Interview with LTC Edoardo Cavalieri d’Oro

Head of CBRN Unit, Fire Department City of Milano, Italy

Photo Credit: VV Roberto Bosi.

Can you first describe your role and the organization you work for? I work for the Fire services nationally, and I work in the headquarters located in Milan, which is one of the three main Fire Stations in Italy in terms of size and capabilities, together with Rome. The division represents around 1000 staff members. Within this division, I am heading the CBRNe Unit in Milan, which is a specialized unit. There are 30 people in the CBRNe Unit divided into four shifts, which means that every day, there is a team of five people working. The unit is equipped with three laboratories, one for each of the following areas: chemical, biological, radiological. The unit has regional coverage and supports the entire Lombardy region, so we can cover a big portion of Northern Italy. We also have capabilities in detection in the 3 areas (chem/bio/radiological). For example, in the last five years in the city of Milan we have had an average of at least one biological intervention carried out by the CBRN unit. Specifically, these interventions concerned envelopes delivered containing substances suspected of being anthrax. These events allow us to use on the use of our biological laboratory for Anthrax detection and Anthrax sampling. (Actually, just last Friday one of these events detected real anthrax for the first time in Italy). We also have a gas chromatographic machine for the chemical part, which means that if there is a fire, we are ready to determine the concentration in the air of any anomaly in terms of chemical agents. For the radiological part, we have a very standard spectroscopy equipment. Additionally, once a week we conduct air sampling to see if there are anomalies in the air from a radiological standpoint. These are a few examples of all the equipment and capabilities we have.

As the Head of CBRN Unit of the Fire Department of Milano, how did you experience the COVID-19 crisis? How did your organization deal with the COVID-19 crisis? I remember well, it was 26 February when I convoked my team and asked them if we were able to convert the biological laboratory, using the "old" PCR technology which was then abandoned in favor of the rapid diagnosis system called Filmarrray. So, I asked my team and they told me that we were ready. We called our headquarters in Rome and they gave us the authorization to buy this PCR machine. We had to wait almost ten days after the lockdown to get the permit to run the biological laboratory with the new configuration. We wrote a process that was interoperated with the Luigi Sacco hospital here in Milan. Thanks to that we were able to create a management structure and system to collect the data, counting all the diagnostics and to extend the diagnostic not only to the personnel of the fire rescue services but also to the police, to the financial police, or the police supporting the prisons. Basically, around this PCR real-time process, we built up a mechanism to monitor the health of all the operational personnel (monitor in almost real time the health of all the operators of the security sector in the city of Milan (there are about 15,000 units included among the police, firefighters, financial police and prison police). Therefore, it could be said that we have created a system to guarantee the resilience of the city of Milan. Indeed, these were the people that could never stop working and had to be on the streets every day to support the social services. Running the laboratory required a constant screening of the health status, the location and the behaviors of staff. In addition, the operating staff besides being involved in field operations also has the problem of often being a resident and therefore of sleeping in the fire station. Therefore, to monitor all these people and these particular work situations, we had to create a Task Force, which was supposed to ensure the health of the staff associated with the laboratory. At the same time, the Task Force would provide a continuous supply chain for Personal Protective Equipment, in case the staff were operating in the streets to support the sanitary services.

Photo Credit: VV Roberto Bosi.

How was your laboratory unit organized? Within the CBRNe Unit running the laboratory we had at least four people every day and 1 doctor coming from the hospital to verify the diagnostic results. There is a reasonable amount of people, but the beauty of this mechanism lies in the use of fire and rescue services personnel being in place to support the medical health personnel, without withdrawing them from hospitals or other laboratories. In other words, we were able to manage the laboratory with biological operators from our unit by rationalizing the request for specialized doctors who instead served in the city in support of population and civil society. If we talk about the entire staff that were also managing all the data and monitoring behaviors and operation procedures, the Task Force was run by five to seven people each day. They were chosen from different areas like safety and security, health, logistics, etc. All the roles were functional enough to ensure quick operation of the machinery, which means that someone had to know how the storage works, someone had to know what to do if there is a problem with the supplying of the equipment (where they are, how long it takes to order them, etc.).

What, in your opinion, was the most challenging in this crisis as the Head of unit?

The most critical variable was time. In this case, it didn’t only mean to react promptly, but it also suggested that time had a real impact on many processes. Indeed, it takes approval time if you have to reevaluate processes and getting them approved. The administrative / bureaucratic part can often include some delays, which you cannot have in a crisis, if you operate as a rescue service. Of course, when we are in the red zone, we are used to operating in the absence of legal structures, or at least with norms that exist only in our jurisdiction. At this junction, the intersection with the health field was putting norms and legal terms on the table, which were new, and thus had to be studied and approved very quickly.

Photo Credit: VV Roberto Bosi.

How did you monitor the data you collected and the evolution of the crisis? Data is probably the thing I started to pay the most attention to since the beginning; it shifted from paper to excel and then to an online platform. We knew that we were going to be managing a lot of data. But in fact, it is more an organizational issue than a technological complexity. Since we had this Task Force working in parallel to the real place where this data was processed, a lot of thoughts came on how to analyze the data. However, more important than the data management, was the data analysis. This was for sure a successful experiment since the understanding of the data was clear to us (every time we had a positive person, we knew what were the immediate actions to put in place in order to limit the spread of the disease). Therefore, out of almost 3000 people that we screened in 2 months, just 50 were positive: which means if you have a working operational and prompt machine in your assets, you can really make the difference. These 1000 guys from our unit (Fire Rescue Services) were spread in about 20 different locations. And we only had to close one location for one day, out of precaution, because we were doing some analysis on a team member. But in general, we maintained complete continuity of the service without exposing our personnel to health risks.

According to you what are the lessons learned from this crisis? What will be the new challenges of the post-COVID-19 era?

That is a big question. Something I wanted to mention is that, parallel to the Task Force and the Laboratory, we also started running experiments on research on how to better understand what the real risks were. We wanted for instance to know if PPE could be re-used, if they can be affected for some circumstances. So if I think about the lessons learned, I think we were able to optimize these three elements: 1- having the managing tools (i.e. a Task Force well-designed and working from Day-0), 2- having the appropriate CBRNe capabilities (analytics, detection, PPE, etc.), 3- trying to understand what is happening around you, by doing specific scientific research. All of the above elements had in common a very strong cooperation with other organizations. For instance, the laboratory was run with the support of a hospital and the research was done in cooperation with universities, the hospital and other entities. My idea is that these three elements, working in-conjunction with each other gave us a better picture of what was happening around us.

Photo Credit: VV Roberto Bosi.

If you look at Italy as part of the European Civil Protection System, do you have considerations to give about the EU capabilities, preparedness and response in facing Covid-19?

Our response was organized very locally, but we have some information about the response in some other countries. For instance, we know that some countries have the capability of having a biological mobile laboratory, since it is something that the DG ECHO, the European Civil protection, designed. We know that Germany and Belgium have this capability. I know from Belgium that they used such a laboratory during their past mission in South Africa for Ebola. I also believe they are operating their laboratory to react to the COVID-19 emergency using the PCR method as well, but on a different scale. In the long run, we are proposing to the Civil Protection Service in Europe an exercise, during which we could look back at our response, study the capabilities available in Europe, and all together study our capacity to acquire these tools. We had to do a transformation of these assets and we can now draw some schemes of response. Everyone who has the same capabilities can employ them. For sure, if we succeed to get this Exercise Call, we also plan to register our laboratory officially in the European Civil Protection System. Indeed, the problem was that, despite the fact that our laboratory is mobile, it had to stay in Italy, where the situation was the most critical. But we don’t want to exclude in the future that wherever a pandemic occurs, we could relocate it to support the local authorities and see if such a mechanism can be replicated. From what I know, at the moment there are only 3 member states that have this capability, but it could be a scaled-up and improved mechanism. The picture we have now is our picture, but it doesn’t mean that it is the perfect one. There are different angles to answer a crisis, and this is where, I believe, the cooperation through the EU Civil Protection Call can be useful. We already collected some partners for the exercise, but it is a bit delicate to promote such an exercise since the crisis is still ongoing. So, it is difficult to be already talking about “lessons learned”. So, we are looking for the right political balance, but we truly think that it can work. Indeed, during this crisis each member state had to think on its own, so even if we might still be at the beginning of this crisis (which I hope not), there is a need for better cooperation. It is an exercise, so it means that in real life we would play with variables that are more complex, however we can still learn so much from it. For sure the biological part in our CBRNe unit has always been critical, mostly because the personnel see it as something really different, requiring hospital or laboratory skills rather than on-the-field operations skills. Traditionally, in CBRNe units, RN and Chemical capabilities are more developed, especially in the Fire units, and the biological element is a bit more difficult to find. Now by looking at my team, there is a change in mindset for sure: by operating on the field as a rescue unit (producing swabs also means saving lives for them even if not in a traditional operating scenario), they saw that they can really make a difference.

What would you add to conclude? A final remark, advice, consideration for the future? How is Italy recovering from the crisis?

In this area, the situation is going almost back to normality, but the last word is not spoken.

Photo Credit: VV Roberto Bosi.

Lt. Col. Edoardo Cavalieri d’Oro has been working for the Italian National Fire and Rescue Services since 2004 and is today heading the CBRN unit in the region of Lombardy from the Milan headquarters since 2013. Edoardo graduated in nuclear engineering from the Polytechnic University of Milan and then specialized in the fields of risk assessment applied to nuclear non-proliferation, and of management and system design at the Massachusetts Institute of Technology. In addition, he holds a Master’s degree in Civil Protection against CBRN events from Tor Vergata University in Rome. Additionally, starting in 2018, he holds the position of national coordinator for the INSARAG activities of the Heavy USAR team certified at the end of this same year. Edoardo has participated in various missions, including the earthquakes in central Italy in 2016 and Emilia in 2012, as well as the two recent accidents in 2018 of the Genoa Bridge and the explosion on the Bologna overpass. Edoardo is the author of various publications in the field of risk assessment, CBRN and of the use of rescue technologies, including the system called SFM for emergency response in CBRN events through IoT systems financed by a European Space Agency feasibility study and currently in development phase.