The Health Ministry is working on a Bill which, if all goes to plan, will place public health in times of natural disasters, epidemic outbreaks and acts of terror in the Concurrent List before the end of this year, giving the Centre the power to independently promulgate laws and lay down rules. Public health is so far a state subject, exclusively in the domain of state governments. The recent outbreak of avian flu in West Bengal has convinced the Ministry that more powers need to be vested with the Centre. “During the avian flu outbreak, Panchayat elections were due in West Bengal. So the state government could not take certain steps which were necessary in those circumstances. The Ministry could not intervene as health is a state subject. Though the Health Ministry had for long felt the need to bring health under its control, this incident highlighted the urgency for such an amendment,” a senior Health Ministry official told The Indian Express. The Bill being drafted by the Ministry will also lay down guidelines to be followed in case of natural disasters and epidemics. The Public Health Bill 2007 aims “to provide, prevent, control and manage epidemics or dangerous epidemic diseases, acts of bioterrorism and threats thereof”. The draft of the proposed Bill has already been examined by a Parliamentary committee and a Cabinet note has also been circulated. The proposed Bill is likely to be discussed in the forthcoming session of the House. For the first time, terrorism and its consequences have been taken into account in the proposed Bill. Together with the National Disaster Management Authority (NDMA), states and Union Territories have evolved Standard Operating Procedures (SOPs) on disaster management. The Bill has three components – epidemics, biochemical disasters and natural disasters. All ministries which have attached medical departments, like the Railways, Defence, Health Ministry, Employee State Insurance (ESI), have been given guidelines on SOPs by the NDMA. As of now, medical emergencies are dealt under the Epidemic Diseases Act of 1897. “This needed to reviewed and the proposed Bill will give the Centre the power to take preventive measures in case of an outbreak. In case where multiple states are involved, it will be easy for the Centre to take necessary action,” said a Health Ministry official, adding that most states have evolved SOPs to strengthen the existing system. In case of Chemical, Biological, Radiological and Nuclear (CBRN) casualties, mass casualty management will begin with decontamination of wounds and burns injuries prior to admission. For CBRN casualties, specialised ambulances will be used for evacuation and patients will be taken to earmarked hospitals with staff trained in CBRN treatment of radiation and burn injuries. The next SOP would be decorporation or the removal of internally deposited radionuclides from the body after accidental intake. And then the long-term treatment will commence. “Around 300 experts across the country have drafted the guidelines on which the SOPs will be based. Making this a Concurrent law will strengthen medical preparedness and mass casualty management during emergencies,” said Lt Gen Dr J R Bhardwaj, member of the NDMA. Simply put, the NDMA is reviewing the existing set-up of various establishments including health departments of state governments, comparing them with best practices used worldwide and telling them how to react better in an emergency. “The Railways have a network of 121 hospitals. In a situation that needs emergency medical response, the Railways have an infrastructure of 172 Accident Relief Medical Vans (ARMV) situated every 200 km. They also have 325 Accident Relief Medical Equipment (ARME) every 100 km and trained manpower. Hence, there is a well-rehearsed action plan in case of a railway accident,” said Lt Gen Bhardwaj.