, 2012)

Discipline 2 – medical, sanitary and psychosocial assistance

According to the royal decision on emergency and intervention plans of 2006, discipline 2 is

responsible for providing medical and psychosocial care for direct and indirect victims of incidents,

taking measures to protect public health and transporting victims. These tasks are conducted by

emergency medical services and the services that are included in a monodisciplinary intervention

plan. In case of a disaster, the administrative authority is the federal health inspector (FHI). The

operational authority over all medical, sanitary and psychosocial assistance on the incident site is the

director of medical assistance (Dir-Med). The Dir-Med is a medical doctor appointed in the

monodisciplinary intervention plan of discipline 2. Either the Dir-Med or the assistant Dir-Med

represents discipline 2 in the CP-OPS. (service public federal interieur, 2006)

The monodisciplinary intervention plan of discipline 2 is divided into four components; the medical

intervention plan, the psychosocial intervention plan, the sanitary intervention plan and the risk and

manifestation plan. The plans each state how to coordinate their subject.

Coordinating staff

Part of the coordinating staff is the FHI. The FHI is the representative of discipline 2 and as

mentioned he is the administrative authority as well. He is assisted by his assistant for operational

support, and will, depending on the situation, either be seated in the coordination committee or

support the Dir-Med on the incident site, or be part of the operational staff. For the psychosocial

aspects of the situation, the FHI is supported by a psychosocial manager. The psychosocial manager

also oversees the operation of the psychosocial intervention plan. The FHI is also helped by the

secretarial coordinator. The secretarial coordinator organizes the administrative tasks at the incident

site and the medical post outside of the red zone. The administrative tasks include registering the

victims and other involved people and where they are transported to. (PIBA, 2008)

Another coordinating staff member is the Tri doctor, a doctor, preferably an emergency doctor of the

first mobile emergency group, who makes an overview of all the patients and performs the triage. He

reports back to the Dir-Med and the coordinator of the medical post outside the of the red zone. The

assistant of the Tri doctor is a nurse of the first mobile emergency group. The coordinator of the

medical post outside of the red zone is a doctor or nurse of a mobile emergency group, that person

organizes the entire medical post. The coordinator makes a task division and makes sure that

everybody executes their tasks properly. The coordinator also creates different classification zones

where victims can be put after the triage is performed. The coordinator reports back to the Dir-Med

and tunes his decisions with the coordinator of regulation. The coordinator of regulation is a doctor

Opmerking [A.E.1]: Verklaren of andere benaming.

20

or nurse of a mobile emergency group that regulates all victims that need to be transported to

hospitals. He knows which hospitals are available and where all the victims were sent. (PIBA, 2008)

To get the medical supplies (like oxygen, drugs etc.) and the logistic supplies (tents, heating, catering)

to the places where they need to be, the logistics coordinator is instated. The logistics coordinator

does not only make sure that everything is where it needs to be, but also that the use of the supplies

is optimal. If needed the logistics coordinator can discuss with the main responsible of discipline 4.

The logistics coordinator does however not take care of the ambulances, that is the task of the

coordinator of the ambulance park. The coordinator of the ambulance park is under the direct

control of the coordinator of regulation, and make sure that patients are transported efficiently and

according to the instructions of the coordinator of regulation. (medics4medics, 2012)

When it is necessary to have someone from the medical dispatch center (HC 100) on site, the

coordinator liaison HC 100 gets sent to the incident site. This coordinator stands for a fast

communication between the CP-OPS, Dir-Med and the HC 100. (PIBA, 2008)

Operating staff

Besides the coordinating staff, the services that deal with patients are also very important. In

Belgium, on the medical area, the services that directly come in contact with the patients are

ambulances, medical corps and nurses, the paramedical intervention team, hospitals and the Belgian

red cross. The ambulances sent to the incident site are usually connected to the dispatch center of

the area of the incident, but if there are more victims than the ambulances of the dispatch center can

handle, the dispatch center can call ambulances that are not meant for emergency assistance, or

ambulances of the red cross. Because border areas of Belgium have agreements with the bordering

countries, border areas can also count on the support of the bordering countries. There are several

different doctors and nurses that can be deployed in discipline 2; doctors and nurses of the mobile

emergency group, hospital doctors, doctors of the fire brigade, general practitioners and nurses.

Next to these doctors and nurses, doctors and nurses that offer to help at the disaster site can also

be used, they will get an action card which tells them what to do. The paramedical intervention team

is a hospital team consisting of a nurse specialized in emergency and intensive care and an

ambulance assistant. They can execute the most necessary procedures and transport the victim to

the hospital. The paramedical intervention team is used in discipline 2 for pre-triage, support of the

medical post outside of the red zone and for transporting victims. The hospitals are also important

players when dealing with victims. In case of a disaster, the victims are divided over the hospitals in

the area and if needed hospitals outside of the area of the disasters are included. The Belgian red

cross can also be deployed in case of a disaster. The red cross is part of discipline 2 since 1972

21

Internal emergency plans

Each company needs to have an internal emergency plan. This plan is to keep the effects of an

emergency situation limited to the company itself. If an emergency situation cannot be handled by

the internal emergency plan, the particular emergency and intervention plan come into action. (IBZ,

2007)

Alerting hospital services

Besides an internal plan, all hospitals except psychiatric hospitals, hospitals that specifically treat

long-term diseases and specialized hospitals need to have a plan called ‘alerting hospital services’ for

when there is a large incident outside of the hospital. This plan needs to be designed actualized and

validated by a permanent committee lead by the head doctor of the hospital. The plan needs to be

approved by the governor of the province where the hospital is situated. The plan must include the

creation of a command- and coordination cell that leads the operations and collects the information

about the incident and that represents the hospital towards families, authorities and the press. The

hospital has to give an indication of their capacity to take care of patients. The plan must describe

the different levels and phases of internal mobilization and reorganization and the efficiency of these

phases. The person that decides over when which phase is applicable must also be appointed in the

plans. In order to have efficiency in these levels, it is necessary to have a list of the staff of the

hospital that says which people are at the hospital and which people can be called into the hospital

so there is a clear overview of which staff is available. The hospitals need to appoint rooms for triage,

press, family, authorities and corpses and provide psychosocial support where needed. The

regulations on the identification of these corpses need to be in the plan. Because the large incident

can be an incident with hazardous materials, the hospital needs to take contamination into account.

The rules and regulations on decontamination and protection against contamination of materials,

victims, staff and the rest of the hospital are therefore described in the plan.

Different staff members need to be educated for these kind of situations and instruction manuals

need to be provided, as well as the alerting hospital services plan summarized in an easy to read

table. The hospitals themselves can decide on how many trainings and exercises will be given on this

subject. (ministerie van Volksgezondheid en van het Gezin, 1964)

Decontamination

The reason why decontamination is brought up extra in the Belgian system is because in Belgium

there are some very interesting discussions going on about decontamination. From the interview

22

with mister Bodson (appendix 2) it became apparent that only decontaminating at the incident site is

not enough to prevent contamination of others outside of the incident site. He said that people that

were in an incident with hazardous materials are not going to wait until all the ambulances have

arrived. The circumstances might be very bad, it might be raining or freezing, they will not stay

around. Victims are going to hospitals themselves with their own car or public transport. The victims

can walk straight into the hospital, contaminating the entire hospital. That is, as mister Bodson

states, a reason for large decontamination areas where ten to twenty people can be decontaminated

at the same time. These areas need to be in front of the entrance of the hospital so the people

coming in can be blocked and under pleasant circumstances. These ideas come from France and are

slowly taken over by Belgium. There are already a couple of hospitals in Belgium with these large

decontamination areas, but the plan is to get more hospitals to do this. These kind of large,

permanent decontamination areas are not yet implemented in the Netherlands.

The Netherlands and Belgium working together

There are agreements for the cooperation between Belgium and the Netherlands and when Belgium

needs help from the Netherlands or the other way around, it works out most of the time without

problems. However, from the interview with mister Bodson one can conclude that sometimes the

laws and regulations slow down the process of handling in a disaster situation. The authorities that

make the rules are often not people that work in the field and that know how the reality is. They

want emergency services to follow every step of the guidelines and sometimes that means losing

valuable time. Also different countries have different regulations, which makes cooperation hard

sometimes. Although this is the case, mister Bodson and mister Moors both say that in practice it

almost always works out. In one case however, when Dutch ambulances came to help with the

shooter in Liège, according to miss Gielkens the ambulance staff could not help the victims, because

the Dutch ambulances have nurses and in Belgium only doctors can treat victims on an incident site.

The Dutch nurses are well qualified to treat people and this is an example of how regulations stood in

the way of disaster management. Problems with international cooperation that were mentioned by

both mister Moors and mister Bodson were problems with communication, especially in the French

speaking part of Belgium, because most of the French speaking Belgians do not know Dutch, German

or English, which makes it hard for other people to communicate with them, since a lot of people do

not know French either. Another communication issue that came forward was that different

countries use different terminologies and measurement systems, which makes it hard to understand

what people mean. A problem that miss Gielkens raised was that a lot of people do not know each

23

other. This makes that you do not know what capabilities a person has and what you can and cannot

expect them to do. The main problem with cooperating with other countries is in the

communication.

Discussion

From the results you can see that the Netherlands and Belgium have similar systems of upscaling in

case of a disaster. The Netherlands works with the GRIP system with five stages and Belgium has a

system with three stages, municipal, provincial and federal. Both systems start at a small area

(municipal) and as soon as the incident seems to be larger than the services appointed to the current

stage can handle, the situation is upscaled to a higher stage. Although the systems are quite similar,

the difference can be clearly seen. The system of the Netherlands is more detailed and elaborate

with five stages and a clear and a detailed description of what happens per stage. The Belgian system

has less stages, and the description of the phases was not that elaborate in the documents that

instated these stages. However, it seems that Belgium has done this on purpose, since the system

previously consisted of four stages, but in the royal decision of 2006 on emergency and intervention

plans it was reduced to three stages. It could be that Belgium chooses not to focus on the definition

of the stages, but more on what happens within the stages. The structure of upscaling seems like a

good system to get a clear coordination in disasters, this can also be derived from the interview with

miss Gielkens (appendix 3). In small disasters you do not need to involve the entire country when

smaller authorities like mayors know more about the situation of a specific area. With large incidents

it is good to have larger authorities that can connect emergency services of more areas and that have

more power to call in the more expensive, specialized services.

The system in the Netherlands is institution-based, every institution has its task when there is a

disaster. The different disciplines (medical, fire brigade, etc.) and organizations within the disciplines

(for health for example the GHOR and the RIVM) are brought together by the safety regions. Within

the safety regions the organizations have their own protocols to handle disasters. In Belgium, the

system is based on plans. The different disciplines are brought together under the multidisciplinary

plans and the disciplines themselves have the monodisciplinary plans on how to handle disasters in

their own discipline. Within the monodisciplinary plans there are organizations that work together in

case of disasters, like in discipline 2, the red cross and hospitals, but the organizations adhere to the

monodisciplinary plan of the discipline they are in. What stands out is that the Netherlands has a

special organization for health in disasters (GHOR) while Belgium does not have anything like it. The

24

reason for this might be that Belgium is more focused around plans than organizations and that the

monodisciplinary plan of discipline 2 is comparable to the GHOR, but the GHOR is an organization

that also does a lot of preventive work, while it seems like discipline 2 is a plan made for the case of

disasters and not for prevention of disasters.

What also stands out is that the Belgian system does not seem to have specific health services for

HAZMAT disasters. In the Netherlands there is the GAGS function (health advisor HAZMAT), the

environmental health department of the GGD and the health and environment department of the

RIVM. Especially the GAGS function plays an important role in HAZMAT incidents; the GAGS is

specialized in the health effects of HAZMAT, this means that they know how to treat HAZMAT health

effects and in some cases that they can see from the complaints of citizens with which substance

they have come in contact with. From the interviews with mister Bodson and mister Moors

(appendix 1 and 2) it became apparent that there is definitely not such a function in Belgium. That

there is not a large focus on HAZMAT in the health department, does not mean that HAZMAT is

completely ignored. It is very common that HAZMAT falls under the fire department, they do the

measurements and try to control the incident, in Belgium and the Netherlands this is also the case.

Mister Moors states in his interview that he thinks that a specific function like the GAGS would be

good to have in Belgium. He says that because there are no specialized functions like this, which

results in one person taking on a task like this next to his official task.

In terms of decontamination one can see that Belgium is a little more ahead of the Netherlands with

their large, permanent decontamination areas in front of hospitals to prevent contaminated victims

that got to the hospital on their own without being decontaminated first from contaminating the

hospitals. This idea is still growing in Belgium, and only a few hospitals have these decontamination

areas, but in the Netherlands there are no hospitals with decontamination systems this big.

The cooperation between Belgium and the Netherlands might not be as smooth as possible, but in

practice almost always works out. However, it is important to keep improving the cooperation,

because misunderstandings due to miscommunication or differences in laws or materials may lose

valuable time, and time is of the essence when you manage a disaster. If people are contaminated

with chemical substances for example, the more time you waste on getting to the disaster site and

decontaminating victims, the more victims will walk away contaminating others, making the disaster

even bigger. The most problems lie in the communication, there is not only a language barrier, but

also a difference in jargon and not knowing people and therefore not knowing what you can ask from

them. There are also differences in regulations and measurement materials. The difference in

25

measurement materials makes that the outcome variables can also be different, this makes it hard to

communicate on the measurements.

Conclusion

There are similarities and differences between the systems of the Netherlands and Belgium. Both

systems use a structure of upscaling when there is a disaster. This seems like a good structure to

have, as it does not unnecessarily involves big authorities, and the smaller authorities like mayors can

efficiently manage smaller incidents without having to report back to all kinds of other authorities.

One of the main differences between the Dutch and the Belgian system is that the Dutch system is

more institution based and the Belgian system is plan based. In my opinion the Belgian system is

clearer, the system is based on three phases which each have the same sort of plans. The plans are

instated by law. In these plans it says exactly what happens when there is a disaster and who does

what, this gives a clear overview. In the Netherlands there is not such a legal plan structure, but more

an institution structure, for example, you have the safety regions in which emergency services work

together. Within these safety regions there are own agreements, there is not a specific guideline on

what these own agreements have to be like.

Another difference is that the area of health within disaster management in the Netherlands has a

much larger focus on HAZMAT disasters than Belgium, especially with the GAGS function of the

Netherlands. An expert that covers the medical part of HAZMAT seems like a very useful staff

member to have in case of HAZMAT disasters. Not only does it reduce the workload of other people,

it is also good to have an expert on the case that knows about the effects of hazardous materials on

people and that has the information in his head, so it does not take extra time to look everything up.

This is not the only HAZMAT focus of health in the Netherlands, the GGD and the RIVM both have

departments that focus on environmental health and within environmental health a focus on

HAZMAT. Belgium does not have a large focus on HAZMAT within the medical area, I did not come

across any special health services or special functions that relate HAZMAT to health. One of the

reasons could be that there is no such thing, but another reason might be that these functions are

hidden deeper in the system and that I simply did not come across any of these functions. However,

from the interviews it became clear that the Belgian side does not have a function like the GAGS. So I

can conclude that the Netherlands does have a larger focus on HAZMAT in health than Belgium.

However the Netherlands can learn from Belgium too, since their ideas on decontamination are

more developed than in the Netherlands. Decontamination is a very important part of HAZMAT since

you can prevent a lot of extra contaminations if you decontaminate properly.

26

The cooperation between Belgium and the Netherlands is already pretty good, in the field the

problems that are experienced are not seen as vital problems that make cooperating impossible.

Nevertheless, there are some problems that could probably easily be solved. It would be good to

work on solutions for those problems to make the cooperation more efficient.

Overall both the Dutch and the Belgian system are good systems, I did not come across any major

problems in the systems and everything seems to be working fine. Nonetheless, there are things that

can be improved to be more efficient and to prevent more victims after a disaster. Both Belgium and

the Netherlands are already slowly trying to improve their systems, and I am sure that they will

continue to do so.

Recommendations

The Dutch system seems to be a good system, the Belgian experts that I interviewed even thought

that there was not much for the Netherlands to learn from Belgium. However, there could be some

improvements. The Dutch system could have a clearer structure or one document that states the

entire structure. In terms of decontamination the Netherlands can learn a lot from Belgium as well, it

would be good for the people responsible for decontamination on both sides to talk with each other

about their ideas, how the large decontamination areas in hospitals in Belgium were realized and

how they could be realized in the Netherlands.

The Belgian system comparable to the Dutch system and also not a bad system. There could

nevertheless be a larger focus on HAZMAT in the area of health. It would be good to have more

specific functions that connect the HAZMAT part of the fire brigade to health. This will also take some

of the workload of coordinators and authorities, that will save time and give the coordinators and

authorities more time to focus on the rest of their tasks.

The cooperation between Belgium and the Netherlands is also not bad, but there is still a lot that can

be improved. For the language barrier it would be good to either create a uniformity in terms

everybody uses, or to make a small on site dictionary. The dictionary cannot be longer than 2 pages

and has to be plasticized so it can be used in all circumstances. It will strictly contain the terms that

are most used and the terms can be on the paper in Dutch, German, French and maybe even English,

this way the cards can be used in the entire EMR. Not every country has the same measurement

devices, to solve this, the measurement devices of one country can be the standard and other

countries just have to get new materials. The replacement of these measurement materials is very

expensive, so another solution would be to have tables on site that transfer the measurement

values. The table has to be easy to read and understandable. It might take a little bit more time than

27

when everybody has the same measurement devices, but it saves a lot of money. Another problem is

that people often do not know their colleagues from abroad, that makes cooperation harder. If you

know someone and what their function is, you do not hesitate to call them when you need

something, and you know who to call for what you need. Different emergency services in the EMR

need to meet each other more regularly. This does not have to be every week, but if emergency

services in the EMR would come together once every half year or year, maybe even just for a cup of

coffee, it will improve the contacts. People will know who does what, and who they can call for what

problem. Finally I think that the EMRIC+ project already forms great support in setting up

cooperation in the EMR, and if the countries keep on working with EMRIC+, there will be many

solutions to problems that occur now.

28

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Appendix

Appendix 1 – Transcript interview doctor Lucien Bodson

Clinical supervisor, emergency department emergency plans, chemical, biological, radiological

nuclear coordinator.

May 8th, 2012

LB = Lucien Bodson

CG = Cindy Gielkens

LS = Lisanne van der Schors

Interview doctor Lucien Bodson

LS: Can I record this interview?

LB: Yes, I am Lucien Bodson and I stand completely behind everything I say.

LB: All authorities in Belgium know about my ideas and why I have these ideas. My goal is not to

make anarchy. My goal is to give positive ways to construct good collaboration, but pragmatic.

CG: I totally agree. The main part of our research and part of the project is public health advice in

incidents with hazardous materials, there is a part of the fire brigade, the exposure assessment is

done by those people. We call it the red column in the project. They have a working group and are

looking for uniformity and cooperation in monitoring across the borders. Michel Moors is from

Belgium in that working group. He is from the exposure side in Belgium. Our column, we call it the

white column, the medical expertise on hazardous substances and our main goal, but this is very

ambitious, is to have at one point in the future a hazardous materials team specialized in the medical

expertise which is cooperating across the borders. But now the focus is on making a network of

experts so we can know each other and know who has which expertise, who we can call when there

is an incident with some sort of materials. and of course there would be some training and exercise.

But I think in this phase of the project, training and exercise should consist of getting to know each

other and each other’s expertise. I have some examples of disaster, but I don’t think I have to show

them to you, since you probably already know the big international incidents. Here you have the

radiation incidents with Chernobyl and Fukushima. Last year there was a very large fire in the

34

Netherlands, I don’t know if you’ve heard about it. There was a very large black cloud which went

over several regions of the Netherlands. Even in one country there are difficulties, mainly on political

level. When there is a large incident, people on national level want to overrule the experts in the

field and there were some difficulties, especially when we look at the Public health risk assessment

and communication to the people. In one region people needed to close their windows and doors

and in the region where the fire was, that message wasn’t given to the people. There were some

inconsistencies. This was just to illustrate that there is a lot of work to do even in one country. Some

euregional examples; there was in April 2010 a release of nitrogen oxide in chemelot, the great

industrial plant in the south of Limburg. People saw a yellow cloud when they looked out of the

window in the morning.

LB: beautiful

CG: there wasn’t anything of public health complaints in the Netherlands, but at one time the fire

brigade gave the message that the cloud was going to Belgium so case closed, but eventually, in

Belgium the land is higher so the cloud did come on the living level. People smelled…

LB: No victims…

CG: no but people saw it and smelled it and were afraid, so I think there should be… when there was

some more collaboration and public health communication, it would have been better.

CG: This is a fire, also on the Dutch side and the clouds went to Germany and there were also some

miscommunications about having windows closed and that kind of stuff. There were a lot of

questions on the Dutch side eventually, and I think that this could have been forecome when there

was some more attention for the public health side. Maybe the fire brigade can really solve the

problem on their side and they think they can give the message that there is nothing going on and

there is no reason for fear, but people want to have the message in another package. They want to

hear it from a doctor or from someone from the public health side and get a good explanation why

there is nothing going on and not just the message that there is nothing going on. Another example…

what I want to illustrate with this example is that when there is a large incident that can have a large

influence on public health, we do need information about the exposure side of it. Which chemicals

are released, how much chemicals are released, what is a good situation? To say something about

what are the health risks, but on the other side it is for us very important to know which complaints

are there under the people, are the complaints the complaints we expected when we know the

release or are there very other health complaints? And maybe when there are other health

35

complaints, we have to look if there’s another chemical released. We do have examples from that

kind of problems.

LB: The same problem since years and years and years, but there is no solution.

CG: In the Netherlands I think that it is not exactly where want it, but probably health hazmat

advisors, the function I do with some colleagues. We have a team with five colleagues in the south of

the Netherlands and we are being called much more often than a few years ago and I think that

mainly for the public and communication that we can play a role in that game.

LB: You THINK so.

CG: yes, but you have to be idealistic

LB: I will prove that we have in the Netherlands, Belgium and Germany no good solution, but we

have to try to find one. I will explain that later.

CG: Yes, but we have to start somewhere. I think that when we have the good people, the end result

can be more than zero, I hope.

CG: We can give advice about the measures and the communication and when we are talking about

cross border incidents I think that should be in collaboration, that we give the same measures in all

the three regions, not that we have in one region the windows closed and in another region

evacuation and in the third region there is nothing going on. I think we can split it up in phases we

have the hazard evaluation and exposure assessment when there is an incident going on, but that is

mainly the part of the fire brigade. This is how it is in the Netherlands, and I’m not saying that this is

how it should be, but this is the way that we’ve arranged it. When there is a toxicological effect an

evaluation and risk assessment the public health advisor hazmat is coming in the picture. We call it

GAGS in the Netherlands, the public health advisor, I don’t have the English name.

LB: It’s funny in French and in English, Gags, Jokes!

CG: this is a German slide, but just to show this is a spider in the web. There are a lot of institutes and

involved people when there is a large incident.

LB: very classical from years and years and years, but effective? No.

CG: Okay, but I still want to try to convince you that… well, I will not convince you but we agree that

there is more needed

LB: Yes, we have to work together, but I will explain why it is not a hundred percent functional.

36

CG: yes, well in the Netherlands you have the police, the fire brigade and the medical people. They

are at the incident location and at national level there are some institutes, you have the GPs, the

hospitals and the public health services and all the people want to do something and to say

something. The public hazmat advisor as we have them, is a spider in the web. What do we do as

public health hazmat advisor, well as I told you, we give advices about public health risk, measures

that need to be taken, protection of the aid workers in the acute phase, but also public information

to the people in the effect location on the basis of the measurements of the fire brigade, but also our

advantage above people of the fire brigade is that we look at the health complaints of the people.

This can be a big advantage.

CG: I just put this slide in it, maybe you know it, this is how it is arranged in the Netherlands when

there is an incident and when there is a small incident; a little fire with chemicals and it can be solved

by running business as usual, the daily business, then we call it GRIP 0.

LB: then you have different steps? From small incidents to major accidents?

CG: yes, that is GRIP 5

LB: classical model

CG: is there a structure like that in Belgium?

LB: yes, but it is unusable. It is theory from people who are not in the field, it is only theory. A very

difficult topic. Maybe it would be interesting to make a little stop and I will explain.

I am a medical doctor, anesthesiologist intensive care unit and a specialist for emergencies and

disasters, but I am also medical officer firemen and commander in the Belgian army on reserve. As

you have seen on my card I am coordinator for nuclear, radiological biological and chemical problems

and all emergency plans. I explain each time that I am not a HAZMAT problems specialist but I am a

coordinator because I am an emergency physicians and working on the butter field, why? Generally

we have very accurate specialists, in your country and in Germany of course there are very clever

people that are HAZMAT specialists. But they are not practitioners and they have a very special point

of view of the risks, it’s an engineer’s point of view. It is interesting of course, but generally it is not

applicable to medical practice. If you work in this area, what is it for? To save people, maybe as a

second goal to save material, houses and so on, but first it is to save people. To have very few deaths

and very few severe injuries, this is the goal. Who can appreciate the gravity and the severity of

health injuries? The medical doctors, or in your country you have the very good staff for nurses and

ambulance staff. I include of course this kind of people, very clever, very accurate.

37

CG: the white column

LB: so the problem is to speak about the same risks and to have the same point of view between

architects, chemists, engineers, firemen and medical teams. The reason why since a few years, the

first time was for exercise eulux in Luxembourg with the civil protection of Belgium, Germany,

Luxembourg and France to save 250 people with radiological contamination and chemical

contamination. Three hours, thirty minutes before the first teams were on site, close to the victims

and since the beginning of the contamination. Is that OK for you?

CG: that’s very long

LB: it’s not OK for me. It’s completely incredible. And the problem was that the only goal of this circus

show was for the ministers of the country to show the people: this is the trucks that we bought with

your money, very nice, a blue one, a red one, a yellow one. But on the field the efficiency was zero.

What do you think what will happen with 250 people, maybe 20 are dead, maybe 20 or 30 others

have big problems, immobile, but 200 people are walking. What do you think they will do during 3

hours and 30 minutes, will they all stay there until we come with showers and so on? Will they stay

with biscuits and cigars, just playing cards? What are they doing?

LS: they will walk around, contaminating others

LB: where?

LS: public spaces

LB: yes, but what public spaces? Hospitals. If you don’t protect hospitals, you will get big problems

with contamination of emergency departments of different hospital, because you will have a wild

evacuation of all these people with taxis, busses, private transport. This evacuation will happen

before you know there is an explosion or a problem on that side. This is the reality. I was last year in

val de grâce, Paris for a big demonstration of the day of HAZMAT and the fire brigade of Paris, very

well known, made a show with firemen of course. It was sunny, 20 degrees, all the firemen were in

swimming suits. It was very easy to say ‘oh, you are here, come this way, do this and this’. They

pretended that 80 people each hour were contaminated. I said ‘it’s impossible, show me.’ And I

explained also the different problems. Just imagine the same situation in your country, your country

is not tunesia or Algeria. It’s just like our country. You are in January, in the night, 2 am. Civilians, not

firemen, not the army, not soldiers. Men and women, muslims, catholics, protestants, children. Snow

everywhere, 2 am, you are in the countryside, what do you do?

CG: yes, that is a large problem

38

LB: they never speak about a problem like this, this is a real problem. This is why we have to speak to

meet and to speak together, because this is reality, not a circus show you see in your country and I

see in my country or Paris and so on. Yes, it’s interesting to have a decontamination system for

soldiers because the decontamination system follows the brigade and so on, for decontamination of

material. But not for an explosion in civilian towns or villages, because when a truck is exploding

during transportation of chemical substances, the situation is completely different. And this is a case

we have to speak about. If we can solve this, we can solve a lot of problem. But I know it is a

problems also in the US, in China. It’s a reason why I travel all around the world and I know the

different answers of each and I know they all have big problems, but since 20 years they all have

these items, these are basic items of the problem. Very easy, but how to go further to the real

answers. This is the reason why I accepted to meet you, because I hope with EMRIC+ to go to real

pragmatic answers. But I refuse to participate to ministries, to dinners, walking dinners, Champagne,

caviar, big sentences, long speeches without any efficiency. So it was just to speak about my job. My

job is real, pragmatic and I know about the problems of firemen, because I am also a medical fireman

and I am in contact with a lot of people and we try worldwide to find solutions. Do you know the

company hot zone solutions? You have to have a look at them, the company has an office in the

Hague.

CG: and it is a company?

LB: this is one of my contacts, it is a former commander of the Belgium army, he’s retired now, but

he works for the hot zone solutions. And here is the address.

CG: and what do they do?

LB: it is only for civilian purposes, they propose to make exercises with real chemical and radiological

agents. They did exercises in Czechoslovakia, in Chernobyl, different zones. This is the only civilian

company authorized to work with real chemical and radiological agents.

CG: they develop exercises for people?

LB: yes

CG: and what kind of… just civilians or also people that work with those kind of agents?

LB: it’s for firemen, policemen, industries who want to exercise and test their own material, it’s very

important to be in contact with these people. You can contact them and say you know mister

Bodson, it’s OK.

39

CG: Okay

LB: I go to China because since 2 years we prepare France, Belgium, China and all the people, a group

exchange about chemical risk and we hope we will have success for international meeting of a

platform for all specialists, but to make all these specialists, different specialists, architects,

engineers, firemen, chemists and so on not to know more about their own practice, because they do

this by themselves, but to try to let them speak the same language. And when they are on an

accident to have the same point of view and to speak the same language and to have good

coordination. And I will give you the reference for this international conference, because it is the first

time we do this in China, shanghai in June. But probably twice a year and it will be bigger and bigger

and of course you will be invited, because you have probably a lot of things to say and to hear with

all these people.

CG: yes, Thank you.

LS: Now I want to ask you a few questions. I have some basic questions about how things are

arranged in Belgium, if you want, I can give you the questions as well. I would like to start with the

basic national information. If there would be some sort of disaster with hazardous materials, what

would happen, can you paint me a picture, how in your opinion things would go. Like in the

Netherlands we would have the GRIP structure, is there something like this in Belgium?

CG: if there is an incident with some sort of chemical and there are health complaints, what would

happen in Belgium, which people would be called, who will give you advice, that kind of stuff.

LB: do you know about the Belgian laws?

LS: Well I tried to research it, but I don’t think I know enough

LB: since 2006 we have a law describing all the process when a disaster occurs. That’s what we

named PUI. It’s in French plan d’urgence et d’intervention. Intervention emergency plan. Three main

levels: communal, provincial, national. Town, province, national. At each level you have a PUI, the

PUI is composed of PGUI. General emergency and intervention plan, general philosophy of

intervention what kind of disaster can take place. Plus PPUI, particular plans for emergency

intervention, for example all seveso industries, nuclear centres and so on, they have particular plans.

Plus monodisciplinary plans, five disciplines 1. Firemen 2. Health(red cross) 3. Police 4. Big logistics

(civilian protection and maybe the army and also the red cross) 5. Information (radio, television) with

authorities. Plus PIU, it’s internal emergency plans. All companies, all big companies also hospitals

must have an internal emergency plan in case of fires, explosions, flood and so on. The PUI is

40

composed of all of these plans at each level. For a hospital we must have of course like all companies

a PIU, it’s a security service, plus MASH planning, in French: mise en alerte de service hospitalier.

Hospital services alert system. So, if we hear about a disaster and we expect to receive in a few

minutes or hours a lot of victims, more than usually, we start the MASH plan in two levels, level 1 and

level 2. Level 1 is only internal reorganization, because we just take some new beds, some nurses

from here to here, because we just expect a number of victims, but not too many. For example here

we expect about 15 victims with 2 major, 4 medium and the others the relient victims, it’s level one.

For more it’s level 2 because we have to call back doctors, nurses and so on. This is the general

organization, the ministerial law of 2006. Of course, if we have a chemical hazard, directly you

probably have the PPUI that will start the specific procedure and also discipline 1 and 4. Maybe if it’s

with a company the PIU, the company itself. With people trained for chemical risk and with special

material to detect, to measure, maybe to count everything, that is a problem for firemen and also for

civilian protection, maybe army.

CG: and the health is not playing a role in this?

LB: only a part of this.

CG: there can be victims that need to go to the hospital and medicine is involved, but when there are

complaints that aren’t necessary to be treated in the hospital but people are afraid that kind of

stuff…

LB: of course if we have that kind of problem, we start our MASH plan, part of the MASH plan is

composed of what to do if CBRN problems occur, but for example the contamination in Belgium is

not good, I explained you the circus show of a few years ago and each year we have a circus show

like that. And until now we have no protection of our hospitals. If you have 10 people coming wildly

from an accident with contamination of their clothes and so on, we have a very big problem, I will

show you our small protections for this hospital. This hospital is a major hospital, one of the 2 state

university hospitals of Belgium, one in Gent, the Flemish part, one here, liege. 4800 work here,

because we have different sides, this is the main one. 80000 people each year come into the

emergency department, just to get an idea. But I will show you our very small protection system if we

have radiological or chemical problems. If we have 1 or 2 victims, it’s ok, if we have 10 or 100 victims,

it’s impossible. I don’t know how it is in your country, but here it is very difficult. That’s the reason

why I come back to what I said a few minutes ago, the real problem is the wild evacuation from a

disaster site with thousands or maybe hundreds of people going directly to the hospital and this is a

very big problem.

41

CG: when there is a smaller incident and there is said that chemical A is released and the health

complaints are much different than what you would expect it would cause by chemical A. on basis of

the health complaints you would expect that it would be chemical C, is there someone who pays

attention to these differences? In our country the public health advisor hazmat is playing that role.

Looking are the complaints those that you would expect, and is the fire brigade measuring the right

chemical, are they putting the right carrier in the air? Do you know examples from that kind of

incidents?

LB: yes, theoretically we tried to do the same, but in practice..

CG: there’s no one that pays attention if that could happen?

LB: they try to, but the timing is very hard.

CG: and who is trying? The fire department?

LB: the fire brigade and civilian protection on the field, but 99% of the accidents we’ve had, the

information was wrong, for example, if you cross our country from liege to monts and you follow la

meuse and somewhere we have a valley with a lot of companies with chemicals. Producing or

receiving chemicals or using chemicals. Included the nuclear central of tirage, four reactors. Try to

know about the main wind direction of the country.

CG: that will probably be the same as with us…

LB: we have wind turning all the time, this is one kind of information they try to give, but in fact it is

quite impossible, but all the emergency plans are based on this kind of information to decide which

country we have to protect. Closing the door or to evacuate.

CG: on paper it’s looking nice, but in reality…

LB: yes, it looks very nice on paper, on site very bad. Remember, the first industrial disaster in the

world was in ainsy (?) a few kilometers from here in 1929, with a company préons reppelles. And you

have an inversion of temperature, metereologic problem, yes. And the smoke pushed on the road. 60

persons dead, 1000 people with problems, eyes, pulmonary problems. It was the first industrial

disaster in the world. In 1952 the same problem was in London, 1200 people died.

CG: in other words you’re saying we didn’t learn anything. Is public health services playing a rolein

those monodisciplinary ?

42

LB: yes, because hospitals start the MASH plan of course. Some hospitals can send on the field

intervention vehicles with a medical team, you know our system, one medical doctor and one nurse.

Sometimes a driver, but for financial reasons generally it is only the nurse driving the car and one

doctor. And they go inside. In Belgium maybe 5 people are trained to go into contaminated sites and

know what to do, to respect and to take care in that case. So not enough exercises, not enough

information, it’s a reason why the university here asked me, we must change this, we must improve

this, because everywhere in Belgium, this is not enough, we are in danger. You know our hierarchy?

For the 2nd discipline, for health, public health ministry, national is one minister for health safety, but

we have also in each province a health inspector. He is an administrative medical doctor. And in

some provinces, not all sadly, but in liege for example, and I was the first one 24 years ago, we have

24/7 a medical director on duty. If there is something happening, he is directly on site and he is the

commander of all the medical teams on site and he decides how we are going to send people to

hospitals and so.

CG: we have that aswell

LB: yes, I thought so. Here we have the abbreviation dirmed from this law also. Dirmed is the

mandatory emergency specialist with complementary education for disaster situation and it stands

for direction de l’aide medicale, so it’s for director of medical help.

CG: we call it the white services, GHOR

LB: and he is the head of all ambulances and meuch, medical interverntion vehicles, but also red

cross. General red cross is a very special part, but when a disaster occurs, the dirmed is the head of

all the red cross systems. And also PSM, also on duty 24/7 for psychosocial management.

CG: and the communication to the public, when that is necessary 5 flies in?

LB: yes. On site, you know we apply the French method with PMA, post medical avance, advanced

medical tent, campaign hospital, triage of course and evacuation with regulation with different

hospitals and the dirmed is head of all the systems on site, but the dirmed is present in the command

room with all the disciplines. So on site the tactic 2-level: strategic (authorities, burgemeester,

government of each province and national is a minister, 2 ministers, the interior minister and the

health minister) and tactic (operational) so it’s level communal, provincial, national. Town, province,

national. Tactic, you have on site during a disaster PCops integé, integrated operational command

room with all the disciplines. You have dirPCops, generally a fireman officer and he coordinates the

disciplines. I am here as dirmed, but you have dirC (?), the fire brigade director, then you have

dirmed, medical, me; dirpol, police directory; dirlog, logistic directory and dirinfo, representative of

43

authorities but outside for information. Only dirPCops gives information to the authorities. The

information needs to be approved and each half hour goes to the crisis center. You can have the

crisis center for a town, local, it’s communal crisis center, provincial crisis center and here national

crisis center or federal in Brussels.

CG: yes, it’s the same in the Netherlands. And the directors are getting the information from the

people in the field?

LB: yes

LS: and this is for Belgium entirely?

LB: yes. Now the problem is if we have a cross border problem, who communicates with whom. This

is why it’s interesting to meet and to put our hierarchy… but very simple, not one or twothousand

pages, one or two pages. And who can speak with whom.

CG: we when we have the public health hazmat advisor, we advice when there’s a little incident, the

people in the field and when we have GRIP one or two then the tactic level is in the air and then we

advice the number two, the medical director.

LB: what is the translation of GRIP?

CG: I always forget that, it’s the… coordinated regional incident management procedure.

LB: but it’s not specific for chemical incidents?

CG: no, it’s for all kinds of disasters

LB: sometimes of course when we have a company problem in the operating command room we

have 6th man from the company, an expert or director or contact of the company. Because it’s

interesting of course to have a man of the company to say ‘the problem is over there, here is the

architecture and so on.’ But he is only for information for all the directors.

LS: how do you feel disaster management in Belgium is handled?

LB: it’s not bad, but it needs to be improved and the last problems we’ve got, for example, in fact

theoretically we have to wait the official declaration of disaster at level 1,2 or 3 by the burgemeester

or the governor, or the people replacing them. And sometimes this can delay, but in fact on the field

we decide with no problems, but the law asks us to wait the official decision of level 1 and so on. So

we have to improve the information at that level to be sure that we can work freehand, even if we

don’t have the official statement of the governor that this is a disaster. I’m sorry, but we have to

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move faster. So we just have… in practice it is no problem, but theoretically it is not good. No, our

system is not, but what we have to improve is exercise in different situations, because we don’t have

two of the same disaster in the world. All are different, different conditions. Remember, we’ve had

explosions, gunner in December, 125 victims, 60 victims had a wild evacuation, directly into the

hospitals, this is a big problem.

CG: if we could prepare all incidents and disasters, then there wouldn’t be any disasters anymore.

LB: yes, I am sure that we just need a philosophy of management, but we have to put well trained old

people, not young people coming from the schools in the field and let the good sense work. But with

a general philosophy. It’s unnecessary to make large plans with thousands of pages, completely

crazy. Generally in a few pages you have the good summary for e good philosophy for people.

LS: and there are no particular cross border regulations or plans, if something happens cross border?

LB: I think since 20 years there must be, somewhere in a box, in a case of a minister. I don’t know

who, why, where, but I think there will be some regulations. In practice it works well, the 112 center

in liege will give a call to the 112 center in Maastricht ‘we need you’, that works well and that are real

problems. But if you know about a text, just send it to me, it will be funny. I’m sure you will find a

text, from a lot of meetings with good champagne, nice caviar and so on.

LS: I haven’t found anything yet, but I also starting to expand my piece about the Netherlands more.

LB: If you want, I can send you some texts.

LS: That would be great, yes, thank you. I think the most important parts for me are covered now.

LB: sure? Let’s take a look at the questions. *reads questions* can you explain how a risk analysis

works if an incident takes place? Risk analysis is a very big problem worldwide, that’s the reason why

I go to China next month for the platform I told you about and to speak about the same thing and risk

is very different if you speak to an engineer, an architect, a producer, a worker, a fireman, a

policeman and a doctor. That’s 6 different analysis

CG: that is what I mean with a spider in the web, it could be our role to translate the technical results

of measurement to the health interpretation and explain them to the public, which have a total other

perception than we have as professionals. I think that could be an advantage of the public health

advisor hazmat, to be the intermediate between all the different disciplines.

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LB: if you want you are welcome to the congress during the 6th and 7th of June very close to shanghai,

it’s 12 hours by airplane. I will give you the website, if you want to have a look. It’s in Chinese and

English.

CG: I don’t know if I will make it this time, but you said there will be more, then maybe I can make it

next time.

LB: Yes, I will just give you the website.

CG: I think it’s is a really big problem that the different disciplines use different reference values and

to make a good risk analysis, you should choose the right risk values and I think we have a role in that

part of the game.

LB: I suppose you know about Reach and you know about FDS for example or all the books with all

chemical substances and for a doctor it’s funny, because you have a very good chemical description,

fusion point and so on and first help: call a doctor. And the doctor: ‘wow, what can I do?’

CG: that is why we are educated, we learn about all the aspects; toxicological, chemical, you call it

and we try to be an intermediator in that

LB: you think you know about toxicological…

CG: yes, the basic aspect, but you don’t need to know all the details to get to the right persons and to

be that spider

LB: toxicological experience is only bad experience worldwide, but you have two the same

experience, so it’s very difficult. It’s very difficult to make experiments of course, you may not ask to

20 people ‘just take this’ just to see the effects. So it’s very difficult and I’m sure toxicology will

improve during the years, it will become better and better, but until now they generally are too late

to give answers on site during a disaster. After 30 days or 2 months they explain why people are

dying, but that’s too late. My people are on site and ask ‘what can I do? Is it dangerous or not?’

nobody can give an answer directly.

CG: I don’t dare to make a statement that we always can, but the cooperation between the people

and to get the right knowledge from the right people and then you will get an answer very quick, but

then you have to meet each other.

LB: I’m sure, but then you have to speak the same language, not only the same language for example

English, but using the same words, saying the same things with good instrument for communication.

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Your system is not compatible with our system and our system not with the French system. But

communication and information is the key of success, I’m sure.

CG: and we need to trust each other, I mean that when you ask me something, you have to trust that

I give the answer you want and not discussing on the location, that costs valuable time.

LB: I will look at the rest of the questions, just to be sure.

LS:How do you think your country handles HAZMAT disasters?

LB: Very badly, because not enough exercise, I also think last years the ideal in Belgium was nurses

and doctors may not go on contaminated site, may not use uniforms or protections, because they are

not trained for this and so on. I agreed with this until a few years ago. I think that not all, but a part of

nurses and doctors have to train, because if in certain circumstances we will have to work in

dangerous sites that’s the reason why I am in contact with hotzone solutions. I don’t say everybody

has to be trained each month with protection and so on, it’s not possible.

LS: What aspects of HAZMAT disaster management are you personally very proud of?

LB: I am very proud of my ideas, and I just tell you some years ago everybody that heard about me

said ‘he is crazy, completely foolish’ now they begin to change. That is the reason why I am proud of

my ideas. Do you want another example? Speak about the decontamination system. Have you ever

seen a decontamination system?

CG: yes, I did.

LB: a tent, showers, people inside with protection. OK? Communication between people with

protection is zero. Generally they don’t have speaking systems, so it is difficult. There is, if you have a

real disaster, a lot of noise, so they will not speak to each other. Have you seen people nude or with

small clothes entering the tent for the beginning of the contamination?

CG: yes, on a film, not in real life.

LB: ok, I hope you will see in reality with 5 degrees outside and during the night. It’s not easy with

civilian people. and another parameter nobody thinks about, you need liters and liters of water.

Generally we say 10 liters per person, that’s crazy, it’s not enough, it’s 50 or 60 liters per person. So

generally if you have 100ds of people to decontaminate, you need a nice barrack. But what is

interesting, if you really have contamination, of course you remove 80% of the contamination by

removing clothes. But if you decontaminate people, the reason is because they are still

contaminated. The first guy entering the tent, you have a washing system with water generally, it’s

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ok for him. The second person, it’s ok. The third one, the fourth one, the fifth one enters with no

protection, no respiratory protection, he enters an aerosol of contaminated substances and this

person will go back directly, because he will contaminate these people. more than before they enter

the tent. Did you think about that?

CG: no, this is a very good lesson

LB: so I am proud of my ideas, I have nothing to prove, very soon I will be retired, my career will end

in about 5 years. I am not searching to win a Nobel price or to be the head of anything. So I can speak

about my ideas with no problems. I don’t want to win a price or something.

CG: your ideas are proving themselves.

LB: yes. I just hope that my ideas can make other people think and that we can meet and speak

together, that we say oh, this is right or we have to correct this and this and we find solutions

together.

LS: On what areas of HAZMAT disaster management could there be done more?

LB:On training and decontamination in front of the emergency rooms of hospitals. I am sure to

decontaminate on site is crazy, because of the time and the wild evacuation. But I think all hospitals

an surely big hospitals must have decontamination system/tent to block these people before they

enter the emergency rooms. Outside but with light and warmth to decontaminate gently 10 or 20

people, because they will arrive like this.

CG: I once heard a presentation at a congress, a Belgian hospital has built such a decontamination

room, probably Genk, can that be?

LB: yes, but very few, too few hospitals have that. If you have an accident here, people will not walk

to Genk. I will show our decontamination room for one person. And because we are the hospital for

nuclear central, and decontamination rooms just for one person, but very slow. We need more, but

that will probably next year. I think all hospitals should have a decontamination system, even if the

system is very simple, they will have great benefit in doing this.

LS: Is environmental monitoring during and after major chemical incidents legally regulated in you

country?

LB: Theoretically yes, but in practice not really.

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LS: Who are the national competent authorities supervising environmental monitoring in case of

major chemical incidents in your country?

LB: It’s the ministries and they have consultants, but it’s not well organized, it’s not sufficient for me

and it’s not rapid. But it’s better than 10 years ago, each year it gets better and better.

LS: do you expect any misinterpretation of shared data? What would be the main reason for this?

LB: Yes! Because we don’t speak the same language, we don’t realy have the same procedures, the

same names for the same thing, so the reason to meet to put our systems and the german and

French system parallel to say ‘this is this, this is that’ just like a dictionary and the most important,

everyone must have the dictionary. Not only the ministers.

CG: no, it would be nice if it is compact and pragmatic and you can put it in your pocket.

LB: yes, very simple, maximum 3 or 4 pages. I am a fan of the 1 page protocols, they are the best.

LS: are there official arrangements on cross-border collaboration in case of major chemical incidents

in place in your country?

LB: I think so, but very secret, only with the people the same with champagne and caviar and so, but

if you ask people from my department if they know about this, they will say no, but they are the

people on the field, the ministers not.

LS: give example of disaster close to borders, what happens?

LB: I can give you examples, I don’t have my presentation, but I can send you. In 2000 you have a

train with wagons with different kinds of chemicals coming from Holland. You know the company

DSM?

CG: that is the chemelot site.

LB: the train falls and the management went completely crazy, not from DSM, but our firemen and so

on. And I took pictures and the pictures had a very deep impact the next weeks, because I proved

‘oh, you worked there, everything was ok?’ ’yes, everything went well!’ ‘take a look…’ 20 people with

only their white coats, 2 meters from the wagon with acrylonitryl dripping out of it. And during all the

phase of re-establishing the wagons and so on, firemen had very light clothes and so on. Take a look

at the pictures. It was twelve years ago, in the past. Since this problem everything got better.

LS: how does it work if you have different emergency services from different countries at the incident

site?

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LB: it’s difficult..

CG: with the shooter in December I had some stories about that there were Dutch ambulances on

site, but there were nurses and they weren’t allowed to save victims and I think that is the point you

make, you know that our nurses are well educated and can do the job, but the people at the site at

that time didn’t know that.

LB: but in fact ministers with caviar and champagne know since years and years that we have some

differences, but these differences are very few and can be summarized in one page. We just have to

say ‘ok, don’t have to meet 10 times with champagne and caviar to say this.’ We can just write down

for example nurses from Holland are able and authorized to do this and this and so on. Of course this

is a problem for the ministers to say ‘oh, our laws are different, but in a disaster we accept the help

of Holland with their way of work.’ One line! They don’t need to meet 20 times for this! And you will

have it all in one page! I know that it is different in Belgium if I want to send a victim to AZM in

Maastricht, it is not possible, just like in our country, when we give a call and say the patient will

come in half an hour, in Maastricht they won’t accept. But it is a problem for the ministers to say ‘oh,

in disasters we all work the same way and we do not have to accept everything that is done and we

dispatch and we send directly and the hospital in Maastricht is obliged to accept the victim. This is

not my problem. My problem is I try to send the victims first to Belgian hospitals of course, but if

there’s not enough hospitals, I don’t want to wait hours and hours to wait for the acceptance of

hospitals in Eindhoven, paris and so on. This is the problem with the ministers and I thought last

years that the meetings with champagne and caviar were focused on this problem and that we would

have a summary of one or two pages. But do you know about such a summary? No. why? Because

champagne and caviar are very expensive. And I wait for the summary. If they continue to meet with

champagne and caviar with no result, they don’t have to expect that I will continue to meet for

nothing. I am a soldier in the field, not of ministries or buildings. I think I have been clear for you.

LS: are there arrangements for data exchange with neighboring countries?

LB: no.

LS: do you feel that there is a need for more cooperation in the EMR on HAZMAT disasters? Why?

LB: yes! To speak the same language and to have this summary of our ministers. I can put on one

page the real questions and I give you and I ask my ministers and you ask your ministers and the

German ministers and I just want them to put yes or no as an answer. This is just one meeting, one

bottle of champagne, no more.

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LS: how do you see disaster management in case of HAZMAT working in the future?

LB: Better and better.

CG: are you interested in the project and if so, would you like to work with the project?

LB: on the field we need anwers to very simple questions and we pay our ministers to give answers

to these questions. What I expect from EMRIC+ is to say ok, now we meet these ministers so we

don’t have to lose any more time. Please mister or misses minister, answer our questions, because

maybe this afternoon a cross border problem will happen and we need the answers since years and

years, and we don’t have them.

CG: yes, that’s a good point you make. And from the public health hazmat part of the project we are

just in the beginning phase and hopefully we will get more results and I think that this meeting for us

is more result already.

LB: but to conclude with a positive speech; each time we’ve had a problem in Belgium and I was on

site; explosion of gasses in heimaten, very close to Aachen, but in Belgium. Very rapid, excellent help

from helicopters from Germany. The problem with the train in visé, cross border, dsm director on

site, there were problems with our staff, but not with Holland. Explosion in coqruilles in liege, 16

burn victims, 2 dead and 1 call from the 112 center from liege to Maastricht, directly ambulances and

helicopters from Holland. The problem with guilland giere (?) gas explosion close to the north of

France, in Belgium. Big help, directly, no problem with just one call to France. Professor Goldstein

from Lille came with 30% of their material and people from France directly. The problem in Liege

with the shooter in December, one call and directly ambulances came from the Netherlands, so we

know that in practice nobody had any problem because they did this, no, they are very happy to have

helped and very little problems on the field. But it is better to have the approval of the authorities

saying ok, just 1 call and we will do this and there is no problem for anybody with the laws and so on.

CG: I want to thank you very much for your time and I am very interested about the information

about the congress and so on.

LS: yes, thank you very much, this was very useful for me.

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Appendix 2 – transcript interview Michel Moors

Civil protection expert

May 10th, 2012

MM = Michel Moors

CG = Cindy Gielkens

LS = Lisanne van der Schors

Transcript interview Michel Moors

LS: ik wil eerst graag wat basic information over Belgie vragen. Kunt u een soort van beeld schetsen

van wat er zou gebeuren als er een groot incident met schadelijke stoffen is. Wat gebeurt er in

Belgie, bijvoorbeeld in Nederland hebben we het GRIP systeem, hoe zit dat in Belgie?

MM: in Belgie is dat echt moeilijk op het moment. We zijn op het moment vooral bezig met de civiele

veiligheid, vroeger was dat the civiele bescherming, nu de civiele veiligheid. Wat zit er in de civiele

veiligheid, bijvoorbeeld de brandweer en de civiele bescherming, de civiele bescherming heeft niks te

maken met de brandweer, wat hebben ze nu veranderd? Ze hebben een reorganisatie gedaan, ze

hebben zones gemaakt van de brandweer. Luik is dan bijvoorbeeld zone 1 in Luik is de brandweer

van Luik, van Warem (?) van verschillende brandweercorpsen tezamen en vroeger als Luik dan een

speciale wagen nodig had, werd de civiele bescherming opgeroepen. Wat doen ze nu onder elkaar,

als ze bijvoorbeeld een nieuwe CBRN wagen moeten kopen, dan zeggen ze bijvoorbeeld we kopen

dat voor zone 1 en dan blijft hij in zone 1. Als er een groot incident is, wat gebeurt er, de mensen

bellen dan de 112 centrale, dan komt de brandweer aan, die hebben meet apparatuur, maar dat is

niet echt hi-tech. Dan zullen ze zeggen ‘oei, hier hebben we een probleem met CBRN’ dan zal de

civiele bescherming worden opgeroepen, want we hebben speciale meetgroepen. Net zoals Hartmut

heeft, we hebben ook speciale meetapparaten voor alles wat we kunnen meten, dat zal zo gebeuren.

Wat zal er automatisch gebeuren, the witte colonne zal worden opgeroepen, je hebt de rode, de

witte en de blauwe en iedereen zal dan in alarm gedaan worden. Maar ik weet niet of wij bij ons

gespecialiseerde mensen hebben bij de geneeskundige kant om erbij te komen helpen, ik denk het

niet. Dat is zo’n beetje onder mekaar spelen, ik weet dat meneer Bodson daar mee bezig houdt, en er

is nog een andere dokter in ... die houdt zich een beetje bezig met CBRN, het heeft niet dezelfde

optiek als meneer Bodson. In het algemeen wie gaat er, politie, brandweer en civiele bescherming.

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Wat zal de civiele bescherming doen, ze hebben nog een officier daarbij, en er zal ook een

commandocel worden opgebouwd en in de commandocel zal ook een specialist zijn die in CBRN

gespecialiseerd is, een officier en die zal dan ook kunnen zeggen ‘OK, dat is dat product en dat zullen

de gevolgen zijn voor de mensen’ en dan zullen ze raad geven mevrouw renaars bijvoorbeeld. In het

algemeen gebeurt dat zo.

CG: en via mevrouw Renaars wordt het dan ook gecommuniceerd naar de bevolking?

MM: nee, dat is nog anders. In België... het is spijtig dat dat in het Frans is, ik heb het niet in

Nederlands. We hebben disciplines in België, 1, 2, 3, 4 en 5. 1 is de brandweer, 2 is de geneeskunde,

3 is de politie, 4 is alles wat logistiek is, de civiele bescherming, het leger en 5 is meneer thierry

brasseur, dat is alles wat communicatie betreft. En dat is ook iets wat we met de EMRIC groep, wat

we met Hartmut willen doen, dat bijvoorbeeld de informatie zoals die in Duitsland gegeven wordt,

dat die hetzelfde is als in Nederland en België. Dat is ook een beetje het probleem, dus wat gebeurt

er, het crisiscentrum wordt geopend bij ons in Luik, iedereen komt daar rond de tafel zitten, dus de

specialiteit van detectie dat is de civiele bescherming, die geeft dan informatie, ze krijgen dan

informatie binnen, dat is het product en wij moeten dan die gegevens aan mevrouw renaars

doorgeven. Zo gebeurt dat.

CG: en zo’n situatie dat de klachten niet overeenkomen met de stof, of er alleen maar klachten zijn

en niet bekend is wat er is.

MM: dat heb ik nog nooit meegemaakt in het crisiscentrum, ik heb altijd meegemaakt dat met een

speciaal product bijvoorbeeld een ongeval met een trein, de politie komt dan, die voelen zich niet

goed, dat wordt doorgegeven aan de brandweer, de brandweer komt dan met meetapparatuur en

die vinden dan het probleem, dat er niet genoeg zuurstof is ofzo. Die willen dan bescherming

oproepen, en ze komen dan met ons speciale apparaten aan. Het product wordt dan geïdentificeerd,

dan halen we zo’n affiche eruit. Maar wat we ook kunnen doen vanuit de brandweer uit Zwitserland,

daar kunnen we een privaat bereel bellen, daar hebben ze experts die kunnen we ook altijd bellen.

Maar wij geven de gegevens dan door aan de geneeskunde.

LS: oké, en zijn er ook verschillende manieren van handelen binnen Vlaanderen, Wallonië en de

Duitstalige gemeenschap?

MM: normaal gezien niet, waarom niet, omdat, dat is juist het mooie, de brandweer is regionaal, dus

dat hangt van een dorp, van een stad, van een provincie af. Vroeger was dat per stad, dus de stad

Luik had haar eigen brandweer. Nu hebben ze daar een vereniging van gemaakt met verschillende

gemeentes. Nu hebben ze eerst gezegd we willen dat provinciaal maken, toen zeiden de gemeentes,

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nee, waarom zou je dat provinciaal maken, ik heb mijn mensen, dat blijven mijn brandweermensen

en er zijn veel vrijwilligers bij. Toen hebben ze gezegd oké, dan gaan we zones maken, maar dat blijft

nog altijd provinciaal, gemeente. Maar de civiele bescherming, dat blijft nog altijd federaal, dus wat

wij in Chris nee doen, wordt ook in liedekerken gedaan. Het enige verschil is dat in brasschaap nog

altijd de mensen van de Nederlandse brandweer worden opgeroepen, dus de specialisten voor geval

van gevaren. En daar hebben wij in Luik de reactietijd niet voor om dat te doen. En ik denk dat dat

het probleem is omdat ze het product EMRIC+ nog niet kennen. En ik denk dat op het moment dat

we het EMRIC+ project goed kennen, dat dat in orde is en dat dat goed werkt, dat er een

overeenkomst is, dat is ook een beetje bij mijn werk nu, ik ben nu bij de THW in Luik, dat is

tegelijkertijd ook andere zaken die er dan bijkomen. Maar we werken helemaal zo nu. Hetzelfde wat

in Luik gebeurt, gebeurt normaal gezien ook in Vlaanderen.

LS: en hoe gaat de communicatie van data van wetenschappelijk tot de praktijk, hoe is dat,

bijvoorbeeld nadat alles gemeten is?

MM: de gegeven hoe die terug binnenkomen en hoe die verwerkt worden, hoe gebeurt dat? we gaan

ter plaatse meten, dat heb ik vroeger gedaan in mijn jonge jaren, die gegevens worden dan naar onze

commandocentrale gestuurd, in Chris nee dan. Daar hebben we een officier of een onderofficier die

gespecialiseerd is in CBRN en die gaat die gegevens analyseren. Dan wordt een rapport opgemaakt

en dat rapport gaat dan zo snel mogelijk naar het crisiscentrum, die gaat dan naar de kolonel toets en

hij krijgt die gegevens binnen en dan gaat hij die gegevens dan nog een keer nakijken en die worden

dan op kaart gezet en die gegevens worden dan verder verwerkt.

CG: wij hebben bijvoorbeeld de voorlichting richtwaarde, alarmering grenswaarde en de

levensbedreigende waarde voor op het incident qua concentraties.

MM: ja, dat doen wij ook.

CG: dezelfde waarden?

MM: nee, dat hangt van ieder land af, ik heb een oefening gedaan met Europa. Dat is het probleem,

ik weet het echt niet, dat moet ik eens nazien met Hartmut, dat gaan we eens goed nazien. Dat ga ik

van de namiddag navragen aan Kolonel Toets wat onze waardes zijn, bijvoorbeeld in radiologisch

bereik, hoeveel microcifers mogen wij hebben, Ik denk dat wij er maximaal 50 mogen hebben in een

keer en in sommige landen mag het 20 zijn. Bij 50 moeten mensen hun akkoord geven, normaal

gezien is het 20. Maar er zijn landen waar het minder is en waar het meer is. Dat is ook een probleem

bij grensoverschrijdende interventies. Daarom is er ook een discussie met hartmut en met andere

mensen om te zeggen wie het bevel moet voeren. Er moet iemand van het land bevel hebben van de

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interventie, maar een officier van bijv. België die naar Nederland komt, maar een officier mag alleen

bevelen geven aan zijn eigen mensen,want hij weet wat hij mag. Dat is het grote probleem denk ik.

CG: en ook opzich heb je het letterlijke taalverschil, dat vind ik ook wel een hele belangrijke. Los van

het Nederlands, Engels, Duits, de taal in het veld. Als wij andere grenswaarden gebruiken dan Belgie

en Duitsland, dan heb je het verschil.

MM: dat is ook een beetje het probleem met Emric, Emric moet dat gereed krijgen.

CG: ja, precies, ik denk dat dat een van onze doelen moet zijn, dezelfde taal spreken in het vakgebied

MM: ik ben op iets aan het werken bij ons, dat is in Chris Nee zelf, ik ben een nieuwe groep aan het

opbouwen daar en dan heeft de kolonel gevraagd, zo’n task team, technical assistance support team.

Dus die mensen zijn nu 4 maanden een opleiding aan het doen op het moment, ik heb er zeker 2 jaar

voor nodig voor die mensen goed zijn. Ik heb dat wel geleerd. Dus al die informatie wordt

automatisch op een kaart ingegeven zoals jullie al doen in Nederland. Dus we weten dan die mannen

gaan daar heen. We hebben contact gehad met mensen uit Israel, die hebben gezegd hoe doen jullie

dat in Belgie. Ik zeg dat die man zoals een sigaar. Dat is niet juist zegt die Israeli, dat is zo in een veld,

maar niet in een stad. Toen heeft die man een website gegeven en een wachtwoord, het is wel in het

hebreeuws, maar je kunt wel naar de plaatjes kijken, maar die doen dat in een rechthoek. Hij zegt de

wind in de straten dat is niet zoals een sigaar, de wind verandert. Hij gaf een heel ander beeld en hij

had daar gelijk in. Dus in de toekomst kan die groep dit soort werken doen. Die gegevens gaan

automatisch, neem aan dat er iets speciaals gebeurt in zeldewaard, dan worden er 2 mensen

ingestuurd en die mensen die doen alleen maar kaarten gereed maken, informatie nemen en die

doorgeven. Bijvoorbeeld de gevarenstoffen en de symptomen automatisch op kaarten ingeven. Dus

als de kolonel van Luik of de civiele bescherming of de burgemeester kan die informatie krijgen.

CG: en die houden dat ook bij in de tijd, dus als er iets verandert dan...

MM: ja ja, die zijn daar ter plaatse, dus een ploeg is ter plaatse en een in het crisiscentrum en als de

GSMs niet meer werken, dan gaat het over de satelliet. Mensen zullen ook altijd communicatie via

internet krijgen. Ik wist zelf niet dat dat bestond, maar met astra 2, ik heb daar testen mee gehad en

dat werkt perfect.

CG: en toen ik gister bij een overleg zat, hadden ze ook zo’n computer model zoals jij net verteld

hebt, bij chemelot, de DSM fabriek. Vanuit mij gezien, als je vanuit gezondheid daarnaar kijken wat

dan nog mooi zou zijn is als je de klachten kunt invoeren. Dat kon daar nog niet, maar dat zou wel

mooi zijn, dan kun je meteen kijken of de klachten wel overeenkomen met de stoffen. In een crisis is

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er natuurlijk heel weinig tijd om dat dan ook nog eens een keer te doen, maar dan zie je ook komt de

wolk die we berekenen ook overeen met de klachten die we krijgen en dan kun je al die lijntjes in een

oogopslag zien.

MM: dan willen we ook de tactische tekens weer naar boven brengen. Dus dat is een

gevarendriehoek met mensen die zijn geëvacueerd, want in het algemeen wat doen we, we tonen

een kaart met daarop de troepen en dan begin je met het overzicht. 72 mensen zijn daar, 80 mensen

zijn daar, maar dat kun je niet gemakkelijk op een kaart zetten. In Duitsland gebruiken ze nog altijd

de tactische tekeningen en die ben ik nu aan het ombouwen naar de Belgische civiele bescherming,

maar de tekeningen zijn hetzelfde. Dus als een Duitser of als die hier in Nederland dat ook

bestuderen, dan zeggen we, we weten dat een vierkant of een rechthoek of een cirkel is, die kleur

dat wil zeggen dat is brandweer, die kleur is politie, die kleur is civiele bescherming of THW of zoiets.

En dan kunnen we zeggen dat teken met 20 erbij, dat wil zeggen dat er 20 mensen geëvacueerd zijn.

Dan kunnen we op die plaats dat product aangeven, we kunnen er ook tekeningen in maken en dan

kun je dadelijk op een kaart de volledige situatie zien. Dat is een beetje voor begin volgend jaar, dan

moet dat in orde zijn. Dat is ook de communicatie dan, het probleem dat ik gemaakt heb tijdens

verschillende interventies, we hebben astrid, de brandweer heeft een folder die ze gebruiken die ik

niet heb. Dus dan slechte communicatie en wat is ook communicatie, spreken, dat kan een probleem

zijn, dan kun je het niet zien, maar als je een beeld door zou kunnen sturen, dan gaat dat veel sneller.

Dus de ploeg heeft ook een fototoestel met GPS en een elektronisch kompas, dus ze nemen een foto

en automatisch, dat is allemaal gratis op internet, allemaal mensen die bij de brandweer geweest zijn

hebben dat uitgevonden. En dat heet Georef en dat geeft je de hoek waarin je de foto genomen

hebt, en de plaats waar je hem genomen hebt. Dat is automatisch, je moet gewoon het kaartje in je

computer steken en dan gewoon dat beeld met print screen doorsturen. En dat gebeurt zo.

CG: voor de beeldvorming is dat handig.

MM: ja en ik heb nu de prijzen gehad en dat kost zoveel niet. Ja, wat is 100 euro tegenover 20000

mensen die in de problemen zijn, dat heb ik ook tegen kolonel Toets gezegd. Het probleem met

communicatie is nu dat de brandweer heeft nu wel in geval van catastrofe dezelfde folder. Dan

moeten we weer een groep veranderen en die moet ook naar dezelfde folder gaan. Dan kan de

brandweer van Luik en de civiele bescherming van Luik en de brandweer van een andere plaats,

kunnen we allemaal tezamen gaan.

CG: oké, een soort LCMS..

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MM: ja, alleen het probleem is, we spreken dezelfde taal af en toe niet. De brandweer zegt a vous of

a toi, normaal gezien is dat over, wacht is wait. En dat is een beetje verloren gegaan en dat zijn we nu

weer een beetje aan het opbouwen. Dus als ik nu met iemand uit Duitsland spreek, ja in Duitsland is

dat sprechen, dat is ook niet wait en over en al die zaken. Dus dat is een beetje ook aan het

opbouwen. Dus een groot probleem is dan wel die communicatie.

CG: als je met zo’n tekening kunt samenwerken, met visualisatie ben je al goed op weg.

MM: ja, dat gaat heel snel. Normaal gezien gaat dat, in de EU bestaat dat, dat heet een task team.

Die hebben een koffer, zo’n grote pelikanenkoffer en als een team naar het buitenland gaat, het

maakt niet uit waar, in Pakistan of China. Ik moet naar Brussel telefoneren, het probleem van die

man is kunnen bellen met spreken. Dat team moet iets kunnen geven waar je mee kunt bellen, dat is

satelliet of internet of GSM, dat is zijn probleem, hij moet spreken en de ander moet dat geven en

dat zijn we ook aan het opbouwen. Dus als er iets gebeurt gaat dat team erheen. Dat nu een

brandweerman mij dat vraagt. Ik heb er met meneer fanuel over gepraat, die werkt op de

alarmcentrale in Luik. Die heeft tegen mij gezegd, als jij mij dat kunt geven, dat ik op ieder moment

internet heb, dan zul je iedere dag op interventie gaan, omdat zij de mogelijkheid niet hebben. Het

voordeel daarvan is dat we gespecialiseerde mensen hebben, dat is hun beroep.

CG: en dat is bij de civiele bescherming?

MM: dat zijn vrijwilligers.

LS: Wat vindt u goed aan hoe Belgie incidenten met schadelijke stoffen afhandelt, wat zou Nederland

van België kunnen leren?

MM: ik denk dat België eerder dingen van Nederland zou kunnen leren.

LS: ja, maar misschien zijn er sommige gebieden waar Nederland wat van zou kunnen leren.

MM: Sommige materialen en nieuwe technieken omdat we iets nieuw aan het opbouwen zijn. Dus

wat was de civiele bescherming vroeger? Hetzelfde als de Nederlandse civiele bescherming voor de

koude oorlog. Toen is de koude oorlog een beetje afgebouwd geweest en toen hebben ze gezegd

wat kunnen we nog met de civiele bescherming doen? Dat wil zeggen we waren met 9000

vrijwilligers in ’81, we zijn nog 1300, dat is niet meer reëel, reëel is dat we nu zijn met minder dan

400, dus dat is echt goed afgebouwd. Dan hebben ze nog gezegd dat we toch een civiele

bescherming nodig hebben, want de brandweer is van de snelle opdrachten, de civiele bescherming

is meer in tijd. Dus dan moeten er meer mensen zijn zoals de THW in Duitsland. Dus dat is een beetje

op elkaar gericht. Wat is er gebeurd, nu hebben ze gezegd dat sommige opdrachten alleen voor de

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brandweer zijn. Alles wat snelle redding is, is brandweer, alles wat brand is, is brandweer. Alles wat

lange opdrachten zijn op lange termijn of gespecialiseerd, is de civiele bescherming. Dus CBRN,

schadelijke stoffen zal de civiele bescherming dan doen. Dus ze zijn het aan het opbouwen, met dat

opbouwen zijn er mensen die les hebben, die naar scholen gaan. Wat ik persoonlijk vind is dat er een

lijn is getrokken in België, zo onder Voeren en die gaat zo langs de taallijn door. En dat voel ik echt

goed, want Nederlandstaligen die gaan meer naar Nederland toe, Franstaligen meer naar Frankrijk.

En dat heb ik tegen de officier gezegd, luister, in Duitsland hebben ze iets moois om de analyses mee

te doen, en dan zegt hij, maar in Frankrijk... ik zeg, ben je weer met een paard onderweg? Dat

bekijken ze maar aardig. ‘maar Michel, wij spreken geen Duits’ ik zeg, ik wel. En we spreken Engels,

zij spreken Engels. ‘maar wij spreken geen Engels’ ik zeg ga naar school. En dus wat ik wel vind is dat

die zijn zaakjes aan het opbouwen en dat modern materiaal, dus materiaal dat nu wordt aangekocht

is ultra modern. En daar wordt ook veel scholing in gegeven, maar ik volg dat echt niet meer op, dat

moet ik een beetje meer aan een officier vragen. Vroeger hadden we ploegen, detectieploegen en

dan hadden we 2 keer in de maand les en dat was vooral gericht op oorlog, niet op dagelijkse

gevaarstoffen, dat was voor de brandweer en nu gaat alles naar de civiele komen. Maar ik denk nu

wel dat België kan meer leren van Nederland. In de contacten die ik nu heb met Emric, dan zie ik

toch dat Nederland verder is. Niet dat als er iets gebeurt in België, dat we het dan niet aankunnen,

we kunnen het wel oplossen. Maar er zijn andere zaken die ik hier veel beter vind dan in Duitsland.

LS: en wat denk je dat speciaal verbeterd zou kunnen worden aan het systeem in België

MM: hoe zeggen ze dan, zoals Hartmut kunnen binnenkrijgen, dat is AGS, dat hebben we bij ons niet,

dat bestaat niet. De officier bij ons die doet alles, die doet brand, die doet hoog water, die doet alles.

Dan moet daar nog CBRN bij komen, ik vind dat dat niet mogelijk is. Dat moet zijn job zijn, alleen dat

doen. Ik ben ook voorzitter van de vrijwilligers en ik heb ook contact met de algemene directie en ik

moet een project binnen leveren voor het eind van december om een voorstel te doen en een van

mijn voorstellen zal zijn om burger mensen, dus specialisten die bij een chemisch bedrijf werken

aannemen als officier bij ons, maar als expert, dus die kan alleen opgeroepen worden als er

problemen zijn met gevaarlijke stoffen. Hij trekt een uniform aan met veel sterretjes erop, want

anders luisteren ze niet naar hem, maar hij mag geen bevel geven, alleen advies. En dat zal een

beetje meer in de toekomst zijn en ook veel meer gespecialiseerde mensen.

CG: dat zie je in Nederland ook, die mensen werken heel ergens anders en die draaien mee in zo’n

pool en op het moment dat ze dienst hebben en er is iets met gevaarlijke stoffen, dan komen die in

actie.

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MM: dat gaat nu gebeuren bij ons. We zullen ploegen opbouwen alleen met vrijwilligers, die alleen

dat zullen doen, dus die zullen echt gespecialiseerd worden.

LS: oké. Weet u nog van speciale wetgevingen op dit gebied?

MM: die zijn ze aan het veranderen heb ik gehoord. Er bestaat een wetgeving van seveso, dus die

fabrieken waar de problemen zijn en ik heb gehoord dat de zaken aan het veranderen zijn voor

bijvoorbeeld terroristen. Dat is een nieuwe wet die uitgekomen is, ik heb die nog niet gezien. Ze

hadden gevraagd of ik daar aan mee wilde werken, maar ik had geen tijd, dus bij ons is er een officier

heengegaan. Ik weet niet of die wetgeving al uit is, maar daar was iets speciaals aan de hand.

LS: oké, wat ik van meneer Bodson hoorde was dat er vaak veel regels en wetten zijn, en dat door die

regels mensen belemmerd worden in hun snelle handelen, dus als zij zich echt aan al die regeltjes

zouden houden, dat het dan te langzaam gaat.

MM: Dat zijn regels... bijvoorbeeld in België mag een dokter geen antigasmasker dragen, geen

gasmasker, want als je een gasmaker opdoet, dan sterf je. Die mogen dat niet dragen, dat is

verboden en ook in België mag een geneeskundig team nooit de rode zone binnenkomen en ook in

de decontaminatie tenten zullen we nooit een dokter binnenkrijgen omdat die niet getraind zijn en

dat is een probleem met wetgeving en daar ben ik ook wel een beetje voor aan het vechten sinds

jaren en dat zal ik nooit gereed krijgen. Misschien zal ik daar met Geert Gijs eens goed over spreken,

maar het probleem is ook, daar zijn verschillende ministeries binnen. Het ministerie van

binnenlandse zaken en in dat ministerie zit ook nog de brandweer, de civiele bescherming en de

politie. Daar zijn altijd bazen boven, die willen dat en die willen dit. En niet alleen dat, dan is er ook

nog geneeskunde, dat is volksgezondheid en dan wordt dat een beetje concurrentie van elkaar. Ik

mag die niet op z’n tenen trappen want dan gebeurt dat. dan hebben we nog het leger, defensie die

er nog bij wordt genomen. Ik vind dat een beetje veel. Er is een die kan zeggen ‘nu ben ik de baas’ en

dat is nog niet gebeurd. Daar heeft meneer Bodson wel een beetje gelijk in, hij heeft veel ideeën,

speciaal af en toe met een helikopter daar, oeh.

CG: hij had het ook speciaal over alle shows die gegeven worden, ook met het decontamineren. Altijd

heel mooi, maar wat er in de praktijk daadwerkelijk verbeterd is, dat is werkelijk nul.

MM: het probleem van de praktijk is vaak dat we een oefening moeten maken, maar met een

oefening moeten we mensen hebben die willen spelen en dat zijn niet burgers die dat moeten

spelen, maar mensen zoals ik die slachtoffer moeten spelen. En de problemen zijn logisch. Kijk maar

naar wat er in Tokio gebeurd is, net zoals in Londen in de tube, mensen wachten niet tot dat de

brandweer daar was.

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CG: ja, dat was zijn punt ook.

MM: in Frankrijk die hebben dat al gezien, die hebben in elk ziekenhuis ongeveer de SAMU daar. Dat

is service d’aide medicale urgente. Dat is de MUG ongeveer. Dus ziekenwagens met dokters en die

zijn allemaal getraind, die mogen ook met antigasmasker werken en die mogen ook in de rode zone

gaan. Die zijn ook getraind om in ziekenhuizen decontaminatie te doen. Dus in de aankomsthal van

de ziekenwagen is al voorzien van decontaminatie, die moeten gewoon nog het plastic in orde

brengen, maar de douches zijn er al en die zijn daar wel voorzien.

CG: dat was zijn punt ook heel duidelijk, decontaminatie bij de eerste hulp en bij de ziekenhuizen,

want daar gaan alle mensen naartoe, die wachten niet.

MM: nee, die wachten niet op de brandweer of de politie. Wie zal er eerst aankomen? De politie en

die is dan ook al besmet. Dan komt de ziekenwagen aan, 9 van de 10 keer is de ziekenwagen eerder

dan de politie. En die nemen dan mensen mee naar het ziekenhuis, dan is het ziekenhuis besmet en

zo kun je nog wel meer scenario’s bedenken.

CG: Dat is wel interessant, misschien voor jou ook wel, dat je iets meer met decontaminatie doet,

daar zijn bepaalde regels voor. Een slachtoffer dat besmet is, kan bepaalde hulpverleners besmetten,

dus daar zijn hele protocollen voor, maar inderdaad wat meneer Bodson zegt, het staat heel mooi op

papier, maar in Praktijk gaat het allemaal niet zo goed.

MM: zelfs op papier is er nog niks geschreven.

CG: bij ons dan in Nederland. We hebben het wel heel mooi op papier staan dat hulpverleners wel in

de warm zone mogen omdat daar in principe de slachtoffers al gedecontamineerd zijn voor 80%, ze

hebben de kleding al uit en ze staan boven de wind. Dus op zich is dat een redelijk veilig gebied en als

ze dan een bescherming opbouwen, kunnen ze daar best wel handelen, maar bij ons willen ze dat

niet omdat ze bang zijn. Op papier ziet et er heel mooi uit, dat we zeggen het is veilig, jullie kunnen

erin, maar de mensen durven dat niet. Daar moet nog kennis en opleiding bij komen.

MM: en vooral de contacten, want ik heb contact met de europese lessen daar en iedere keer komt

dat op tafel. ‘wat is uw specialiteit?’ ‘ja, decontaminatie’ ‘ah, hoe doen jullie dat dan?’ ‘wij doen dat

zo’ daar zijn landen die werken heel anders dan ons. Ik denk dat het land in Europa dat het beste

voorbereid is, is Frankrijk. Ja, Frankrijk en Noorwegen, Zweden, Denemarken, die zijn echt goed

voorbereid. Dat is ook altijd... hoe doen we dat? Meneer Bodson wil dan de wagen nemen en dan

kleren uit en die op de weg gooien en dan wegrijden en dan als ze aangekleed zijn... ik zeg ‘oei oei oei

oei’. Nee, je kan dan wel zeggen van zou het gebeuren.

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CG: in een crisis gebeurt het dan toch altijd wel net iets anders dan hoe het in theorie gaat. Maar

toch wel goed dat daar over nagedacht wordt.

MM: ja, dat wel. En Canada en Amerika zijn ook goed voorbereid, en Engeland, die zijn ook zeer goed

voorbereid, die Engelsen. Daar ben ik verwonderd van, dat is ook, die hebben nog geen keer een

probleem gehad.

CG: nee, maar dat komt vast nog wel.

LS: maar als er iets is, dan zijn ze voorbereid.

MM: nee, dat zal nooit gebeuren.

CG: laten we dat hopen.

LS: dan heb ik nog een paar vragen over grensoverschrijdende hulp. Weet u of er officiële

overeenkomsten zijn op het gebied van grensoverschrijdende samenwerking?

MM: nee. Ik heb dat gehoord, de overeenkomst van Mainz, van Koblentz. Dat wist ik ook niet, daar

heb ik de laatste hoge venen brand interventie, toen hadden we helikopters nodig van de Duitsers en

dat was zo’n groot probleem. Toen hebben we een keer gereed gekregen dat we die helikopters

mochten krijgen op basis van dat verdrag. Een andere overeenkomst, ik denk... nee, dat zijn meer

mondelinge overeenkomsten, geen schriftelijke overeenkomsten. De enige schriftelijke

overeenkomst, dat is met de THW, de brandweer van zuid limburg, noord limburg, de

brandweerkazernes die daar aan de grens bij nord rein west falen zitten, die hebben daar een

schriftelijke overeenkomst, dat weet ik. Die heb ik wel thuis staan, maar dat is mijn job om dat nu

voor België ook gereed te krijgen, maar echt schriftelijke, dat weet ik niet.

LS: ik weet zelf dat er wel een paar zijn, bijvoorbeeld die van Madrid.

MM: ja ja, maar ik denk meer nu over Belgie en wat daar bestaat, maar dat Europese, dat ken ik van

buiten. Euregionaal, ja, ik weet dat er soms een mondelinge overeenkomst is tussen de brandweer

van Eupen en van Aken, maar echt schriftelijk op papier, nee, dat denk ik niet.

LS: en heeft u ook een voorbeeld van iets dat dicht bij de grens gebeurt is en hoe is er dan

gehandeld?

MM: ik heb er meerdere, de hoge venen bijvoorbeeld, die brand. Dat was een dennenbrand, de hoge

venen in Belgie, en dat is echt speciaal, want dat gaat tot diep in de grond, tot 2 meter diep in de

grond en dan moet wel snel ingegrepen worden. Daar waar ook Nederlandse brandweermensen die

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paraat stonden of die zijn misschien gekomen. Hoe gebeurt dat dan? Dat gaat naar het crisiscentrum,

sommige fasen zoals de hoge venen, die worden automatisch door het crisiscentrum geholpen waar

meneer faurait, de gouverneur komt. Ik heb het geluk of de pech gehad om daar bij te moeten

komen. Ik heb echt de beginfases gezien. Hoe gebeurt dat? er wordt contact opgenomen met het

crisiscentrum en er wordt een commandocel opgebouwd ter plaatse. Alles wordt gezamenlijk

besproken. De officier ter plaatse mag sommige bevelen dadelijk uitvoeren, andere bevelen worden

door de gouverneur gedaan. En toen heb ik gehoord dat ze meteen de brandweer van Aken hebben

opgeroepen, want Aken heeft dan Herzhogenrat die dichterbij zijn erbij geroepen. En wie is daar dan

nog bijgekomen? De THW, de politie uit Duitsland en Nederland. Wat heb ik nog meer meegemaakt?

Gasexplosie in coqruilles sambe. Ziekenwagens kwamen uit Nederland en Aken en helikopters uit

Nederland en Aken. Toen met die schutter zijn er ook ziekenwagens uit Nederland gekomen

LS: en dat ging allemaal soepel of waren er nog problemen?

MM: ik denk dat het soepel ging, maar het probleem is weer de communicatie, daarom wordt ook

ons team opgebouwd. Dat team dat gaat niet zeggen dat gaat alleen gebruikt worden als civiele

bescherming. Het objectieve doel zal zijn, iedereen bij mij, we spreken ten minste 3 talen,

Nederlands, Engels en Frans en ik ben de enige die daar ook nog Duits bij spreekt, maar de rest

spreekt allemaal 3 talen, dat is een heel groot voordeel, die weten ook hoe ze moeten coördineren.

Ik denk dat het probleem ook is dat we elkaar niet kennen.

CG: ja, dat is het grootste probleem, het scheelt al heel veel als je elkaar kent.

MM: ik kan naar de THW gaan, want ik ken die al 25 jaar, maar ik kan niet naar de kazerne van

Maastricht gaan, want ik ken daar niemand. Vroeger kende ik daar iemand, maar dat was niet in

Maastricht, dat was in Kerkrade. Nu begint dat weer een beetje op te bouwen. Maar ik ken mensen

uit Luxemburg al 10 jaar, ik ken de mensen in Frankrijk sinds meer dan 20 jaar, ik ken die mensen, ik

weet wat de civiele bescherming kan doen en ik weet nu wat de THW kan doen. Daarom heeft de

THW mij graag bij hen, omdat zij mij kennen. Ik vind dat een heel groot voordeel, vooral de mensen,

de bevelhebbers moeten weten wat er in Nederland kan gebeuren, dat is belangrijk.

CG: en wat de bevoegdheden zijn, dat was nu in Luik met de schietpartij een beetje misgegaan, er

was wel een Nederlandse ambulance, maar in Nederland hebben we geen dokter op de ambulance,

maar wel verpleegkundigen die de bevoegdheden hebben. Maar ze mochten in België niemand

helpen, ze waren daar wel, maar ze mochten niemand redden terwijl ze het wel kunnen. Als men al

wist van Nederlandse verplegers zijn bevoegd en getraind om dat wel te doen, dan hadden ze wel

kunnen helpen.

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MM: in Frankrijk is dat hetzelfde als bij jullie, maar in België niet.

CG: ja, dat zijn van die kleine dingen. Als je het van elkaar weet is dat geen probleem, maar als je het

niet weet.

MM: ja, maar het grote probleem is wel de taal. Dat vind ik persoonlijk, voor mij is dat geen

probleem, ik voel me goed daarbij. Maar dat zijn de taalproblemen, Frans, Nederlands.

CG:en vooral het Franse gedeelte, tenminste voor ons dan.

MM: en de Fransen zeggen Nederlands... pfoe. En dat is het grote probleem en daarom in mijn

team, iedereen spreekt bijna wel Nederlands.

LS: zijn er ook nog regelingen voor uitwisseling van data met andere landen?

MM: ja, dat was een project, ik weet niet of dat in orde is geweest, door de vroegere

brandweercommandant van Aken. Die had een programma, dat werd betaald door de EU, het was

een Italiaanse firma die dat opgebouwd heeft. Dat wilde zeggen op het moment dat er door de 112

een oproep binnenkwam, bij heimaten, dat kan naar Nederland gaan, naar Luik of naar Aken. Dan

ging dat automatisch naar Aken en dat was dan een probleem. Nu met dat programma kun je

automatisch zien dat er iets gebeurt. Het probleem is ook de taal. Van Luik weten we dat er iemand

is die Nederlands en Duits spreekt bij de 112, maar neem eens aan dat die aan de telefoon is. En door

dat programma werd dat automatisch vertaald. En dat begint automatisch, hij neemt de telefoon op,

voert dat in op de computer en drukt op een toets, dan gaat dat automatisch naar de

alarmeringscentrale in Maastricht en in Luik. En als dat dan in Duitsland gebeurt, dan komt dat in het

Nederlands en in het Frans aan. En het antwoord dat in Luik gedaan werd, werd automatisch

omgezet naar het Duits en naar het Nederlands. Ik weet niet waar dat programma is.

CG: en dat is niet operationeel, dat is gebouwd maar...?

MM: het bestaat en ik weet niet of dat aanvaard is. Ik weet in België hebben ze een nieuw

programma in Luik waar ze tekeningen erop kunnen doen en alles.

LS: vindt u dat er een behoefte is aan meer samenwerking in de euregio?

MM: ja! Ja, ik vind dat echt persoonlijk. Er moet meer contact zijn, want de contacten zijn nog niet

genoeg. ik ben in 2 landen, België en Duitsland. Met Nederland hebben we nog niet veel contact,

want die zijn zich langzaam aan aan het opbouwen door het euregioproject emric en emric+ ook. Ik

ga dat van de namiddag vragen, de brandweer van Maastricht heeft contact opgenomen met de

kazerne bij ons en die zijn ook verleden week naar Maastricht gekomen naar de 112 centrale. Maar

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het probleem is weer de taal, maar hier in Maastricht spreken veel mensen Frans. Maar ik zal daar

meer over weten na deze middag. Maar niet genoeg samenwerking, we kennen elkaar niet goed

genoeg. het is niet gewoon om elkaar te spreken, we zullen een oefening moeten doen. Een moet

naar de kazerne komen, we moeten routines doen, met de wagen elke maand 50-60 kilometer

rijden. Ja, 50-60 kilometer, dan zijn we naar Maastricht heen en terug. Dus gewoon 6 man in die

wagen, en tot aan Maastricht rijden, daar gewoon een kopje koffie komen drinken en een beetje

praten. Dat zal dan veel beter gaan en dan kennen we elkaar ook.

LS: ja, dan heb ik ook nog een paar laatste vragen. Hoe denkt u dat de rampenbestrijding van

schadelijke stoffen eruit gaat zien in de toekomst? Ziet u dat het goed gaat of dat er meer aan

gedaan moet worden?

MM: in de toekomst met het emric+ programma, zie ik dat echt positief in. Ik voel dat persoonlijk zo

en dat heb ik ook al aan de mensen van Emric+ gezegd, ook tegen Hartmut, ook tegen mensen van

de brandweer, tegen Ivan ook gezegd toen, ik weet hoe het hier in Europa gaat, dus ik zie dat een

beetje groter. Dat dan mensen vanuit België naar Spanje of Slovenie moeten gaan, wat we moeten

doen, maar het probleem is ook een Belg zal nooit aanvaarden om bevel te krijgen van een Duitser.

Of een Nederlander zal het nooit aanvaarden om bevel te krijgen van een Belg. En dat zal een beetje

aangepast moeten worden, ik denk dat als we zo’n groep gereed kunnen krijgen met Emric+, dan is

dat top. Ik heb eens gehoord, ik weet niet meer wie dat tegen mij gezegd heeft, ‘mijn zoon is

geboren’ ‘ah, waar, in Luik?’ ‘nee, in Aken’ ‘waarom in Aken?’ ‘ja, we zijn commissies gaan doen en

toen reden we naar huis en ze kreeg haar krampen. We hebben moeten stoppen in Hauset, we

hebben 112 gebeld en in een keer stond er een Duitse ambulance voor ons.’ Want wat hebben die

gedaan, het was echt nodig dat ze zo snel mogelijk naar het ziekenhuis ging en Aken was veel dichter

bij dan Eupen. Dus hun zoon is ter wereld gekomen in Aken. En toen heb ik gevraagd ‘en hoe is dat, is

dat aardig?’ ‘het enige aardige is dat hij in Aken geboren is, ik vind dat speciaal, maar dat er dan een

Duitser is die een beetje Frans probeert te spreken tegen mij... maar ja, mijn vrouw is geholpen

geweest en die dokter sprak ook een beetje Frans en alles is goed afgelopen en dat is het

belangrijkste.’ En ik denk dat dat met het Emric+ project, als dat zo verder gaat zoals nu, dan kan dat

alleen maar positief in de toekomst zijn. Want een wolk als die in Luik begint en die komt in

Maastricht aan, die hebben geen grenzen, die stopt niet. Als op dat moment specialisten van

Nederland al naar Luik kunnen komen, of Hartmut of anderen van Duitsland naar ons kunnen komen,

of andersom, wij naar de andere kant kunnen komen. Ik zie in de toekomst dat die grenzen zullen

verdwijnen en ik vind ook persoonlijk dat dat moet.

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LS: ik heb nog een laatste vraag, heeft u nog interessante bronnen waarvan u denkt dat ze wel

interessant kunnen zijn?

MM: dan zitten we hier morgen nog. Over gevaarlijke stoffen? Ja, ik heb zoveel contacten met

Europa. Websites die kun je overal wel vinden, bij ministeries enzo, maar ik heb veel persoonlijke

contacten. Ja, wat kan ik erover zeggen? Er zijn dingen die gebeuren in Frankrijk, die gebeuren in

Nederland, in belgië, ja, in heel Europa. Ik word op de hoogte gebracht door de kennissen, de

persoonlijke contacten. Echt interessante zaken die vind ik in Canada.

CG: ja, dat is ook qua cursussen en trainingen heel goed.

MM: ja, Canada is echt de top en zelfs de Amerikanen.

LS: oké, dank u wel, en als ik verdere vragen zou hebben, zou ik die dan mogen stellen?

MM: je hebt mijn email adres, ik hoop dat het interessant was voor je.

LS: ja, zeker, bedankt.

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Appendix 3 – transcript interview Cindy Gielkens

Medical advisor HAZMAT

June 7th , 2012

CG = Cindy Gielkens

LS = Lisanne van der Schors

LS: ik zal meteen maar beginnen met vragen hoe je het systeem in Nederland vindt.

CG: en dan bedoel je gewoon als er een incident is dat opschalen en alles?

LS: ja

CG: nou, in principe denk ik dat het heel... ik ben nog maar heel kort in dat wereldje, maar op papier

werkt dat zeker heel erg goed, maar ik denk in praktijk dat er nog wel hele grote verschillen zijn

tussen de regio’s en de verschillende colonnes zeg maar, tussen de brandweer en de medische tak en

de politie, maar dat we zeker een stuk verder zijn dan in het verleden. Maar we kunnen door het

netwerk en het oefenen en noem maar op, daar nog wel heel veel stappen in kunnen nemen, maar

goed, het goede begin is. Vanuit mijn weinige ervaring denk ik dat het de goede kant op gaat.

LS: en wat zijn de problemen die je nu nog ziet?

CG: het hele systeem is bedoeld eigenlijk om multidisciplinair ook samen te werken en ik werk daar

nu als GAGS voor 5 verschillende veiligheidsregio’s en dan zie je wel goed de verschillen. In Brabant

koppelen ze bijvoorbeeld altijd nog wel terug naar de GAGS en hier in Limburg doen ze dat nog niet

of nauwelijks. Dus daar zijn nog grote verschillen om elkaar multidisciplinair op te zoeken terwijl daar

nog heel veel winst te behalen is.

LS: en wat denk je dat goed zou zijn om verbeterd te worden?

CG: ik denk dat het vooral begint bij de mensen te kennen, dus echt het netwerk. En als is het maar 2

keer per jaar, om toch met de mensen van de brandweer, van de AGS als mensen van de GHOR, van

de GAGS, om gewoon rond de tafel met elkaar de incidenten te bespreken, maar vooral elkaar even

in de ogen te kijken en elkaar leren kennen. Als er dan toch een incident is en je hebt elkaar aan de

telefoon, dan werkt het veel makkelijker. Dat is een eerste stap, dan kun je dan vervolgens nog de

procedures of wat er allemaal nog bij komt kijken als er een incident is, dat nog met elkaar beter

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afstemmen of aanscherpen. Maar ik denk dat het vooral begint met het stukje netwerk en elkaar

leren kennen.

LS: ja. En heb je ook wel eens ervaren dat je door de wetgeving belemmerd werd?

CG: nee, dat heb ik zelf nog niet meegemaakt.

LS: en dan heb ik nog wat vragen over grensoverschrijdende incidenten, heb je voorbeelden van

rampen dicht bij de grens en wat er dan gebeurde, watvoor problemen er waren, wat heel goed ging.

CG: vooral een paar voorbeelden op afstand, niet dat ik er zelf bij betrokken was, maar die er zijn

geweest. Die gifwolk van het DSM, die heb ik ook in presentaties verwerkt. Dan kwamen er op een

gegeven moment, een collega had die wolk zelf gezien, dan kwamen we erachter dat er een wolk

richting belgie trok van het DSM met ... dampen. Toen zijn we gaan bellen en hebben we met

mensen gesproken. De brandweer heeft de wolk gevolgd zo van; komt hij ergens op leefniveau uit?

Voor zover ik weet hebben ze ook met collega’s van de Belgische kant overlegd en gezegd dat er een

wolk aan komt, maar ze hebben er geen rekening mee gehouden dat in Belgie het leefniveau hoger is

dan hier en dat de wolk daar wel op leefniveau uitkwam en er ook mensen zijn geweest met

klachten. Uiteindelijk is dat allemaal wel goed afgelopen, maar de communicatie over en weer had

beter gekund en de inschatting van de situatie ook.

Een goed voorbeeld van samenwerking was, daar was ik zelf ook niet bij, de brand in een

parfumfabriek in kerkrade. En daar voor zover ik weet, kon er niet zo snel iemand ter plekke zijn

vanuit Nederland om metingen te doen en toen is meneer Prast uit Duitsland overgekomen met zijn

meetwagen om de metingen te verrichten. Dat is heel goed onderling afgestemd en teruggekoppeld

en daar heeft men een goed gevoel aan over gehouden.

LS: en zijn er ook nog problemen met wetgeving met communicatie, als er dan een ander land naar

Nederland komt om te helpen, want in Belgie had je natuurlijk dat met die ambulances van

Nederland die niet mochten helpen bij de schutter. Is dat in Nederland ook zo geweest?

CG: dat weet ik eigenlijk niet zo goed en zeker niet voor de CBRN incidenten, ik heb nog niet ervaren

dat daar problemen zijn qua wet- en regelgeving, het is gewoon dat er andere regels zijn.

LS: vind je dat er meer behoefte is aan samenwerking in de euregio op HAZMAT gebied?

CG: of er echt behoefte is.. ik denk dat we vooral even van elkaar moeten weten wat er is, en dat we

dan moeten bepalen of er behoefte is aan een concrete samenwerking. Een volgende stap is om over

een project te gaan nadenken, zijn er aanknopingspunten en hebben we behoefte om wat dichter bij

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elkaar te zitten qua incidentbestrijding. Ik denk wel dat het goed zou zijn, want nu is er helemaal niks.

Dat is ook wel de rode draad van het hele project, want incidenten houden niet op bij landsgrenzen,

dus als er eens een keer iets is, dan moeten we elkaar minimaal weten te vinden en weten wie we

moeten bereiken. Ik denk dat we allemaal op onze beurt de nodige expertise hebben en dat het

zonde zou zijn om daar geen gebruik van te maken. Maar het is een heel ambitieus doel om ooit een

HAZMAT team te hebben, maar ik denk dat we al een goede eerste stap hebben gezet.

LS: hoe zie je het in de toekomst, wat denk je dat er verbeterd zal worden en wat zal er ook echt

verbeterd moeten worden?

CG: ik denk dat het leren kennen wat ik zojuist aangaf, dat vind ik echt belangrijk en daar hebben we

al een goede eerste stap in gezet, maar dat zal wel echt onderhouden moeten worden, dat sowieso.

Dat er mensen zich toch verantwoordelijk moeten voelen om toch een paar keer per jaar iets te

organiseren dat je elkaar in ieder geval treft en dingen kunt uitwisselen. Je hebt toch ook nog wel de

taalbarrière denk ik, Nederlands, Duits en als daar Engels bij komt is het ook nog goed, maar ik denk

dat Frans voor de meeste partijen lastiger is. Ja, en gewoon, wat ik nu als volgende stap zou zien is

om gewoon een aantal incidenten praktisch te beoefenen, wat zouden jullie van jullie kant doen en

wat zouden wij daarvan kunnen leren. Maar de communicatie zal met name verbeterd moeten

worden en van daar uit kun je werken aan de inhoud.

LS: maar dat gebeurt nu ook al met het project nu. Zijn er nog andere dingen die al een beetje

begonnen zijn met verbeteren? Zoals je nu bijvoorbeeld de communicatie hebt.

CG: ja, ik denk vooral dat we in ieder geval nu langzaam weten wat ieder land wel of niet kan en hoe

het geregeld is en de echte winst zal daaruit moeten komen door het ook warm te houden en een

aantal keren echt met elkaar rond de tafel en wellicht nog andere personen. Ik denk dat we nog lang

niet alle mensen die er veel van weten gevonden hebben. Dus nu op dit moment is het dat we een

aantal contactpersonen weten uit de regio, we hebben al met ze om de tafel gezeten en we hebben

uitgesproken dat we er interesse in hebben om het samen te verkennen. Ik hoop dat dat een hele

grote eerste stap zal zijn, maar dat zal de komende tijd moeten blijken of het ook echt gecontinueerd

zal worden.

LS: en dan wil ik nog vragen wat je vooral heel erg goed vind aan het Nederlandse systeem, wat je

denkt dat andere landen nog van Nederland zouden kunnen leren.

CG: het is niet helemaal objectief, maar ik denk vooral de GAGS functie. Ook door gesprekken met

collega’s van beide andere kanten, die spinnen het web. Het is een beetje het linkende punt tussen

de leden van de brandweer, tussen de medische kant, tussen de landelijke instituten die wat roepen

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als er een incident is, dat dat wel een hele belangrijke sleutelfunctie kan zijn. Ik begreep dat ook uit

de interviews, dat mensen dat vaak aangaven, zo van de brandweer doet zijn ding aan zijn kant, de

medische kant doet zijn ding, maar daar missen nog een beetje de dwarsverbanden en dat dan de

functie van de GAGS, het kan ook heel iemand anders zijn, maar in ieder geval zo’n intermediair die

de verschillende lijntjes tussen de verschillende partijen kan leggen en onderhouden en de juiste

mensen met elkaar in contact brengen, dat dat aan de GAGS functie van de Nederlandse kant een

goede zaak is. En vooral ook als je vanuit medische-toxicologische kant naar het incident kijkt. Je hebt

op zich wel de echte artsen en verpleegkundigen die levensreddend werk verrichten op het moment

dat er een incident is. In Duitsland zijn die notarzen er gewoon bij de incidenten en kijken vooral naar

de levensbedreigende zaken, mijn eerste indruk van de gesprekken. Meer een stapje terug doen en

kijken van kunnen de effecten ook veroorzaakt worden door de stoffen, zijn er effecten waarvan je

eigenlijk verwacht dat ze door hele andere stoffen veroorzaakt worden, een beetje die invalshoek.

Dat is het voordeel van de GAGS functie aan de Nederlandse zijde en die ontbrak eigenlijk aan de

beide andere zijden.

LS: en heb je nog dingen gezien in Belgie of in Duitsland wat je heel interessant vindt en die je ook

door zou willen voeren in Nederland?

CG: nou, doorvoeren weet ik niet, maar wat ik wel, omdat ik weet dat in Nederland die discussie ook

heel actueel is, van doe je nu wel of niet biomonitoren, kun je bij mensen bloed of urine afnemen om

te zien wat de blootstelling is geweest. Er is in Nederland nu pas een richtlijn over verschenen, maar

daarmee ook het inzicht dat daar nog wel heel wat haken en ogen aan zitten qua privacy wetgeving

en ethische vragen. We waren bij de ATF in Keulen, die nemen standaard in een incident in hun

industrie bloed en urine af bij de mensen die daarbij betrokken zijn geweest en wordt dat op

verschillende stoffen getest. Ik weet niet of wij dat moeten doorvoeren, maar daar wordt er blijkbaar

gemakkelijker mee omgegaan dan in Nederland. En je zou er eens echt in moeten duiken of je daar

echt winst mee behaalt of je mensen eerder kon behandelen en of ze daar echt gezondheidswinst

mee hebben kunnen maken, maar dat zou je eens echt moeten analyseren. Maar op zich zit daar nog

wel een verschil waarvan ik niet zeker weet of dat in Nederland beter is dan in Duitse zijde. Op zich

zou daar ook wat voor te zeggen zijn als het wat gemakkelijker zou kunnen. Met betrekking tot Belgie

kan ik me daar even niet zo snel een voorbeeld vinden. Ja, daar zijn ze met decontamineren in

bepaalde gedachtes wellicht wat verder, zonder het te hebben over die dingen die opgetuigd moeten

worden, maar meer ook waar moeten ziekenhuizen op voorbereid zijn als er mensen aan komen

lopen die besmet zijn met het een of het ander. Ik denk dat er allemaal zaken zijn waar we van elkaar

zouden kunnen leren, en dat dat de meerwaarde van een goede samenwerking zou zijn in de

euregio.

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LS: okee, bedankt voor het interview.