South West Health`s Draft Pandemic Plan

Transcription

South West Health Pandemic Influenza Plan
September 2005 Draft
SECTION 0 INTRODUCTION TO PANDEMIC INFLUENZA PLANNING..................... 9
0.1.0.0 ACKNOWLEDGEMENTS .................................................................................................. 10
0.2.0.0 INTRODUCTION............................................................................................................... 10
0.3.0.0 WHO PHASES ............................................................................................................... 11
0.3.1.0 Pre-pandemic........................................................................................................... 11
0.3.2.0 Pandemic.................................................................................................................. 12
0.3.3.0 Post Pandemic ......................................................................................................... 12
0.4.0.0 ESTIMATED IMPACT OF AN INFLUENZA PANDEMIC ON NOVA SCOTIA........................ 15
0.5.0.0 PANDEMIC INFLUENZA PLANNING GOALS ..................................................................... 17
0.6.0.0 PLANNING ASSUMPTIONS .............................................................................................. 17
0.7.0.0 SWH PANDEMIC INFLUENZA PLANNING ....................................................................... 17
0.7.1.0 Pandemic Influenza Steering Committee .............................................................. 18
0.7.2.0 Surveillance Working Group .................................................................................... 18
0.7.3.0 Vaccine – Anti-viral Working Group.................................................................... 18
0.7.4.0 Emergency Preparedness Working Group ........................................................... 18
0.7.5.0 Health Services Working Group ........................................................................... 19
0.7.6.0 Influenza Treatment Clinic Working Group ......................................................... 19
0.8.0.0 PANDEMIC INFLUENZA CONTINGENCY PLAN ACTIVATION ........................................ 20
0.8.1.0 Legal Basis............................................................................................................... 20
0.9.0.0 PANDEMIC INFLUENZA RESPONSE TEAM ................................................................... 21
SECTION 1 SURVEILLANCE................................................................................................ 22
1.0.0.0 INTRODUCTION .............................................................................................................. 23
1.0.1.0 INTERNATIONAL SURVEILLANCE ................................................................................... 23
1.0.2.0 NATIONAL SURVEILLANCE ............................................................................................ 23
1.0.2.1 Flu Watch Program .............................................................................................. 23
1.0.3.0 PROVINCIAL SURVEILLANCE ......................................................................................... 23
1.0.3.1 Laboratory Influenza Surveillance Program (LISP) ............................................... 24
1.1.0.0 PRE-PANDEMIC PERIOD ................................................................................................. 24
1.1.1.0 DEFINITION OF ILLNESS AND REPORTING REQUIREMENTS ............................................ 24
1.1.1.1 Health Protection Act Section 31: ........................................................................ 24
1.1.1.2 Health Act Regulations:........................................................................................ 25
1.1.1.3 ILI in the general population:............................................................................... 25
1.1.1.4 Definitions of ILI/Influenza outbreaks .................................................................. 25
1.1.2.0 THE MEDICAL OFFICER OF HEALTH ............................................................................... 25
1.1.3.0 SURVEILLANCE RESPONSIBILITY ................................................................................... 25
1.1.3.1 Reporting................................................................................................................... 25
1.1.4.0 SURVEILLANCE STRATEGIES ......................................................................................... 26
1.1.4.1 Sentinel Physician:................................................................................................ 26
1.1.4.2 School Absenteeism: ............................................................................................. 26
1.1.4.3 Child Care Centres:.............................................................................................. 26
1.1.4.4 Long-Term Care Facilities ................................................................................... 26
1.1.4.6 Emergency Departments.......................................................................................... 29
1.1.4.7 Communication with District Laboratories .............................................................. 29
1.1.4.8 Surveillance Linkages .............................................................................................. 29
1.1.5.1 Infectious disease specialists ................................................................................ 29
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1.1.5.0 Investigations of Outbreaks ..................................................................................... 29
1.1.6.0 Surveillance reporting process:............................................................................... 29
1.2.0.0 PANDEMIC PERIOD ........................................................................................................ 30
1.2.1.0 Laboratory Diagnostics ........................................................................................... 30
Special Studies ...................................................................................................................... 30
1.2.2.0 NOVEL VIRUS DETECTED OUTSIDE NORTH AMERICA (PANDEMIC POTENTIAL)............. 31
1.2.2.1 Surveillance Strategies – South West Health............................................................ 31
1.2.3.0 NOVEL VIRUS DETECTED IN NORTH AMERICA (PANDEMIC IMMINENT)........................ 32
1.2.3.1 Surveillance Strategies............................................................................................ 32
1.2.4.0 PANDEMIC INFLUENZA VIRUS DETECTED LOCALLY ..................................................... 33
Surveillance Strategies.......................................................................................................... 33
1.2.4.1 Surveillance during a Pandemic............................................................................... 33
1.3.0.0 POST-PANDEMIC PERIOD ............................................................................................... 34
1.3.1.1 Surveillance.............................................................................................................. 34
1.3.1.2 Laboratory Diagnostics ........................................................................................... 34
1.3.1.3
Special Studies ..................................................................................................... 34
1.3.1.4 Evaluation ................................................................................................................ 34
SECTION 2 COMMUNICATION........................................................................................... 35
2.0.1.0 GOAL............................................................................................................................. 36
2.0.2.0 OBJECTIVES ................................................................................................................... 36
2.0.3.0 PRINCIPLES .................................................................................................................... 36
2.0.4.0 SPOKESPERSONS ............................................................................................................ 36
2.0.5.0 POLICY FOR HANDLING MEDIA ENQUIRIES DURING A PANDEMIC ................................... 36
2.0.6.0 AUDIENCES ................................................................................................................... 37
2.1.0.0 PRE-PANDEMIC ............................................................................................................. 38
Goals ..................................................................................................................................... 38
2.1.2.0 MESSAGES ..................................................................................................................... 38
2.2.0.0 DURING PANDEMIC ....................................................................................................... 39
2.2.1.0. Goals:....................................................................................................................... 39
2.2.2.0 Messages (To be developed during the pandemic) .................................................. 39
2.3.0.0 POST PANDEMIC ............................................................................................................ 40
2.3.1.0 Goals:........................................................................................................................ 40
2.3.2.0 Messages:................................................................................................................. 41
2.4.0.0 PANDEMIC TOOLS MATRIX ............................................................................................ 42
2.5.0.0 CRISIS COMMUNICATION TEAM: ROLES AND RESPONSIBILITIES ................................... 46
2.6.0.0 AFTER HOURS MEDIA CONTACT INFORMATION: ............................................................ 48
2.7.0.0 DRAFT COMMUNICATION TOOLS .................................................................................. 51
SECTION 3 VACCINE MANAGEMENT............................................................................... 52
3.0.0.0 INTRODUCTION .............................................................................................................. 53
3.0.1.0 SETTING PRIORITIES FOR IMMUNIZATION ...................................................................... 53
3.0.2.0 TRANSPORTATION AND SECURITY ................................................................................. 54
3.0.3.0 VACCINE ASSOCIATED ADVERSE EVENTS SURVEILLANCE............................................ 54
3.0.4.0 SPECIAL STUDIES .......................................................................................................... 54
3.1.0.0 PRE-PANDEMIC PERIOD ................................................................................................ 55
3.1.1.0 Setting Priorities for Vaccination in the Pre-pandemic Period............................... 55
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3.1.2.0 Vaccine Management Strategies for the Pre-pandemic Period............................... 55
3.2.0.0 PANDEMIC PERIOD ........................................................................................................ 55
3.2.1.0 Vaccination Management ........................................................................................ 55
3.2.1.1 Vaccine Storage ........................................................................................................ 56
3.2.1.2 Vaccine Transportation ............................................................................................ 56
TRANSPORTATION OF VACCINES IN A KOOLATRON OR USE AT A CLINIC ................................... 56
3.2.1.3 Vaccine Security....................................................................................................... 57
3.2.1.4 Vaccination Prioritization ....................................................................................... 57
3.2.1.5 Public Vaccine Clinics.............................................................................................. 61
3.2.2.0 VACCINE AVAILABILITY SCENARIOS ............................................................................ 68
3.2.2.1 Scenario 1 ................................................................................................................. 68
3.2.2.2 Scenario 2 ................................................................................................................. 68
3.2.2.3 Scenario 3 ................................................................................................................. 68
3.3.0.0 POST PANDEMIC ............................................................................................................. 69
SECTION 4 ANTIVIRALS ....................................................................................................... 70
4.0.1.0 CURRENT ANTIVIRALS DRUGS ...................................................................................... 71
4.0.2.0 INDICATIONS AND LIMITATIONS ..................................................................................... 71
4.1.0.0 PRE-PANDEMIC PERIOD .................................................................................................. 72
4.1.1.0 Antiviral Management Strategies in the Pre-pandemic Period................................ 72
4.2.0.0 PANDEMIC PERIOD ....................................................................................................... 72
4.2.1.0 Antiviral Medication Priorities............................................................................... 72
4.2.2.0 Antiviral Management Strategies ........................................................................... 73
4.3.0.0 POST-PANDEMIC PERIOD ................................................................................................ 73
SECTION 5 EMERGENCY PREPAREDNESS AND RESPONSE .................................... 74
5.1.0.0 EMERGENCY PREPAREDNESS AND RESPONSE ................................................................ 75
5.2.0.0 LEGISLATION & GOVERNMENT ROLES .......................................................................... 75
5.3.0.0 PRE-PANDEMIC PERIOD ................................................................................................. 77
5.3.1.0 Essential Community Services .................................................................................. 77
5.3.2.0 Roles and Responsibilities ....................................................................................... 77
5.3.3.0 Contingency Plans ................................................................................................ 77
5.3.4.0 Identify voluntary organizations to assist during the pandemic.............................. 77
5.3.5.0 Environmental Assessment of surge capacity .......................................................... 78
5.3.6.0 Community Transmission of influenza..................................................................... 78
5.3.7.0 Mortuary, burial/funeral service plans.................................................................... 78
5.3.8.0 District plan for social/psychological services for families .................................... 78
5.4.0.0 PANDEMIC PERIOD ........................................................................................................ 78
5.4.1.0 Emergency Management Strategies......................................................................... 78
5.5.0.0 POST-PANDEMIC PERIOD ............................................................................................... 79
SECTION 6 HEALTH SERVICES .......................................................................................... 80
6.0.0.0 INTRODUCTION............................................................................................................... 81
6.1.0.0 EPIDEMIOLOGY OF PANDEMIC INFLUENZA ..................................................................... 81
6.2.0.0 PLANNING ACTIVITIES AND RESPONSIBILITIES .............................................................. 81
6.2.1.0 Estimated Impact of an Influenza Pandemic on Nova Scotia ................................... 82
6.2.1.1. Triggers.................................................................................................................... 82
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6.2.2.0 INFLUENZA RESPONSE TEAM ......................................................................................... 82
6.2.3.0 Ethical Considerations.............................................................................................. 83
6.2.3.1 Guiding principles: ................................................................................................... 83
6.2.3.3 Principles of the Ethical Practice of Public Health.................................................. 84
6.2.4.0 COMMUNICATION .......................................................................................................... 85
6.2.4.1. Draft Communication Tools .................................................................................... 85
6.2.5.0 PRINCIPLES OF INFLUENZA TRANSMISSION.................................................................... 86
6.2.5.1 Routine Practices and Additional Precautions to Prevent The Transmission Of
Influenza................................................................................................................................ 86
PLEASE SEE SECTION 2.0.0.0 FOR FULL COMMUNICATION PLAN ................................................ 87
6.2.6.0 OCCUPATIONAL HEALTH MANAGEMENT OF HCW’S (AND HEALTH CARE VOLUNTEERS)
DURING AN INFLUENZA PANDEMIC ........................................................................................... 87
6.2.6.1 Fit for Work............................................................................................................. 87
6.2.6.2 Unfit for Work .......................................................................................................... 87
6.2.6.3 Fit to Work with Restrictions .................................................................................... 88
6.2.6.4 ILI Assessment Tool to Monitor HCW’s/Volunteers................................................. 88
6.2.7.0 HUMAN RESOURCES ............................................................................................... 88
6.2.7.1 Staffing ..................................................................................................................... 88
6.2.7.2 Education for Health Care Workers ........................................................................ 89
6.2.7.3 Training Program to cross-train staff: .................................................................... 90
6.2.7.4. Temporary Licenses ................................................................................................. 90
6.2.7.5 Volunteers ................................................................................................................. 91
6.3.0.0 HEALTH SERVICES ......................................................................................................... 91
6.3.1.0 PLAN FOR INCREASING SURGE CAPACITY: ..................................................................... 91
HOSPITAL ADMISSIONS, TRANSFERS AND DISCHARGES ............................................................. 91
6.3.2.0 PATIENT FLOW (ACUTE CARE)...................................................................................... 92
6.3.2.1 Surveillance in Triage............................................................................................... 94
6.3.3.0 INTENSIVE CARE SERVICES ............................................................................................ 95
6.3.4.0 CLINICAL CARE GUIDELINES ......................................................................................... 95
6.3.4.1 Most Common Clinical Presentations (Adults) ........................................................ 95
Hepatic diseases, cirrhosis ................................................................................................... 97
6.3.4.2. Patient Management – See Assessement Forms Appendix D .................................. 98
6.3.4.3. Initial Influenza Illness Assessment ....................................................................... 100
6.3.4.4. Secondary Influenza illness assessment................................................................. 101
6.3.4.5. Microbiologic Diagnostic ...................................................................................... 102
6.3.4.6 Pediatric Triage ...................................................................................................... 103
6.3.6.0 PHARMACY .................................................................................................................. 108
6.3.6.1 Hospital Antiviral Policy and Procedure: .............................................................. 108
6.3.7.0 MENTAL HEALTH ......................................................................................................... 109
6.3.8.0 SUPPORT SERVICES ...................................................................................................... 109
6.3.8.1. Material Management Services Pandemic Plan (Also see Appendix J) ............... 109
Patient Portering Pandemic Flu Plan at YRH.................................................................... 110
6.3.8.2 Food and Nutrition Services .................................................................................. 110
6.3.8.3 Environmental Services ......................................................................................... 111
6.4.0.0 INFLUENZA TREATMENT CLINIC .................................................................................. 112
6.4.1.0 THE INFLUENZA TREATMENT CLINICS SITES – SEE APPENDIX I .................................. 112
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6.4.2.0 ACTIVATION OF CLINICS .............................................................................................. 113
6.4.3.0 CARE PROVIDED IN INFLUENZA TREATMENT CLINICS .................................................. 113
6.4.4.0 TRIAGE AND PATIENT FLOW (INFLUENZA TREATMENT CLINIC) .................................. 114
6.4.5.0 STAFFING INFLUENZA TREATMENT CLINICS ............................................................... 114
6.4.6.0 CRITERIA FOR DISCHARGE FROM AN INFLUENZA TREATMENT CLINIC ........................ 116
6.4.7.0 TRANSPORTATION (TO AND FROM ITC)....................................................................... 116
6.4.8.0 SUPPLIES FOR INFLUENZA TREATMENT CLINICS ......................................................... 116
6.4.9.0 PHARMACY FOR INFLUENZA TREATMENT CLINIC SITES .............................................. 116
6.6.9.1 Pharmacy – Pandemic Influenza Antiviral drugs- Patient Education.................... 116
6.7.0.0 MORTUARY SERVICES: MULTI-DEATH DISASTER SITUATIONS ................ 117
APPENDIX A SURVEILLANCE ........................................................................................... 121
APPENDIX A01 CONTACT INFORMATION ................................................................................. 122
APPENDIX A02 SURVEILLANCE DATA SUMMARY WORKSHEET .............................................. 123
APPENDIX A03 SURVEILLANCE TALLY WORKSHEET............................................................... 125
APPENDIX A04 DRAFT LETTER TO SCHOOLS ............................................................................ 127
APPENDIX A05 DRAFT LETTER TO DAYCARES ......................................................................... 127
APPENDIX A06 SURVEILLANCE FORM FOR LTC...................................................................... 127
APPENDIX A07 DRAFT LETTERS TO EMPLOYERS RE. PANDEMIC INFLUENZA ............................ 128
APPENDIX A08 SURVEILLANCE DATA SUMMARY WORKSHEET..................................... 132
APPENDIX A09 LETTER TO MANAGERS RE. EMPLOYEE ABSENTEEISM FOR ILI ....................... 134
APPENDIX A10 STAFF RESPIRATORY ILLNESS LINE LISTING ................................................... 135
APPENDIX B COMMUNICATION TOOLS ....................................................................... 136
APPENDIX B01 COMMUNICATION FAN-OUT ............................................................................ 137
APPENDIX B02 NOTICE & FACT SHEET RE INFLUENZA ............................................................ 142
APPENDIX B03 POSSIBLE Q&AS FOR HEALTH CARE WORKERS ............................................. 144
APPENDIX B04 LETTER TO PARENTS/GUARDIANS RE. SCHOOLS AS CLINICS ............................ 149
APPENDIX B05 COMMUNICATIONS SOFTWARE/HARDWARE INVENTORY ............................... 151
APPENDIX B06 DISTRIBUTION LISTS ....................................................................................... 152
APPENDIX B07 HOW TO ISSUE A NEWS RELEASE ................................................................... 153
APPENDIX B08 NOTES ............................................................................................................. 154
APPENDIX B09 SAMPLE DISTRICT UPDATE (DAILY, BIWEEKLY, OR WEEKLY??) ..................... 155
APPENDIX B10 SAMPLE PUBLIC SERVICE ANNOUNCEMENTS ................................................. 156
APPENDIX B11 NEWSLETTER ARTICLE PRE-PANDEMIC ........................................................... 158
APPENDIX B12 LETTER TO EDITOR RE. PANDEMIC PLANNING ................................................ 163
APPENDIX B13 MEMO TO STAFF, PHYSICIANS AND VOLUNTEERS RE. PANDEMIC FLU PLANNING
................................................................................................................................................. 166
APPENDIX B14 LETTER TO MEDIA RE. PANDEMIC INFLUENZA ................................................ 167
APPENDIX B15 GENERAL Q&AS FOR THE PUBLIC RE. PANDEMIC FLU .................................... 169
APPENDIX B16 DRAFT NOTICES RE. LIMITATIONS ON VISITATION ......................................... 175
APPENDIX B17 NOTICE FOR ERS RE. PANDEMIC INFO LINE .................................................... 180
APPENDIX C VACCINES ...................................................................................................... 181
APPENDIX C01 ESTIMATE OF VACCINE DOSE REQUIREMENTS ................................................ 182
APPENDIX C02 SWH LTC, HC, VON EMPLOYEE LIST ........................................................... 187
APPENDIX C03 PHARMACY STAFF PRIORITY LIST FOR INFLUENZA VACCINATION................. 188
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APPENDIX C04 ESSENTIAL SERVICE PROVIDERS PRIORITY LIST FOR VACCINE ...................... 189
APPENDIX C05 MUNICIPAL UNITS .......................................................................................... 191
APPENDIX C06 ESSENTIAL SERVICE PROVIDERS TOTALS ....................................................... 192
APPENDIX C07 ESP PRIORITY LIST FOR VACCINATION - FORM .............................................. 193
APPENDIX C08 ESP PRIORITY LIST FOR SHELBURNE COUNTY ............................................... 194
APPENDIX C09 ESP PRIORITY LIST FOR YARMOUTH TOWN ................................................... 198
APPENDIX C10 ESP PRIORITY LIST FOR MUNICIPALITY OF ARGYLE ...................................... 201
APPENDIX C11 ESP PRIORITY LIST FOR MUNICIPALITY OF CLARE......................................... 205
APPENDIX C12 ESP PRIORITY LIST FOR MUNICIPALITY OF DIGBY ......................................... 210
APPENDIX C13 SHELBURNE COUNTY EAST CONTACT LIST .................................................... 214
APPENDIX C14 BEAR RIVER FIRST NATION ESP PRIORITY LIST FOR VACCINE ...................... 218
APPENDIX C15 CLINIC POPULATION DATA ............................................................................. 219
APPENDIX C17 CLINIC REGISTRATION TECHNICAL OPTION ................................................... 223
APPENDIX DHEALTH SERVICES...................................................................................... 224
APPENDIX D01 SERVICES TEMPORARILY SUSPENDED DURING PANDEMIC .............................. 225
APPENDIX D02 DISCHARGE PLANNING WORKSHEET............................................................... 227
APPENDIX D03 DEPARTMENT MANAGER CURRENT BED STATUS ........................................... 228
APPENDIX D04 ASSESSMENT FORMS ....................................................................................... 230
APPENDIX D05 DEFINITIONS ................................................................................................... 240
APPENDIX E OCCUPATIONAL HEALTH & INFECTION CONTROL ....................... 242
APPENDIX E01 PRINCIPLES OF INFLUENZA TRANSMISSION ...................................... 243
APPENDIX E02 ROUTINE PRACTICES & ADDITIONAL PRECAUTIONS TO PREVENT THE
TRANSMISSION OF INFLUENZA ................................................................................................. 244
APPENDIX E04 INFECTION CONTROL PRACTICES FOR PANDEMIC INFLUENZA.............. 248
APPENDIX F LAB ................................................................................................................... 257
APPENDIX F01
APPENDIX F02
APPENDIX F03
APPENDIX F04
APPENDIX F05
VIRAL SWAB ACTION SHEET .......................................................................... 258
PERSONNEL RESOURCES ................................................................................. 260
DISASTER PLAN FANOUT - YRH ..................................................................... 261
DISASTER PLAN FANOUT - RH........................................................................ 262
DISASTER PLAN FANOUT - DGH..................................................................... 263
APPENDIX G PHARMACY ................................................................................................... 264
APPENDIX G01 SWH PHARMACEUTICAL SERVICES OFFERED ................................. 265
APPENDIX G02 DISBURSEMENT OF VACCINES TO CLINIC SITES ............................................. 270
APPENDIX G 03 VACCINE/ANTIVIRAL TRANSFER FORM ......................................................... 271
APPENDIX G 04 VACCINE TRACKING FORM ............................................................................ 273
APPENDIX G 05 ADVERSE DRUG AND VACCINE REACTIONS REPORTING ............................... 275
APPENDIX G 07 ADVERSE DRUG REACTION MONITORING FORM ........................................... 278
APPENDIX G 08 AUXILIARY DRUGS ........................................................................................ 280
APPENDIX G08A AUXILIARY DRUGS FOR ANTIVIRAL/VACCINE CLINIC SITES ....................... 282
APPENDIX G 08B AUXILIARY DRUGS FOR PALLIATIVE CARE SITES........................................ 283
APPENDIX G10 ANTIVIRAL POLICY AND PROCEDURE ............................................................. 285
APPENDIX G 11 ANTIVIRAL ESTIMATES.................................................................................. 287
APPENDIX G12 DISBURSEMENT OF ANTIVIRALS TO TRIAGE SITES ......................................... 288
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APPENDIX G13
APPENDIX G14
APPENDIX G15
APPENDIX G16
APPENDIX G20
ANTIVIRAL COUNT FORM ............................................................................... 289
AMANTADINE ................................................................................................. 290
OSELTAMAVIR (TAMIFLU®) .................................................................... 291
ZANAMIVIR (RELENZA®)........................................................................... 292
ANTIVIRAL DRUGS – PATIENT EDUCATION .................................................... 293
APPENDIX H MENTAL HEALTH SERVICES .................................................................. 294
APPENDIX H01 MENTAL HEALTH SERVICES DURING A PANDEMIC INFLUENZA ..................... 295
APPENDIX H02 DEALING WITH STRESS AND FEAR ABOUT PANDEMIC FLU (PUBLIC).............. 305
APPENDIX H03 PANDEMIC FLU AND HEALTH CARE WORKERS ............................................... 308
APPENDIX I INFLUENZA TREATMENT CLINICS ........................................................ 314
APPENDIX I01 SAIC RECOMMENDED CRITERIA FOR NOVA SCOTIA ......................................... 315
APPENDIX I02 FROM THE CANADIAN PANDEMIC INFLUENZA PLAN RE. NTS .......................... 317
APPENDIX I03 NON-TRADITIONAL SITES PLANNING TO DECEMBER 2004................................ 319
APPENDIX I04 INFLUENZA TREATMENT CLINIC – HILLCREST ACADEMY ................................ 320
APPENDIX I05 - INFLUENZA TREATMENT CLINIC – SHELBURNE HIGH ..................................... 326
APPENDIX I06 INFLUENZA TREATMENT CLINIC – ARGYLE ...................................................... 329
APPENDIX I07 – INFLUENZA TREATMENT CLINIC – FORREST RIDGE ....................................... 333
APPENDIX I07 INFLUENZA TREATMENT CLINIC – DIGBY ELEMENTARY .................................. 336
APPENDIX I08 INFLUENZA TREATMENT CLINICS – MAPLE GROVE .......................................... 339
APPENDIX I09 – INFLUENZA TREATMENT CLINICS – MEADOWFIELDS ..................................... 345
APPENDIX I10 – INFLUENZA TREATMENT CLINIC – JEAN MARIE GAIE .................................... 350
APPENDIX I11 – INFLUENZA TREATMENT CLINIC – JOSEPH DUGAS ......................................... 351
APPENDIX J MATERIALS MANAGEMENT .................................................................... 352
APPENDIX K HUMAN RESOURCES.................................................................................. 367
APPENDIX KO1 HUMAN RESOURCE STAFF COORDINATION .................................................... 368
APPENDIX K02 HUMAN RESOURCE MANAGEMENT ISSUES THAT REQUIRE CLARIFICATION ... 369
APPENDIX K03 RETIREE LISTS ................................................................................................ 372
APPENDIX K04 MEMO RE VOLUNTEERS .................................................................................. 375
APPENDIX K05 LETTER TO JOHN WEBB................................................................................... 384
APPENDIX K06 MEMO TO COMMUNITY SERVICES ................................................................... 386
APPENDIX K07 VOLUNTEERS .................................................................................................. 389
APPENDIX LSECURITY ....................................................................................................... 390
APPENDIX L01 SECURITY PLAN .............................................................................................. 391
APPENDIX L02 SWH VACCINE & ANTIVIRAL SECURITY/SAFETY PLAN ................................. 394
APPENDIX L03 VACCINE & ANTIVIRAL SECURITY PLAN - STORAGE ....................................... 395
APPENDIX M FUNERAL HOMES....................................................................................... 397
APPENDIX M01 SOUTH WEST HEALTH FUNERAL HOMES ....................................................... 398
APPENDIX M02 MEMO FROM NORMA BOUDREAU................................................................... 399
APPENDIX M03 FUNERAL SERVICE ASSOCIATION OF NOVA SCOTIA DISASTER RESPONSE PLAN
................................................................................................................................................. 403
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APPENDIX N ............................................................................................................................ 414
APPENDIX N01 – EMO LIASON LIST ....................................................................................... 415
APPENDIX N02 MUNICIPAL GOVERNMENT ROLES AND RESPONSIBILITIES ............................. 416
APPENDIX N03 RCMP ROLE .................................................................................................. 417
APPENDIX N04 COMMUNITY SERVICES ROLE.......................................................................... 418
APPENDIX N05 EMERGENCY HEALTH SERVICE ROLE ............................................................. 419
APPENDIX N06 FIRE DEPARTMENT ROLE ............................................................................... 420
APPENDIX N07 LOCAL NON-GOVERNMENT ORGANIZATIONS ROLE ....................................... 421
APPENDIX N08 PUBLIC WORKS ROLE ..................................................................................... 422
APPENDIX N09 UTILITIES ROLE .............................................................................................. 423
APPENDIX N10 PROVINCIAL MEDICAL OFFICER OF HEALTH ROLE ........................................ 424
APPENDIX N11 PHARMACISTS ROLE ....................................................................................... 425
APPENDIX O COMMUNITY CONTACTS ........................................................................ 426
APPENDIX O 01 NURSING HOMES, HOMES FOR THE AGED & RESIDENTIAL CARE FACILITIES 427
APPENDIX O 02 BOARDING HOMES ........................................................................................ 429
APPENDIX O 03 CONTINUING CARE CONTACTS ...................................................................... 432
APPENDIX O 04 CANADIAN CANCER SOCIETY AND RED CROSS ............................................. 433
APPENDIX O 05 DEPARTMENT OF COMMUNITY SERVICES ...................................................... 434
APPENDIX O 06 DEPARTMENT OF VETERAN’S AFFAIRS .......................................................... 435
APPENDIX O 07 VICTORIAN ORDER OF NURSES ...................................................................... 436
APPENDIX O 08 DALHOUSIE SCHOOL OF NURSING ................................................................. 437
APPENDIX O 09 DISCHARGE PLANNING PROGRAM FIRST NATIONS ........................................ 438
APPENDIX O 10 YARMOUTH CORRECTIONAL CENTRE ............................................................ 439
APPENDIX O 11 HOME OXYGEN VENDORS ............................................................................. 440
APPENDIX O 12 ACADIA FIRST NATION COMMUNITY CONTACTS ........................................... 441
APPENDIX O 13 ANNAPOLIS VALLEY BAND CONTACTS .......................................................... 442
APPENDIX PFIRST NATIONS ............................................................................................. 444
APPENDIX P01 LETTER TO DR. SCOTT ..................................................................................... 445
APPENDIX P 02 LETTER TO DR. BAILEY................................................................................... 446
APPENDIX P03 SOUTH WEST HEALTH & FIRST NATIONS PLANNING ....................................... 447
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Section 0 Introduction To
Pandemic Influenza Planning
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0.1.0.0 Acknowledgements
Much of the information provided in this plan has been acquired from various sources. These
sources include but may not be limited to: Canadian Pandemic Influenza Plan (http://www.phacaspc.gc.ca/cpip-pclcpi/index.html) and the Nova Scotia Pandemic Influenza Preparedness Plan,
February 2004.
0.2.0.0 Introduction
Annual influenza epidemics occur because the influenza virus is able to change enough to cause
infections within the general population, despite varying levels of immunity from previous
infections. New influenza viruses capable of causing pandemics in human populations arise
through antigenic shift and genetic mixing (reassortment ) between human and avian influenza
viruses. Pigs, which can be infected with both human and avian influenza viruses, may act as
vehicles for such reassortment events. In 1997 direct transmission of avian H5N1 influenza from
chickens to humans was demonstrated in the Hong Kong “bird flu” incident, indicating that
contact with pigs is not essential for human infection with an avian virus.
A pandemic is an outbreak over a large geographical area, often worldwide, with the potential to
cause serious illness, death and colossal social and economic disruption. Historic evidence
suggests that pandemics occurred 3 to 4 times per century. In the last century there have been 3
influenza pandemics (“Spanish influenza” in 1918-1919; “Asian influenza” in 1957-1958 and
“Hong Kong influenza” in 1968-1969), separated by intervals of 11 to 44 years. The Spanish Flu,
in 1918-1919, killed an estimated 30,000 to 50,000 people in Canada and 20 to 100 million
worldwide. Mortality rates were reduced in both the Asian and Hong Kong pandemics in part
because of available antibiotics for treating secondary bacterial infections. During each of the
last three pandemics, the greatest number of deaths occurred among persons less than 60 years of
age; in 1918-1919, the greatest number of deaths occurred in those 20 to 40 years of age.
The following conditions make a pandemic more likely:
• A new influenza A virus arising from a major genetic change i.e., an antigenic shift. This is
caused by major changes to the hemagglutinin surface protein and sometimes changes to the
neuraminidase surface protein.
• A susceptible population with little or no immunity
• A virus that is transmitted efficiently from person to person
• A virulent virus with the capacity to cause serious illness and death
Based on the last two pandemics, it is estimated that the next pandemic virus will be present in
Canada three months after it emerges in another part of the world, but could be much sooner due
to increases in the volume and speed of global air travel. The virus could spread across Canada
with great speed. In 1918, returning soldiers with influenza traveling on trains carried the virus
from Quebec to Vancouver within a few weeks. The first peak of illness in Canada may occur
within two to four months after the virus arrives in Canada. The first peak in mortality is
expected to be approximately one month after the peak in illness. Based on past pandemics, in
temperate climates when the pandemic virus arrives close to the usual annual influenza season
Page 10 of 448
(November to April) the interval from the arrival of the virus to the height of the epidemic can be
very short.
An influenza pandemic usually spreads in two or more waves, either in the same year or
successive influenza seasons. A second wave may occur within 3 to 9 months of the initial
outbreak wave and may cause more serious illnesses and deaths than the first. In any locality, the
length of each wave of illness is likely to be 6 to 8 weeks.
At the national level, a Canadian Contingency Plan for Pandemic Influenza has been developed.
Pandemic preparedness planning is a responsibility that is shared between the public health unit
and local emergency response agencies. Local Medical Officers of Health have been given the
responsibility of ensuring that pandemic plans are developed, tested and reviewed regularly in
the pre-pandemic period.
Upon notification that Nova Scotia may/will be impacted by a pandemic influenza, South West
Health will activate this Pandemic Influenza Plan.
Senior Management will convene a SWH Pandemic Influenza Response Team. This team will
meet regularly to share information, identify issues and send plan or recommended actions. If
the District determines that it is necessary to activate its Emergency Response Plan and sets up
the District Emergency Response Centre, it will link with this South West Health Pandemic
Influenza Response Team. Membership of the SWH Pandemic Influenza Response Team should
include the following internal and external partners:
0.3.0.0 WHO Phases
This contingency plan provides guidelines for the management of an influenza pandemic in the
South West Health. It is intended to complement the existing municipal emergency response
plans. The Canadian Pandemic Plan utilizes Phases, which correspond to the WHO (World
Health Organization) pandemic phases. The South West Health, South Shore Health and the
Annapolis Valley Health Authorities have agreed to use three divisions which incorporate the
WHO phases as follows:
0.3.1.0 Pre-pandemic
WHO Phase 0, Level 0: No indications of any novel virus subtype have been reported within or
outside Canada.
WHO Phase 0, Level 1: Novel virus detected in a person within or outside Canada. There would
be little or no immunity in the general population. Potential, but not an inevitable precursor to a
pandemic
WHO Phase 0, Level 2: Confirmation that the novel virus have infected 2 or more persons
within or outside Canada, indicating that the virus is infectious for humans.
Page 11 of 448
WHO Phase 0, Level 3: Novel virus demonstrates sustained person-to-person transmission
(within or outside Canada) with at least one outbreak over at least a 2-week period in one
country or identification of the novel virus in several countries.
0.3.2.0 Pandemic
WHO Phase 1: WHO declaration of pandemic occurs when the novel virus is causing unusually
high rates of morbidity and/or mortality in multiple, widespread geographical areas.
WHO Phase 2: Further spread of the virus with outbreaks reported in multiple geographical
areas in Canada, resulting in the first peak of morbidity and mortality.
WHO Phase 3: End of the first wave when influenza activity has stopped or reversed in initially
affected areas in Canada.
WHO Phase 4: Recrudescence of outbreaks in Canada caused by the pandemic virus (within 3-9
months in past pandemics) following the initial wave of infection; may affect a different segment
of the population.
0.3.3.0 Post Pandemic
WHO Phase 5: When influenza activity has returned to normal pre-pandemic levels and
immunity to the new virus is widespread in the general population
NOTE: Since the drafting of this document, the WHO has redrafted their phases.
Page 12 of 448
Following is a table that outlines the differences between the 1999 phases and those
published by WHO in 2005.
Page 13 of 448
Page 14 of 448
0.4.0.0
Estimated Impact of an Influenza Pandemic on Nova Scotia
The impact of the next influenza pandemic is difficult to predict, and is dependent on how
virulent the virus is, how rapidly it spreads from population to population, and the effectiveness
of prevention and response efforts. Despite the uncertainty about the magnitude of the next
pandemic, estimates of the health and economic impact remain important to aid public health
policy decisions and guide pandemic planning.
An estimate of the health and economic impact of a pandemic in Canada has been done using a
model developed by Meltzer and colleagues, CDC, Atlanta,
http://www.cdc.gov/ncidod/eid/vol5no5/meltzer.htm
The estimates according to Meltzer are:
• 75% of people will be infected
• 15% to 35% will be clinically ill
• 6.8% to 17% will require out-patient care
• 0.1% to 0.3% will require hospitalization
• 0.03 to 0.1% will die
In Nova Scotia
the estimated
impact will be: Meltzer %
Population
Infected
Clinically Ill
Out Pt Care
Hospitalization
Die
75.00%
15.00%
35.00%
6.80%
17.00%
0.10%
0.30%
0.03%
0.10%
Nova Scotia
908005
681004
136201
317802
61744
154361
908
2724
272
908
South Shore South West Nova Annapolis Valley
63370
63123
78297
47528
47342
58723
9506
9468
11745
22180
22093
27404
4309
4292
5324
10773
10731
13310
63
63
78
190
189
235
19
19
23
63
63
78
It will have a devastating effect on Canada and Nova Scotia.
The U.S. Centres for Disease Control and Prevention (CDC) has created and made available a
software program, FluAid, ( http://www2.cdc.gov/od/fluaid/), which uses the model developed
by Meltzer and colleagues to provide estimate of mortality, hospitalizations and outpatient visits
for a particular population in the event of a pandemic influenza.
FluAid is available as downloadable software or an online calculator from the above website.
The address of the home page is: http://www2..cdc.gov/od/fluaid/default.htm
Documentation and other important background papers are also available from this site.
Page 15 of 448
South West Health
Calculation of Possible Influenza Impact as per Flu Aid
0-19
20-65 ›65
Total
% of total
POPULATION
High Risk
Non-high Risk
1035
15150
16185
Attack Rates
5343
31767
37110
15%
4174
6261
10435
25%
10552
53178
63730
35%
DEATHS – Ages
0-19
0
0
4
0
0
6
0
1
8
DEATHS – Ages
20-64
2
12
22
3
19
35
4
27
50
DEATHS – Ages
›65
17
17
21
28
29
35
39
40
50
HOSPITILISATION
Ages
0-19
2
4
5
HOSPITILIZATION
Ages
20-64
13
21
30
69
75
114
125
160
175
33
54
76
46
58
76
96
106
135
HOSPITILISATION
Ages
›65
OP VISITS – Ages
0-19
1200
1436
1672
1999
2393
2787
2799
3350
3902
OP VISITS – Ages
20-64
2056
2863
4370
3426
4772
7284
4797
6681
10198
OP VISITS – Ages
›65
764
810
1274
1350
1784
6681
1257
2096
2934
13%
17%
21%
28%
29%
37%
% Present Hospital
Beds Used for Flu
% Morgue Capacity
VACCINES – For
Population 63730
75%
Uptake
70%
Uptake
4%
7%
Population
97798
Population
4461
7%
10%
11% 16%
Doses
47798
Doses
44611
16.65%
83.44%
100.00%
Hours
7966.25
Hours
735.167
FTE
4.07
FTE
5.8
Page 16 of 448
0.5.0.0 Pandemic Influenza Planning Goals
The goals of this plan are as follows:
• To reduce influenza morbidity and mortality among Canadians during an influenza
pandemic by providing access to appropriate prevention, care and treatment,
• To minimize societal disruptions and ensure essential services are maintained
0.6.0.0 Planning Assumptions
•
•
•
•
•
•
•
•
•
•
•
•
•
Based on the last two pandemics, it is estimated that the next pandemic virus will be in
Canada within 3 months after it emerges in another part of the world, but could be much
sooner due to the increases in the volume and speed of air travel
Upon arrival, the virus may spread across Canada with great speed.
The first peak of illness in Canada may occur within two to four months after the virus
arrives in Canada.
The first peak in mortality will be one month after the peak in illness.
It is believed that if the pandemic virus arrives close to the usual annual influenza season,
the time interval for the virus to have its maximum impact on the population in terms of
morbidity, mortality and societal consequences will be shortened.
A pandemic usually spreads in two or more waves, either in the same year or in
successive influenza seasons.
A second wave may occur within 3 to 9 months of the initial outbreak wave and may
cause more serious illnesses and deaths than the first.
In any locality, the length of each wave of illness is likely to be 6 to 8 weeks.
Vaccine will be the primary means of prevention of pandemic influenza. The supply may
be limited during the early stage of the pandemic, therefore priorities for vaccination will
need to be established. Vaccine when available should be distributed in an equitable
manner and Provinces/Territories should adhere to similar vaccination protocols.
A substantial number of the workforce may not be able to work for some period of time
due to illness in themselves or their family members.
Health care workers are likely to be at higher risk of illness due to their exposures.
Effective preventive and therapeutic resources will likely be in short supply
Essential community services are likely to be disrupted.
0.7.0.0 SWH Pandemic Influenza Planning
Between 2002 and 2005 a Pandemic Influenza Steering Committee and 5 working groups
prepared the first draft of the South West Health Plan. The planning process was inclusive and
many partners were educated and developed a working relationship which will help to ensure
effective response during a pandemic.
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0.7.1.0 Pandemic Influenza Steering Committee
Nan Holden, Chairperson
Holly Cottreau, Lab
Linda MacLaughlin, Infection Control
Marilyn Comeau
Marilyn Pothier, HR
Barb Lutz
Joye Gaudet
Donna Coggins
Ellen Pothier, VON
Tami Crosby, Pharmacy
Angela Marling, Materiels Management
Judy LeBlanc, Nursing
Dianne Hankinson, Home Support
Chris Newell, Support Services
Paulette Babin
Eugene Doucette, EMO
Angela LeBlanc, Risk Management
Patti Simpson, FNS
Holly Campbell
Susan Rice
Ruth DeMolitor, Continuing Care
Nancy Blackmore, Public Health
Bill Theriault
Karl White, DCS
Jannine Doucette, Red Cross
Peter Maillet, EHS
Tanya Warford
Brenda Belliveau
Paul Dawson, EHS
Keith Crosland, EMO
Harold Richardson, EMO
Barb Johnson, Communications Dir.
0.7.2.0 Surveillance Working Group
Nancy Blackmore, Public Health, Chairperson
Heather Devine
Holly Cottreau
Debbie Roberts
Sharon Houston
Holly Campbell
Linda James
Faith Stoll
Bea MacConnell
Dr. Dominique Coutere
Barb Johnson
Ruth Davis, Public Health
Peter Maillet, EHS
John Dow, Pandemic Coordinator
0.7.3.0 Vaccine – Anti-viral Working Group
Nancy Blackmore, Public Health, Chairperson
Ruth Davis, Public Health
Faith Stoll
Linda James
Dana Andrews-Cunningham
Angela Marling
Donna Braun
Bea MacConnell
Chris Newell
David Pothier
Barb Johnson, Communications
Susan Rice
Keith Crosland, EMO Controller
Beck Doucette, EMO
0.7.4.0 Emergency Preparedness Working Group
Nan Holden, Chairperson
Holly Campbell
Patti Simpson, FNS
Chris Newell
Marilyn Pothier, HR
Hubert d’Entremont
Ruth DeMolitor
Barb Johnson, Communications
Linda MacLaughlin
Nancy Blackmore, Public Health
Pauline Watt
Karl White, Community Services
Susan Rice
Jannine Doucette, Red Cross
Page 18 of 448
Keith Crosland, EMO, Zone Controller
Don Bower, EMO
Eugene Doucette, EMO
Becky Doucette, EMO
Harold Richardson, EMO
Hubert Robichaud, EMO
0.7.5.0 Health Services Working Group
Holly Campbell, Chairperson
Nicole Thimot Gennette
Holly Coutreau, Lab
Dianne Thimot Hankinson
Margaret Thibeau
Brenda Belliveau
Ellen Pothier
John Dow, Pandemic Co-ordinator
Linda MacLachlan
Ruth DeMolitor
Heather Devine
Paula Doucette
Leona Brown
Chris Newell
Patti Simpson, FNS
0.7.6.0 Influenza Treatment Clinic Working Group
Jodi Ybarra, Nancy Blackmore & Holly Campbell – Chairs
Yvonne Banks
Donna Braun
Holly Cottreau
Bill Curry
Heather Devine
David Evans
Peggy Green
Melford Haley
Susan Hazelton
Barbara Johnson
Angela Marling
Danny Moulaison
Kim Ott
Patty Simpson
Faith Stoll
Dianna Surette
Ellen Suttle
Thimot-Gennette, Nicole
Dan Wilms
Page 19 of 448
0.8.0.0
Pandemic Influenza Contingency Plan Activation
Identification of antigenic shift (A novel hemagglutinin surface protein with or without changes
in the neuraminidase surface protein) by the World Health Organization (WHO)
↓
Public Health Branch, Bureau of Infectious Diseases obtains information about the new
influenza strain from Health Canada
↓
Public Health Branch notifies Provincial Medical Officer of Health (pandemic potential is
confirmed)
↓
Provincial Medical Officer of Health notifies local Medical Officers of Health (pandemic
potential is confirmed)
↓
Local Medical Officer of Health notifies the District Health Authority’s Pandemic Influenza
Outbreak Control Team (OCT). The local plan is activated at the discretion of the District Health
Authority CEO in consultation with the Medical Officer of Health
Once pandemic influenza is imminent, it is anticipated that the District Health Authority CEO
will activate the District Health Authority’s Emergency Response Plan. As well, it is expected
that all municipalities will also need to activate their emergency response protocols. The District
Health Authority health services representative will act as a liaison between the Pandemic
Influenza Response Team and local municipality.
0.8.1.0 Legal Basis
The Medical Officer of Health determines the actions needing to be taken to protect the
population from a communicable disease as outlined the Health Protection Act.
In addition, the Medical Officer of Health has the authority to issue an order under section 32 of
the Health Protection Act with respect to a communicable disease:
“32 (1) Where a medical officer is of the opinion, upon reasonable and probable grounds, that
(a) a communicable disease exists or may exist or that there is an immediate risk of an
outbreak of a communicable disease;
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(b) the communicable disease presents a risk to the public health; and
(c) the requirements specified in the order are necessary in order to decrease or eliminate the
risk to the public health presented by the communicable disease,
the medical officer may by written order require a person to take or to refrain from taking any
action that is specified in the order in respect of a communicable disease.”
0.9.0.0
Pandemic Influenza Response Team
Health will activate this Pandemic Influenza Plan.
Senior Management will convene a SWH Pandemic Influenza Response Team. This team will
meet regularly to share information, identify issues and send plan or recommended actions. If
the District determines that it is necessary to activate its Emergency Response Plan and sets up
the DEOC, it will link with this South West Health Pandemic Influenza Response Team.
Membership of the SWH Pandemic Influenza Response Team should include the following
internal and external partners:
The SWH Pandemic Influenza Response Team will meet regularly during the Pandemic to
coordinate the district’s response.
Internal:
• Senior Management
• Infection Control
• Occupational Health
• Lab
• Public Health
• Pharmacy
• Nursing
• Support Services – Security, Environment
• Clinical Support
• Materiel Management
• Food & Nutrition
• Communication
• Human Resources
• Medical Staff
• Flu treatment Site Team Leaders
• Mental Health
External:
EHS
EMO
Home Care
LTC
Continuing Care
Community Services
Red Cross
Home Support
RCMP
VON
Funeral Homes
First Nations
Page 21 of 448
Section 1 Surveillance
Page 22 of 448
An efficient surveillance system is the cornerstone of influenza control. In the prepandemic period it provides valuable data about the incidence and impact of influenza.
Influenza surveillance can include clinical cases (ILI), laboratory confirmed cases, mortality,
outbreaks, immunization and vaccine associated adverse events.
1.0.1.0 International Surveillance
Internationally, influenza surveillance is the responsibility of the World Health Organization
(WHO).
Surveillance is reported to WHO by national Public Health authorities. National influenza
centres submit virus samples for analysis to one of three centres for antigenic and genetic
analysis. The centres identify viruses, including sub-types and evaluate drug resistant isolates
and prepare reagents for diagnosis and identification of influenza sub-types. This system allows
national immunization programs to collect information on the antigenic drift and recommend the
composition of influenza vaccines for the upcoming influenza season.
1.0.2.0 National Surveillance
The Public Health Agency of Canada maintains a national influenza surveillance program, Flu
Watch. Flu Watch provides a national picture of activity during the influenza season.
1.0.2.1 Flu Watch Program
This program is carried out by the College of Family Physicians of Canada. The Public Health
Agency of Canada, and Provincial/Territorial Departments of Health. The program provides upto-date weekly information on the presence and geographical distribution of influenza and
influenza-like-illness.
The designated Flu Watch surveillance contact in each province gives a weekly activity level of
influenza-like-illness for their province. Influenza activity is based on various indicators,
including laboratory surveillance, ILI reports, school absenteeism of >10% long-term care
reports and with anecdotal reports of respiratory activity from the community, including
emergency departments.
1.0.3.0 Provincial Surveillance
The aim of the surveillance is to detect and monitor strains of influenza virus that cause disease.
Because virus isolation is essential, it is important to maintain a network to collect specimens.
Provincial laboratories send up to five of the first isolates of the season to the National
Microbiology Laboratory of Health Canada, as early as possible, and 10% of subsequent isolates.
Page 23 of 448
They also send isolates from distinct outbreaks, unusual late season activity and strains with
inconclusive results. Nova Scotia participates in the Flu Watch Program. Public Health officials
use the confirmation to implement prevention and control strategies. LTC facilities, ER’s and
schools are used as part of an informal surveillance system. This could be expanded to include
community colleges, boarding schools, universities, day cares, prisons and large work sites.
Between pandemics the aim of the surveillance is to detect, as soon as possible, strains of
influenza virus that cause disease and then to monitor them. Because virus isolation is essential,
it is important to maintain a network through which specimens can be systematically collected.
Provincial laboratories send up to five of the first isolates of the season to the National
Microbiology Laboratory of Health Canada, as early as possible, and 10% of subsequent isolates.
As well, they send isolates from distinct outbreaks or unusual late season activity and any strains
that show inconclusive results.
1.0.3.1 Laboratory Influenza Surveillance Program (LISP)
Nova Scotia’s Laboratory Influenza Surveillance Program monitors epidemiologic and serologic
trends in culture-confirmed influenza illness. The program is a partnership between the Nova
Scotia Department of Health, Public Health Services, the QE II laboratory and the IWK labs.
The National Microbiology Laboratory of Health Canada coordinates the provision of diagnostic
reagents to provincial laboratories and regularly tests the influenza diagnostic capabilities of
these laboratories (proficiency testing). Provincial Laboratories isolate the viruses, and the
National Microbiology lab. of Health Canada confirms the identification, does strain sub-typing
and sends representative virus isolates received early in the season to the WHO reference
laboratory, U.S. Centres for Disease Control and Prevention, for strain confirmation and further
analysis.
1.1.0.0 Pre-Pandemic Period
The aim is to detect novel strains of influenza as soon as possible. Surveillance throughout the
influenza season (November to March) provides a picture of the influenza activity.
1.1.1.0 Definition of Illness and Reporting Requirements
Cases of influenza meeting the following case definition must be reported to the Medical Officer
of Health under the Health Act and the Health Protection Act.
1.1.1.1 Health Protection Act Section 31:
NOTIFIABLE DISEASES OR CONDITIONS
31 (1) A physician, a registered nurse licensed pursuant to the Registered Nurses Act or a
medical laboratory technologist licensed pursuant to the Medical Laboratory Technology Act
who has reasonable and probable grounds to believe that a person
Page 24 of 448
(a) has or may have a notifiable disease or condition; or
(b) has had a notifiable disease or condition, shall forthwith report that belief to a medical
officer.
1.1.1.2 Health Act Regulations:
Communicable Diseases Regulations
made under Section 12 of the Health Act R.S.N.S. 1989, c. 195
May 14, 1957, N.S. Reg. 28/57
as amended up to O.I.C. 2003-143 (April 1, 2003), N.S. Reg. 79/2003
Notifiable diseases reportable by attending physician to local health authority include
Influenza (lab. Diagnosis), and Influenza - suspect in long term care.
1.1.1.3 ILI in the general population:
Acute onset of respiratory illness with fever and cough and with one or more of the
following - sore throat, arthralgia, myalgia, or prostration which could be due to influenza
virus. In children under 5, gastrointestinal symptoms may also be present. In patients
under 5 or 65 and older, fever may not be prominent.
1.1.1.4 Definitions of ILI/Influenza outbreaks
Schools and work sites: greater than 10% absenteeism on any day most likely due to
ILI. Residential institutions including LTC: two or more cases of ILI within a sevenday period, including at least one laboratory confirmed case. Institutional outbreaks
should be reported within 24 hours of identification.
1.1.2.0 The Medical Officer of Health
[MOH] is available 24 hours a day, 7 days a week contact information see Appendix C 01.
1.1.3.0 Surveillance Responsibility
1.1.3.1 Reporting
All surveillance collected in the DHA is forwarded on a weekly basis to the local Communicable
Disease Prevention and Control [CDPC] Nurse or back up. The surveillance for the district is
collated and forwarded to the CDPC Manager and copied to the Directors, Communication or
Page 25 of 448
Public Affairs of the DHA. In the absence of the CDPC manager, all surveillance is to be
forwarded to the Biological Coordinator in the same office as the CDPC Manager for forwarding
to the Department of Health, via the Provincial Medical of Health Office [PMOH].
• In SWH, all surveillance is to be forwarded to the CDPC Nurse
• See Appendix A01 Contact Information
1.1.4.0 Surveillance Strategies
1.1.4.1 Sentinel Physician:
The College of Family Physicians of Canada (CFPC) recruits sentinel physicians throughout the
country. In NS, the goal is to have one GP per county. Sentinel physicians collect
nasopharyngeal specimens from symptomatic patients on designated days of the week and
submit the specimens for testing and sub-typing. They also provide the ILI rate observed in their
offices on the designated day to Health Canada for the weekly Flu Watch report.
1.1.4.2 School Absenteeism:
Normal influenza activity: Each year, the local Communicable Disease Prevention and Control
Nurse sends out letters to all schools reminding them to report school absenteeism in excess of
10%. After there is an indication that a pandemic is imminent either by declaration from WHO,
Health Canada or the PMOH, another letter will be sent to each school advising them of the
pending pandemic and reminding them of the importance and urgency of reporting absenteeism
in excess of 10%. The sample letter to be sent to all schools in the event of a pandemic will be
found in Appendix A04 (pending).
1.1.4.3 Child Care Centres:
All child care centres in Nova Scotia are obliged to report absenteeism of 10% to the local CDPC
Nurse according to specific guidelines outlined in CDC strategies for Child Care Centres. This is
reported regardless of illness suspected, e.g. respiratory, gastrointestinal. After there is an
indication that a pandemic is imminent, a letter will be sent to each child care centre advising
them of the pending pandemic and reminding them of the importance and urgency of reporting
10% absenteeism as soon as it is noted. The sample letter to be sent to all childcare centres will
be found in Appendix A05 (pending).
1.1.4.4 Long-Term Care Facilities
Person[s] responsible: CDPC Nurses and LTC administration staff
o In SWH, the following LTCs participate in Flu Watch:
o Nakile Home for Special Care
o Roseway Manor
o Surf Lodge Community Continuing Care Centre
o Tidalview Manor
o Tideview Terrace
Page 26 of 448
o Villa Acadienne
o Villa St. Joseph du Lac
Investigation of Outbreaks and Clusters of Influenza-like Illness (ILI) in Long Term Care
Long Term Care [LTC]:
Case definition:
Any two of the following: fever (a single temperature of 38 C taken at any site), chills, new
headache or eye pain, myalgia, malaise or loss of appetite, sore throat, new or increased cough.
It is important to note that the elderly may not have a fever with influenza-like illness.
Cluster of acute respiratory illness
A cluster of acute respiratory illness should be considered when two or more residents develop
acute respiratory illness within 72 hours of each other
Suspect an outbreak when you have a cluster of acute respiratory illness, (two or more residents
who develop acute respiratory illness within 72 hours of each other) during influenza season
(November to April). Staff may also have influenza-like illness.
The identification of two residents with laboratory confirmed influenza suggests that influenza is
being transmitted in the facility. If in doubt about the possibility of a cluster of respiratory
illness, discuss the situation with Public Health Services [PHS].
Review the current Guide to Influenza for Long Term Care Facilities for more info. This
document is sent to all LTCs in Nova Scotia each year at the beginning of each flu season and
guides the specimen collection, identification, notification and management of an annual
influenza outbreak in LTC.
Response to influenza in long term care
Normal influenza activity:
During the normal influenza season, the local CDPC Nurse contacts Each Long Term Care
facility in each DHA each week to review any respiratory among residents in the previous week.
Any activity reported is part of the LTC surveillance information submitted to the CDPC
Manager. If there is any suspect respiratory activity, the management process is directed by the
annual Guide to Influenza for Long Term Care Facilities. The annual Flu guide guides the
notification of the MOH, submission of line listings, specimen collection, identification,
notification and management of an annual influenza outbreak in LTC.
Pre-pandemic activity: Surveillance for outbreaks in institutions will be enhanced. All nursing
homes, LTCF's, retirement homes and hospitals will be advised to obtain appropriate specimens
Page 27 of 448
for viral culture and report any cases of ILI to the Medical Officer of Health immediately. Line
listings of all active cases among residents and staff are to be faxed to the MOH and the local
CDPC Nurse, detailing the number of cases and epidemiological info, including symptoms, onset
etc. The local CDPC Nurse will contact the Long Term Care facilities each week or daily as
directed to review any respiratory illness among residents in the previous week/day. [Alternate
possibility: The LTC will complete the weekly/daily surveillance tally form and fax it to their
local Communicable Disease Prevention and Control Nurse.
See Appendix A02 & 03 for surveillance forms.
[Note: the weekly/daily surveillance tally sheet is being designed now, would be included
as an appendix and it is planned to pilot the use of this form this influenza season in some
or all LTCs. This tally would indicate whether there was any ILI activity and if there were
an outbreak occurring, it would also provide information on morbidity and mortality.]
Reported ILI activity, is part of the weekly/daily surveillance information submitted to the CDPC
Manager and VP of Communications. If there is any suspect respiratory activity, the outbreak
management process is directed by the Medical Officer of Health, and LTC pandemic
contingency plans that each LTC should have complete as part of their emergency response plans
1.1.4.5 Industrial Workplace Surveillance:
Large employers in each DHA participate in weekly flu watch activity. PHS sends a letter each
year to the employers requesting their assistance with surveillance. Those employers who are
willing send a letter to employees each influenza season, with a flu fact sheet provided by the
CDPC Nurse. The letter requests that those experiencing influenza like illness report to the
employer’s occupational health services office (letters – Appendix A03). Employees are assured
that only numerical information will be shared outside of the employer’s occupational health
office. The CDPC Nurse contacts the occupational health office early each week and requests
employee absenteeism rates believed to be due to self –reported ILI form the previous week. The
occupational health service staff document their influenza activity on a tally sheet (Appendix C
03).
When it appears that a pandemic is imminent, the participating employers will be advised of this
by letter from the CDPC Nurse from PHS, and requested to assist with pandemic influenza
surveillance. The letter to employers also provides direction for employees seeking medical
attention due to ILI. Fact sheets will be attached to the letter. As well as assisting the DHA
gather surveillance information, the letter would alert the employer to activate their contingency
plan for managing their workplace during a pandemic with the anticipated high rates of
absenteeism.
The participating employers in the South West Health are listed below:
Register Dot.Com, Hebron Industrial Park, Yarmouth County
See Appendix A01 for contact information
Page 28 of 448
1.1.4.6 Emergency Departments
Infection Prevention & Control staff at each site conduct weekly surveillance October-May
yearly during Influenza Season. OPD records are reviewed one day/week for those that meet the
case definition for ILI. Rates are documented on the Shared District IC Directory. Data is
monitored for trends in collaboration with PHS who monitor LTC facilities and schools in the
District.
The ER surveillance procedure will be detailed and provided by each DHA As well as
numerical info, they will be collecting epidemiological info, e.g. age, gender, symptoms etc.
A SRI (Severe Respiratory Illness) Form is completed on all patients admitted with a respiratory
illness. If managers note note an increase in numbers of staff reporting ill, the OHN at the site is
advised. Staff will be requested to contact the OHN and a Line Listing will be starting.
1.1.4.7 Communication with District Laboratories
Lab Managers in the DHA have participated in pandemic planning and have submitted standard
operations plans, as well as their own contingency plans detailing what they will continue to
provide, what they will need to set aside as elective during a pandemic, how they will provide
service and how they will have critical flu swabs moved to the QE11 lab for confirmation during
a pandemic. These plans are included as Appendix F.
1.1.4.8 Surveillance Linkages
1.1.5.1 Infectious disease specialists
Contact can be made with the Infectious Disease Specialists @ the QE11 by calling the QE11
locating service @ 473-2222 and asking for the ID Specialist available.
1.1.5.0 Investigations of Outbreaks
1.1.6.0 Surveillance reporting process:
The following submit their surveillance daily or weekly as advised to the local Communicable
Disease Prevention and Control Nurse:
• Acute Care:
o ERs @ each hospital
o Flu treatment clinics
Page 29 of 448
•
•
•
•
o OHNs or HR [employee ILI activity]
LTCs
Child Care Centres
Schools
Participating Industrial Workplaces
Submitted surveillance includes information on the level of influenza like illness activity, with
epidemiological information on any cases, including age, gender, symptoms, outcomes, etc.
The CDPC Nurse will compile the weekly or daily surveillance tally and forward it electronically
to the CDPC Manger [or designated biological administrator in the same office] and to the
DHADIR of Communications. The CDPC Manager will compile the 3 DHA reports and forward
it to the PMOH. The DHA Directors, Communications (SSH & SWN) or Public Affairs (AVH)
will distribute the surveillance tally to all partners. The full description of this should be included
in the Communication plan see 2.4.0.0.
1.2.0.0 Pandemic Period
Surveillance
When global surveillance indicates a novel influenza strain showing antigenic shift, Health
Canada will obtain information about the strain. As soon as appropriate diagnostic reagents are
available, provincial and national laboratories will test for the novel strain. Surveillance for ILI
and outbreaks will be stepped up. The provincial, territorial and district health officials will alert
clinicians to report any clusters and submit appropriate specimens for virus culture.
Non-specific indicators of influenza activity, such as rates of illness and death, should be
interpreted cautiously since increased awareness can lead to increased reporting. The use of
influenza vaccine in different target groups, different areas and the occurrence of adverse
reactions should be closely monitored.
1.2.1.0 Laboratory Diagnostics
At the onset of a pandemic, the National Microbiology Laboratory of Health Canada will obtain
the new virus for antigenic analysis and classification and inform public health laboratories of
the new strain’s growth requirements providing appropriate diagnostic reagents.
Special Studies
The National Pandemic Influenza Committee makes recommendations for any targeted studies to
better monitor and define the pandemic. Such studies could include:
Susceptibility testing for different populations
Clinical trials of vaccines or antiviral drugs
The monitoring of bacterial infections secondary to influenza infection to identify the
most common organisms responsible and the best antibiotic treatments
Page 30 of 448
Assessments of the effectiveness of antiviral drugs in nursing home populations
The impact of the pandemic on health care staff and the delivery of services
The efficacy of vaccination
1.2.2.0 Novel Virus detected outside North America (Pandemic Potential)
The National Microbiology Laboratory of Health Canada will obtain information about any new
influenza strain that shows antigenic shift, including its ability to cause human disease, and about
the responses of the countries involved. When pandemic influenza has been identified outside of
North America, pre-pandemic surveillance strategies will remain in place (refer to 0.1.
Surveillance) and be intensified in the following ways.
1.2.2.1 Surveillance Strategies – South West Health
The Medical Officer of Health & Chair of the Pandemic Influenza Steering Committee will
assemble the Pandemic Influenza Response Team to review the major elements of the plan.
Nursing homes, Long Term Care Facilities and hospitals will closely monitor all individuals with
respiratory tract infections and carry out specimen collections on Persons meeting the case
definition (outlined in Definition of Illness and Reporting Requirements).
Physicians will obtain laboratory specimens from all persons traveling from geographic areas in
which the novel strain has been isolated and who are presenting with clinically compatible signs
and symptoms.
As well Physicians will obtain laboratory specimens from family members and close contacts of
those persons traveling from geographic areas in which the novel strain has been isolated and
who are presenting with clinically compatible signs and symptoms.
The Occupational Health Staff at each facility are responsible to ensure the collection of
information on staff with ILI. The process for the collection and submission of staff surveillance
information is as follows.
“SWH Staff Respiratory Line Listing Forms” will be issued to all who normally take “sick” calls
from employees. They will collect the information from any staff reporting ill to complete the
form.
Until our pandemic “Hot Line” is established, at the end of each day (1500 hours) all line listing
information from the previous 24 hours should be forwarded to the Human Resources
Administrative Assistant for the compilation of the SWH Daily Summary Worksheet. The
Human Resources Administrative Assistant will then forward the completed SWH Daily
Summary Worksheet to Public Health, Attention CDPC Nurse @ fax # 742-6062.
Page 31 of 448
After the “Hot Line” is established the intake person on that line will complete the SWH Staff
Respiratory Line Listing Forms. At the end of each day (1500 hours) all line listing information
from the previous 24 hours will be compiled and transferred to the SWH Daily Summary
Worksheet. This sheet will then be forwarded to the SWH Daily Summary Worksheet. This
sheet will then be forwarded to Public Health, Attention CDPC Nurse at fax # 742-6062 by the
Hot Line intake person.
If you have questions about completing this work sheet you may call:
Human Resources
Occupational Health -
Yarmouth
Yarmouth
Shelburne
Digby
742-3542 ext. 307.
742-3542 ext. 340
875-3011 ext. 252
245-2502 ext. 3222
Bulletins on national surveillance from the CDC, WHO and PHAC regarding the virological,
epidemiological and clinical findings associated with the new virus will be monitored on a daily
basis and disseminated where appropriate.
1.2.3.0 Novel Virus Detected in North America (Pandemic Imminent)
Once the pandemic strain of influenza reaches North America it will be essential to track the
spread of the disease. The surveillance tasks outlined in 1.1. will continue and be intensified in
the following ways:
1.2.3.1 Surveillance Strategies
The Pandemic Influenza Response Team will meet weekly to review the influenza activity.
Influenza activity will be classified as one of the following categories 0 through 3.
(0) No activity
(1) Sporadic activity: Sporadically occurring influenza-like illness or laboratory
confirmed influenza with no outbreaks detected.
(2) Localized outbreaks: Outbreaks affecting a single geographical area within the Health
Unit jurisdiction (for example: an outbreak in a single nursing home).
(3) Widespread outbreaks: Outbreaks affecting multiple and non-adjacent areas within
the Health Unit jurisdiction.
Local sentinel physicians will obtain viral specimens from patients presenting with influenza-like
illness. All specimens from patients presenting with influenza-like illness will be processed as a
priority.
Surveillance for outbreaks in institutions will be enhanced. All nursing homes, LTCF's,
retirement homes and hospitals will be advised to obtain appropriate specimens for viral culture
and report any cases of ILI to the Medical Officer of Health immediately.
Page 32 of 448
Notices will be sent to all schools, day nurseries and large businesses encouraging reports of
absenteeism rates greater than 10% to the Medical Officer of Health.
1.2.4.0 Pandemic Influenza Virus Detected Locally
Surveillance Strategies
Once the pandemic influenza virus has reached South Shore, South West Nova and Annapolis
Valley District Health Authorities, the surveillance actions outlined in 1.2.1. will continue and be
intensified in the following ways:
The Pandemic Influenza Response Team will meet daily as necessary.
Local epidemiological data will be accumulated and reported daily to the Pandemic Influenza
Control Team and disseminated to appropriate stakeholders, including: laboratories, hospitals,
emergency rooms, poison control and long term care facilities
1.2.4.1 Surveillance during a Pandemic
In the Emergency Departments
In the Triage room:
• The triage RN uses the Daily Surveillance Tally Worksheet (Appendix C08) for ILI,
and records Health Card number of patient, relevant symptoms, immunization status,
onset, and age; the RN keeps a running tally.
• When the Daily Surveillance Tally Worksheets are full, they are inserted in a binder
in the triage room.
• A new Daily Surveillance Tally Worksheet is started every midnight, whether the
sheet is full or not.
• The Daily Surveillance Worksheets are accessible to the Infection Control
Practitioner, or designate, within the facility.
In the Emergency Room or Observation Room:
•
•
The RN, who initially triages the patient upon arrival to the Emergency Department,
will document patient on the Daily Surveillance Tally Worksheet as written above.
The Daily Surveillance Tally Worksheets will be updated by the RN who is in charge
of the patient after initial Triage and/or the RN in charge of the patient at the time of
disposition of the patient, regarding admission, discharge, tansfer or referral
information.
The Ward Clerk (or designate):
•
The ward clerk collects the Daily Surveillance Tally Worksheets first thing in the
morning and adds any additional information that is missing such as admission,
referral, transfer, or discharge status.
Page 33 of 448
•
•
The ward clerk uses the Daily Surveillance Tally Worksheets to complete the
Surveillance Date Summary Worksheet (Appendix A08) and then faxes (902-7426062) the completed worksheet to the CDC nurse in Public Health every morning.
Both the Daily Surveillance Tally Worksheet and the original Surveillance Data
Summary Worksheet will remain in a binder in the Emergency Department. Also see
Letter to managers re Employee Absenteeism for ILI (Appendix A09), Staff
Respiratory Illness Line Listing (Appendix A10).
1.3.0.0 Post-Pandemic Period
1.3.1.1 Surveillance
Surveillance activities will resume.
1.3.1.2 Laboratory Diagnostics
Post-pandemic, the National Microbiology Laboratory of Health Canada will summarize the
laboratory experiences during the pandemic and will stock pandemic strains.
1.3.1.3 Special Studies
The Pandemic Influenza Committee makes recommendations for any studies that would assist in
their conducting evaluations of the pandemic influenza response capacity.
1.3.1.4 Evaluation
Evaluate the SWH Pandemic Influenza Planning & Response Teams surveillance system and the
health system response.
Prepare for second wave.
Page 34 of 448
Section 2 Communication
Page 35 of 448
2.0.1.0 Goal
To deliver timely, accurate and relevant information to staff, physicians, board members,
volunteers, patients, emergency services personnel, media, partners and the residents of
Shelburne, Yarmouth and Digby Counties before, during and after a pandemic.
2.0.2.0 Objectives
•
•
•
•
To co-ordinate consistent messages at all levels
To minimize panic and confusion during a crisis
To identify, manage and track emerging issues
To support and facilitate the development of a communication infrastructure that ensures
relevant information reaches appropriate audiences as accurately and quickly as possible
2.0.3.0 Principles
•
•
•
•
Essential information is promptly distributed through multiple mechanisms.
Information must be clear and consistent.
All communications activities should be developed to ensure public confidence and
minimize confusion and anxiety
Media are essential partners in the delivery of relevant information to our publics
2.0.4.0 Spokespersons
The Department of Health and Province’s Medical Officer of Health will lead Nova Scotia’s
communications response to pandemic.
For general information related to District planning activities and health services, the CEO,
Communications Director (or designates) and Infection Control Practitioners are the preferred
spokespersons for South West Health.
The Medical Officer of Health, Medical Director or designated physicians will provide medical
expertise for the District.
2.0.5.0 Policy for handling media enquiries during a Pandemic
During a pandemic, all media enquiries will be directed to the Communications Director or
assigned designates. (See roles and responsibilities of Communications Team).
Page 36 of 448
2.0.6.0 Audiences
Internal
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Staff
Physicians
Volunteers, Foundations and
Auxiliaries
Community Health Boards
Board Members
Patients and Families
Unions
Security
DoH
Other district health authorites
OH&S Committee
District Disaster Committee
Renters (ex Hearing and Speech,
Stroke Project)
EMO (RCMP/Town Police,
Municipal Units, Red Cross
Fire Departments, Community
Services)
EHS
Community Pharmacists
Pandemic Planning Committee
Members
Long Term Care
Home Care
VON
Suppliers, Contractors, Vendors
External
•
•
•
•
•
•
Public
Media
School Boards
MLAs/MPs
Community Supports (Clergy,
Family & Children’s Services,
Funeral Directors)
Government Departments (Dept of
Environment, Public Works &
Transportation)
Page 37 of 448
2.1.0.0 Pre-Pandemic
Sharing of timely and accurate information among health care professionals, the media and the
general public will be an important part of the pandemic response. It is essential that
communication networks be established during the pre-pandemic period.
Goals
•
•
•
•
•
To develop a general level of awareness and understanding about the possibility of a flu
pandemic
To establish active communication links with all partners
To inform all audiences that planning activities are underway
To educate the media
To educate health care providers about their roles and responsibilities during a pandemic
2.1.2.0 Messages
•
A Pandemic Influenza is basically a worldwide outbreak of a new and especially strong
flu virus that will cause more widespread and severe illness than the regular flu season. It
will place a huge strain on health and community resources.
•
NO ONE knows when the next pandemic will occur, but historically, flu pandemics have
occurred every 30 years. It has been more than 30 years since the last pandemic - the
Hong Kong Flu in 1968. Many health professionals believe that we are overdue. That’s
why health care organizations around the world have been preparing for the possibility of
a flu pandemic.
•
South West Health continues to work with a wide variety of community partners
including the Emergency Measures Organization, Emergency Medical Services,
Community Services and Municipal Units to develop plans that would help us manage
and maintain essential services during a pandemic to help our family, friends and
neighbours.
•
Our Plan is consistent with Health Canada’s Influenza Pandemic Preparedness and
Response Plan and Nova Scotia’s current planning activities and is intended to reduce the
impact on our community.
•
Influenza clinics will be established in schools to treat people with influenza and to ensure
that hospitals are available to treat emergencies and those who are most ill.
Page 38 of 448
2.2.0.0 During Pandemic
2.2.1.0. Goals:
•
•
•
•
•
To define the situation and provide an explanation of the expected impacts on the
organization and the community
To ensure a consistent, accurate source of information
To help reduce panic and confusion
To ensure health care providers have the information they need to maintain essential
services and deliver care in a safe and supportive environment.
To provide residents of Shelburne, Yarmouth and Digby Counties with the information
they need to make informed decision ie self care, seeking medical treatment, supporting
family, friends and neighbours
2.2.2.0 Messages (To be developed during the pandemic)
Getting medical help:
• Do not go to the hospital if you have the flu, go to the nearest influenza treatment clinic.
Expert care will be available for you at the influenza treatment clinic.
• The following schools have been identified as influenza treatment clinics…
• Our goal is to maintain hospital services for those who are most ill, please seek medical
help at an influenza treatment clinic.
Availability of health services:
• RH, DGH and YRH are closed to all visitors. If you need to visit for compassionate
reasons contact (to be determined at the time).
• Elective surgeries and procedures.
• Hospitals closed to all but emergencies?
• If in doubt, call first before coming to the hospital.
Tips to avoid flu:
• Avoid close contact with people who are coughing and sneezing.
• Avoid crowds, where you will be in close contact with people who might have influenza.
• Wash your hands thoroughly before and after touching your eyes, mouth or nose.
• Eat a healthy diet and get plenty of sleep.
If you have the flu:
• Rest and drink plenty of fluids.
• Take acetaminophen or ibuprofen, if needed, for aches and pains. Note: Children and
teenagers with influenza SHOULD NOT take ASA (aspirin), as this has been linked to the
development of Reye’s Syndrome, a serious condition affecting the brain and liver.
• Avoid contact with others, especially people who have lower resistance to infections, eg.
those with cancer, chronic heart/lung disease, seniors and young children – remember
you are contagious from 24 hours before to 3-5 days after peak symptoms appear.
• Cover your cough and dispose of tissues immediately.
Page 39 of 448
•
Wash your hands often – handwashing is the most important way of preventing the
spread of germs.
People with flu symptoms sometimes develop other serious infections, such as pneumonia,
bronchitis, sinusitis or ear infection. You should consult your doctor (or influenza clinic)
immediately if:
• You are coughing up thick, coloured or bloody mucous
• You have symptoms such as recurring fever, chest pain, facial swelling, severe pain in
the face or forehead or earache.
•
•
•
•
•
•
•
Managing Flu at Home
Influenza treatment clinics (where & when to seek treatment)
Vaccination (who and where)
Seeking medical attention
Cancellation of services
Patient visitor status
Staff Reporting ( how to report to work, illness or absenteeism)
More information is available …. Provincial toll-free phone number (about Pandemic)
Information and Referral Line (about local services)
(The Information and Referral Line will be answered by someone who is familiar with the
District’s Pandemic Plan and is able to respond to general inquiries of the public such as service
availability and visitor status, or direct callers to the appropriate source.)
Counseling Supports are available (public – There is a service available to help people cope with
the stress and fear etc. can get counseling support from clergy, family physician, mental health
services, staff/physicians – can access counseling support from same groups as public and OHN
& EAP)
Help each other – check on neighbors that might need help, volunteer, etc.
2.3.1.0 Goals:
•
•
•
To recognize the support and co-operation of health care providers, volunteers and
community members in managing the pandemic response.
To inform the public about the expected second wave
Re-evaluate and update the communications plan
Page 40 of 448
2.3.2.0 Messages:
•
•
•
•
This has been an extremely challenging time for our staff and our community.
We appreciate the help and support our community partners for their cooperation, patience
and sense of volunteerism during this time
We know it has been particularly difficult for our staff who have gone over and above the
call of duty to ensure we were able to care for our community, even while facing their
own personal struggles.
We welcome your input and suggestions as we prepare for the next outbreak.
Page 41 of 448
2.4.0.0 Pandemic Tools Matrix
Pre-Pandemic
Pandemic Tools Matrix
Methods of Distribution: Internal Mail, Bulletins Boards, District Websites, Newsletters, Media, Teleconference Calls, Face-to-face, Information Lines
Letters to
Employers
Poster
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Distributed By
Responsibility
of
Employers
Major
MLAs/MPs
Municipal
Govt.
School Boards
Community
Supports
Media
Gen. Public
Red Cross
X
X
X
X
VON
X
Pharmacists
X
X
Renters
Dis. Disaster
Comm.
X
X
DHAs
Unions
Patients &
Families
Red Cross
EHS
EMO
Security
Letters to the
editor
Memos to Staff
Education
sessions
Newsletter
Articles
Newspaper
Articles
Fact Sheets for
Health Care
Workers
Q&A
PowerPoint
Presentation to
Community
Editorial Board
Long-term
care
Healthcare
Professional
Tool
District Board
Long Term
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Page 42 of 448
Pre-Pandemic
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Distributed By
X
X
X
X
X
Responsibility of
X
X
X
X
X
MLAs/MPs
X
X
X
Municipal Govt.
X
X
School Boards
X
X
X
X
X
X
Community
Supports
X
X
Media
X
X
Gen. Public
X
X
X
X
Red Cross
X
X
X
X
VON
X
X
X
X
X
X
Pharmacists
X
X
X
X
Renters
X
X
X
X
DHAs
Unions
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Dis. Disaster
Comm.
Security
X
EHS
Patients &
Families
Long-term care
X
EMO
Memos
Letters to GP/ERs
Fact Sheets
Q & As
News coverage
PSAs
General
Preventive
Measures
Posters
Status Reports
Staff Information
Line
Public
Information Line
District Board
Healthcare
Professional
Tool
Red Cross
Short Term
X
X
X
X
Page 43 of 448
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Distributed By
X
X
X
X
X
X
Responsibility
of
X
X
X
MLAs/MPs
X
X
X
Municipal
Govt.
X
X
X
School Boards
X
X
X
X
Community
Supports
X
X
X
Media
X
X
Gen. Public
X
X
X
Red Cross
DHAs
X
X
X
VON
Dis. Disaster
Comm.
X
X
X
Pharmacists
Unions
X
X
Renters
Security
X
X
X
X
Patients &
Families
X
X
Red Cross
X
EHS
Long-term
care
X
EMO
Regular Briefings
Regular Status
Reports
Prevention and
Self Care
Dealing with
Stress
Q & A for staff
Q & A for public
Fact sheets on
vaccine
Phone Messages
Patient Updates
re: Visitors
Overhead Page
Critical Incident
Stress
management
Website
HR Policies
District Board
Tool
Healthcare
Professional
Pandemic
Page 44 of 448
Prepare of tools
for second
Revise the tools
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Distributed By
X
Responsibility
of
X
MLAs/MPs
X
Municipal
Govt.
X
School Boards
X
X
X
X
Community
Supports
X
X
X
X
Media
X
X
X
X
Gen. Public
X
X
Red Cross
X
X
VON
X
X
Pharmacists
X
Renters
X
X
DHAs
X
Dis. Disaster
Comm.
X
X
Unions
X
Security
X
X
Patients &
Families
Red Cross
EHS
Long-term
care
EMO
Debriefing
Critical Stress
Management
Q&A
Evaluation
District Board
Tool
Healthcare
Professional
Post Pandemic
X
Page 45 of 448
2.5.0.0 Crisis Communication Team: Roles and Responsibilities
(excerpt from the District Crisis Communication Plan)
During a pandemic, the communications office at YRH will be designated as the work area for
the Communications Team
Communications Director
• Selects and prepares spokesperson
• Advises management and the Disaster Crisis Team of appropriate responses
• Writes response
• Works with the spokesperson to anticipate difficult questions and answers
• Analyzes the outcome
• Main liaison with media
• Prepares information for public distribution
• Collects data from technical experts and translates into layman’s terms
• Prepares and distributes news releases and staff/patient information
• Prepares responses for the Rumor Control Officer
Potential recruits if the Communications Director is unavailable: A member of the Sr.
Management team or Patti Simpson/Kevin Vickery
Information Officer (designated during a crisis)
• Directs media calls to the Communications Director and official spokesperson
• Is stationed in the media room and escorts the media to interviews or on-site photo
opportunities
Potential recruits: Paulette Sweeney-Goodwin, Yarmouth Hospital Foundation
Rumor Control Officer (designated during a crisis)
• Ensures all radio and television items are recorded and newspaper articles are clipped and
logged (see media report sheet)
• Monitor news coverage for content and identify areas that require clarification
• Meets regularly to discuss issues with the Communications Director
• Manages special telephone lines
• Records rumors and ensures they are quickly delivered to the Communications Director
(see rumor control form)
Potential recruit: Nicole Delaney, Site Secretary
Security Liaison Officer (designated during a crisis)
• Ensures only credentialed media gain entrance to the facility and the onsite media room
• Records the name and media outlet of media when IDs are issued
• Accompanies media at all times until the information officer takes over either the media
room or as the reporter is escorted to an interview
• Capable of handling the media in a polite but firm manner
Potential Recruit: Chris Newell, Director of Environmental Services
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Family Liaison Officer (designated during a crisis by Communications Director or Disaster
Team)
• Assists family members who are waiting on-site
• Ensures that new information is communicated to waiting family members
• Arranges social work and pastoral care assistance
• Accompanies family members to visit with the patient
Potential recruits: A Minister for each site.
Community Leader Liaison (designated during a crisis from the Sr. Management team)
• Ensures local and provincial government officials and community leaders are informed
during a crisis
• Uses information prepared by the Communications Director, does not speculate
• Monitors community leaders and government officials reactions and addresses
misinformation
Potential Recruits: A member of the Sr. Management team.
Runners (designated during a crisis)
• Handle phone calls
• Send faxes
• Distributes copies of news releases and patient information to switchboard, information
desk, staff, physicians, volunteers, disaster team and rumor control officer, as directed by
the Communications Director or Information Officer.
• Supports the communications team as required
Potential recruits: Business office staff
Special Considerations
Designate special telephone lines (One for staff and a separate one for public enquiries.)
The event may not require the full communication team in action, determination will be made
closer to the event.
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2.6.0.0 After hours media contact information:
Radio
Some information has been removed from the public copy to protect confidentiality.
CJLS Radio
Inside Booth – (5 a.m. to 6 p.m. week days, 8 a.m. to 6 p.m. Saturday & 1 p.m. to 6:00 p.m.
Sunday)
Ray Zinck (residence) –
Gerry Boudreau (residence) –
Chris Perry (residence) –
Gary Nickerson (residence) –
CKBW Radio
Newsroom Phone – 543-2401
Sheldon MacLeod (residence) –
AVR Radio
Phone – 678-2111/1113, 678-7857, 678-6397
CBC Radio
News phone – 420-4357
Metro Radio Group (Q104, SUN FM, KIXX, CJCH/C100)
Phone: 453-1000
Fax: 453-3120
Newspapers
Chronicle Herald
Brian Medel (residence) –
Weekly newspapers can be contacted during business hours (Yarmouth Vanguard, Shelburne
Coast Guard and Digby Courier).
Media Monitoring Companies
In the case of intense media coverage, a media monitoring company should be hired to monitor
TV, radio and print media.
Mediascan Canada Inc./Bowden’s Media Monitoring
Phone: 902-422-9200
NewsWatch
Phone: 902-455-7241
1-888-414-6397
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Television
Eastlink:
News Division
Ph: 446-6397
Fax: 446-3292
Email: eastlinknews@eastlink.ca
Or eastlinkmagazine@eastlink.ca
Shelburne and Barrington Passage
Reporter: Dan Peacock
Phone: 875-1267
Fax: 875-4219
Email: dpeacock@corp.eastlink.ca
Yarmouth and Pubnico
Producer: Michael MacDonald
Assistant Producer: Peter Muise
Phone: 742-0936
Fax: 742-6259
Email: m.macdonald@corp.eastlink.ca
Sabina Capaldi –PSAs
scapaldi@eastlink.ca
453-5714
ATV/ASN
Phone: 454 – 3200
Fax: 454-3280
CBC TV/Halifax
Phone: 420-8311
Fax: 420-4137
CBC TV/Yarmouth
tba
Cell phone:
CBC Newsworld
Phone: 420-4024
Fax: 420-4034
CTV
Phone: 422-7405
Fax: 422-1918
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Global
Phone: 481-7400
Fax: 481-7427
Broadcast Services/News Agencies
Broadcast News
Phone: 422-8496
Fax: 425-2675
Canadian Press
Phone: 422-8496
Fax: 425-2675
For more information, please refer to District’s Emergency/Crisis Communications Plan and the
Communications Toolkit.
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2.7.0.0 Draft Communication Tools
Draft tools are available in Appendix B or from Communications Office or Pandemic Folder on
the Shared Drive include:
Communication Fan out – Appendix B
Letter to Editor – Appendix B11
Memo to staff re: planning activities – Appendix B12
Community Power Point Presentation
Newsletter articles – Appendix B10
Q&A for health care workers – Appendix B02
Q&A for public – Appendix B14
Letter to media – Appendix B13
Letter to targeted business re: surveillance
Posters for flu prevention/handwashing
Fact Sheets on flu prevention, managing flu at home, seeking medical attention, taking
temperature, self care algorithms (Canada Pandemic Influenza Plan –Pages 246-264)
PSAs (Managing Flu at Home, Flu treatment Clinics, Vaccination Clinics, How you Can
help)
District Status Reports
Information Line Poster
Dealing with Stress - Health Care Workers Appendix H03
Dealing with Stress – Public Appendix H02
Notice of visitor status
Letters to Parents/Guardians re use of schools as clinics – Appendix B03
Communications Software/Hardware Inventory – Appendix B04
Distribution List – Appendix B05
How to issue a news release – Appendix B06
Websites – Appendix B07
Sample DHA update – Appendix B08
Sample Public Service Announcement – Appendix B09
Draft Notices – Appendix B15
To be developed:
Letter to Physicians ( Provincial Medical Officer of Health)
Fact Sheet on Vaccine – Department of Health
Phone messages/scripts - Communications
Pandemic Websites – (Department of Health, Communications)
Info for Staff re: HR Policies such as refusal to work, sick time, etc) – Human Resources
Guidelines for staff re: Isolation Precautions – Infection Control
Page 51
Section 3 Vaccine
Management
Page 52
Immunization of susceptible individuals is the method of choice to prevent disease and death
from influenza, whether epidemic or pandemic.
It is assumed that, in a pandemic, two doses of vaccine will be required for people who have
never been exposed to the novel hemagglutinen (H) before. (If people have been exposed, only
one dose might be needed. It may be possible to reduce the quantity of vaccine in the injections
and thus extend the coverage of the vaccine supply, but this would have to be based on clinical
studies conducted after the vaccine is developed.
3.0.1.0 Setting Priorities for Immunization
There are many timing issues related to the isolation and manufacture of a vaccine. The disease
can have a significant impact on essential services. A pandemic could seriously endanger the
essential services of our communities. Cities and towns could face a loss of law enforcement,
fire fighting capacity, financial institutions and municipal transportation. As a result, vaccine
will be administered to groups within the province according to community and individual need.
The following list considers the impact that a pandemic would have on maintaining services, the
role particular individuals have in caring for others, preventing individual morbidity and
mortality, and optimizing the number of potential years of quality life. These rankings will be
reassessed as the pandemic progresses based on observed morbidity and mortality rates.
Procedures must be in place to ensure that individuals who receive a first immunization receive
their second dose of influenza vaccine. The following are population size estimates for the
priority grouping. The priority grouping is not intended to be a fait accompli, but to offer
consideration for planning purposes.
Group 1:
Group 2:
Group 3:
Group 4:
Group 5:
Group 6:
Group 7:
(Health Care Workers, Emergency Health Services staff and Public Health staff) –
Nova Scotia estimate: 20,000
(essential service providers) – Nova Scotia estimate: 30,000 {Definition of
essential service providers is found in Appendix I.)
A = (people with NACI identified high risk medical conditions) – Nova Scotia
estimate: 163,000
B = people >65 and not in “A”, plus people living in long term care – 125,095
(household contacts) – Nova Scotia estimate: 300,000
(infants <1 year) – Nova Scotia estimate: 12,000
(healthy adults) – Nova Scotia estimate: 142,719
(1 to 18 year olds) – Nova Scotia estimate: 150,000 see Appendix T 03 for
detailed population breakdown by age.
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3.0.2.0 Transportation and Security
The Nova Scotia Department of Health will use the biological refrigerator at the Joseph Howe
site. The V.G. alarmed fridge and the I.W.K. alarmed fridge will also be used as required.
If further refrigerator storage is necessary, the biological coordinator will negotiate with the
Dartmouth General and the Canadian Blood Services for additional refrigerator space. The
transportation and security will be done by a security company that will be contracted to both
transport and secure the vaccine from the airport to the Joseph Howe Building and on route to
the districts. The company will also be responsible for the security while in storage at the
Halifax sites.
3.0.3.0 Vaccine Associated Adverse Events Surveillance
Adverse reactions associated with influenza immunization are monitored through reports from
the provinces. In addition, information about severe neurologic disorders possibly associated
with immunization is provided by the children’s hospital in Canada that participate in the Impact
program.
3.0.4.0 Special Studies
The Bureau of Infectious Diseases, Health Canada, and the provinces and territories participate
in periodic health surveys and assess immunization coverage in populations and groups targeted
by the National Advisory Committee on Immunization.
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3.1.0.0 Pre-pandemic Period
3.1.1.0 Setting Priorities for Vaccination in the Pre-pandemic Period
In order to reduce the morbidity and mortality associated with influenza, immunization programs
are focused on the following groups during the pre-pandemic period. Individuals at high-risk for
complications. Individuals capable of transmitting influenza to individuals at high risk for
complications. Individuals who provide essential community services.
However, individuals who wish to protect themselves from influenza are encouraged to receive
the vaccine even if they are not in one of the previously listed groups.
3.1.2.0 Vaccine Management Strategies for the Pre-pandemic Period
Following its development more than 50 years ago, the influenza vaccine has long been
considered the foundation for influenza control and prevention. Since it is likely that vaccination
will act as the main control strategy during the next pandemic, the following actions will be
taken during the pre-pandemic period.
•
•
•
•
Continue to increase the use of the influenza vaccine during the pre-pandemic period
within the community.
Ensure high-risk patients (as defined by NACI) receive the pneumococcal vaccine.
Fact sheets on the influenza vaccine will be maintained on the Health Unit web site
and/or the DHA website.
Promote influenza vaccine each year for the high risk groups.
3.2.1.0 Vaccination Management
•
•
•
•
Assemble the Pandemic Influenza Response Team to review the immunization plan that
corresponds to the appropriate scenario. Ensure that human resources and logistics are in
place to begin vaccinating.
All persons receiving vaccine will be given an immunization record with a date to return
for a second dose (if second dose is required).
Records will be kept on all individuals receiving vaccination. Data collected on each
person will include; name, gender, date of birth, address, allergies, date issued, dose,
route, lot number and expiry date. Data will be maintained in a live-time database on the
DHA server. (See Appendix T 04)
It is necessary to work with a paper system for tracking it will require the assigning of
communities to specific immunization clinic sites in order to maintain the necessary
control over the delivery of the vaccine to individuals in a timely and effective manner.
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NOTE: As tracking individuals on paper would be cumbersome and extremely difficult
to ensure that if 2 doses are necessary that the 2nd dose was administered to the correct
person at the right time, thereby minimizing loss of vaccine due to inadequate
immunization, it is imperative that an electronic data entry system be designed. It has
been determined that a simple data base created on Access, a Microsoft Office software
program would be sufficient. This data base could be designed quickly to enter, name,
health card number, age, priority category, e.g HCW, ESP or high risk individuals
identified by surveillance, date of immunization, site, lot #, and nurse who gave the
immunization.
3.2.1.1 Vaccine Storage
Public Health Services will be responsible for the pandemic influenza vaccine. Vaccine shall be
delivered from the Department of Health to the DHA.
In SWH, the vaccine shall be stored in a commercial fridge, equipped with an alarm to monitor
appropriate cold chain temperature, dedicated to this purpose in the pharmacy of the Yarmouth
Regional Hospital. The alarm is to be tested at least 4 times per year at the discretion of the
pharmacy manager to ensure the proper procedure is followed in the event of a fridge failure. It
is critical that any fridge failure be quickly managed to ensure the efficacy of any vaccine stored
there. The inventory will be controlled by the pharmacy manager in the same manner as
narcotics, requiring sign-off for release. All vaccine moved to a clinic or released for an
authorized clinic shall be signed for and all accounting done each day. Public Health Services
will indicate who has authority to release, who has authority to alter any authority procedures,
which will be required in writing, and where, when and how much vaccine is to be released. For
security reasons, any sample forms related to vaccine storage or movement will not be kept in
this plan, but rather in 2 copies of the plan held exclusively by the DHA pharmacy manager and
the MOH.
3.2.1.2 Vaccine Transportation
Transportation of vaccine outside of the acute care site is done by Materials management staff
from the DHA with a security guard present at all times.
Transportation of Vaccines in a Koolatron or Use at a Clinic
Vaccines must be transported in such a way to maintain the cold chain (between 2 and 8 degrees
C unless otherwise specified). Use a thermometer in the Koolatron to monitor the temperature.
Read Operation Manual.
Points to remember regarding the use of the Koolatron.
•
•
Plug the cooler in a 12 volt cigarette lighter receptacle in your vehicle.
Ensure that the arrow on the power cord bi-pin plug is aligned with the BLUE dot to
have it in cooling mode.
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•
•
•
•
The Koolatron can be operated continuously from a 110/220 AC outlet using the power
pack.
Do not operate in direct sunlight or in hot enclosed areas such as automobile trunks. The
cooler generates heat and must have free air circulation to perform properly.
Do not block the ventilation area of the control panel.
Ensure the cigarette lighter socket is clean and safeguarded with a correctly fused circuit.
• Push the plug firmly into the lighter socket to ensure a good contact.
• Use the Koolatron to transport vaccine directly to a clinic. The cold chain will not be
maintained if the vaccine is left in the cooler in the car without the car engine running.
On arrival at your destination, immediately connect the power pack and plug the cooler
into a wall socket.
Maintenance:
See Operation Manual. To clean, wipe the inside with a warm damp cloth sponge and mild soap.
Keep lid open after cleaning to allow the interior to dry.
Procedure for use of Koolatron:
•
•
•
•
•
•
•
Ensure cooler is on cooling mode by checking that arrow and blue dot are on same side.
Cool unit for approximately 1.5 hours prior to placing vaccines in cooler.
Use a min/max thermometer to monitor cold chain.
When temperature in cooler is between 2-8oC, place vaccine in cooler; close lid; keep
cooler connected to the power supply until ready to leave.
Plug the cooler in car cigarette lighter outlet for transporting vaccine.
On arrival at destination, connect power pack and plug the cooler into wall plug.
Bring other cooler and appropriate number of ice packs for placing vaccine to be used at
the clinic. Koolatron will be used as storage for vaccines but vaccines for immediate use
will be put in a separate cooler. This minimizes the number of times the Koolatron lid has
to be opened.
See Appendix G04 Pharmacy for tracking forms.
3.2.1.3 Vaccine Security
See Appendix L03
3.2.1.4 Vaccination Prioritization
The priority groups to receive immunization shall be in the following order, guided by the
recommendations of NACI, and the national pandemic influenza committee:
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3.2.1.4a Health Care Workers
[HCWs], will be immunized by the OHNs, clinical resource nurses, and certified immunizers
from the health care system, e.g LTC certified immunizers will immunize LTC staff, etc.
The DHA HCW list will detail the number of each category of HCW and the priority
of immunization. See Appendix F01 for staff numbers, estimate of vaccine
requirement and contacts.
Order of Priority for Influenza Vaccine: Acute Care
First Priority:
Those giving vaccine: in all Hospitals, Essential Service Provider [ESP] Clinics, and the
designated ILI Clinics:
• Public Health Nurses; Occ Health Nurses; RN’s giving vaccine including: ICP,
Clinical Resource, RN’s from outside agencies seconded to the clinics such as: VON,
Health Care NS, SON staff, Burridge staff, Nurse Practitioner
ER/OPD staff directly involved in delivery of care in DGH, RW and YRH and the flu
treatment clinics:
• RN’s; LPNs; ER doctors; Chief of Medical Staff; Shift Coordinators; Internists;
Psychitrist-1, Respiratory Therapists; laboratory techs*, Pharmacy-(1-2), X-ray
techs*; environmental (2in OPD and 1 Main FLoor)*; EHS personnel; RN’s floating
to ER; Security*; Admitting/Registration (total 34)*; Nurse Manager, Porters(3)*,
SPD staff * (4-YRH, 1-DGH,1-RW), FNS*, Staff cooks, Early Response Worker
(Mental Health-1 in each site), Boiler operator/Maintenance (#s?), all other staff
serving in the ERs
Intensive Care:
• RN’s; LPNs; Drs who work in ICU; RN’s who will float to ICU; environmental (2)*;
EKG*; Nurse Manager, Ward Clerks, FNS*, Laundry*, all other staff serving in ICU
Maternal/Child:
• RN’s; LPNs; Pediatrician; Obstetricians; attending Drs; environmental (2)*, Ward
Clerks, FNS*, Laundry*, all staff who directly serve on Mat/Child
Oncology and Dialysis Units:
• RN’s; LPNs; Ward Clerk; environmental*
CISM Team: 3 mental health workers (1 from each MHC)
* Note: the first priority will be given to those who are directly involved in the area of operation
in the specific unit, other staff members in a particular discipline will be vaccinated according to
function and availability of vaccine.
Second Priority: (in descending order of priority)
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Remainder of Acute Care staff including:
• All RN’s; LPNs; Infection Control Practitioner (if not an RN and giving vaccine),
remainder of Clinical Resource; Nurse Managers*; Ward Clerks, environmental*;
remainder of lab, EKG, Pharmacy, DI staff, Laundry, Materials Management (4);
FNS, Porters, for Nursing Units in the following order:
o YRH: 4 North, 4 East/South, 3 East, ALCU
o DGH: Nursing Units-DI, Lab
o Roseway: Nursing Units, DI, Lab
• Psychiatry inpt unit-10 RNs, 2 LPNs, 1 Ward Clerk
• Nursing and Medical staff seconded to acute care from other units e.g. OR, RR, Day
Surgery, Ambulatory care, DEC, Inpt & Outpt Psych (casual staff-2RNs, 5LPNs, 1
Comm Health nurse), Detox, TVM or other disciplines e.g. VON, Public Health,
Home Care, LTC, Decision Support, Holly Campbell, District Director of Nursing
• Administrative dietitians, food Service Supervisors, Cooks Assistants, VP Clinical
Care; VP Community Health; RH Site Manager; DGH Site Manager; CEO
• Remainder of Doctors
• Admitting staff
• Communications Director
• Remainder of clinical staff not yet vaccinated who are necessary for patient care e.g.
EKG, DI, Laboratory, Laundry, FNS staff who prepare trays, FNS assigned in
dishwashing, garbage collection, cleaning of FNS areas, remainder of Materials
Management staff; remainder of SPD; remainder of Porters; remainder of
environmental
• Mental Health Services backup to Early Response and/or community-YMCH-2
psychologists, 1 Comm Health Nurse, DMHC-3 psychologists, 1 social worker,
SMHC-2 psychologists, 2 social workers, 1 general practitioner
• Also: support staff directly involved in the immunization of the Essential Service
Providers [ESPs] including: all remaining Public Health staff; Security;
environmental; registration staff, Materials Management (1?), volunteers, clerical
support
• Health records staff (18), Clinical Engineering, Business Office, Discharge Planner,
• Rehab/OT Therapists
• Remainder of Ward clerks
• Remainder of Maintenance staff
• Laundry personnel
• Remainder of Environmental staff
• Remainder of Maintenance staff, IS Team
• Tidal View Manor, Harbourside Lodge, Veteran’s Place, directly involved in
designated patient care areas including: RNs, LPNs, environmental, Nurse Manager
Third Priority:
• Remainder of Mental Health staff-Mental Health Community support worker-YMHC
3, DMHC –2, SMHC –2, 1 Occupational therapist, 1 clerical support
• VP Operations; HR Director; Finance Director; Admin Secretaries (4)
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•
•
•
•
•
•
•
Risk Manager
Director of Support Services, Director of Clinical Support, Supportive Care Services,
Telehealth coordinator
Human Resource Coordinators and HR Manager (3)
Pastoral Care
Director of Finance
Admin secretaries
Human Resources Assistants (2)
Support staff
• Remainder of: Laundry, Maintenance, FNS, Materials Management, Pharmacy,
Rehabilitation, remainder of ward clerks/secretaries, Ambulatory Care, EKG,
Discharge Planner, Health Records, Library, Physician Resource/Primary Care
Manager, PHC Assistant
Fourth Priority:
All others that work in the buildings.
Delivery of Vaccine to HCWs and ESPs with comments:
• Public Health gives to Essential Service Providers [ESPs] simultaneously with Acute
Care
• OHN/ICP/Clinical Resource give to those who will be delivering vaccine within the
hospitals in a small clinic prior to giving the vaccine to acute care HCWs
• At YRH: Make every effort to have at least two teams of vaccinators who will
immunize staff working on day one
• Managers alert staff to vaccine clinics and arrange for HCWs to come in for vaccine
on day two
• ER/ ICU done first (simultaneously if possible) plus all staff who work in those areas
• Immunization teams travel to nursing floors, lab
• Then set up clinic(s) and managers call staff to go to clinic
• The second day managers arrange for staff to come in for immunization clinics
according to the priority list
• This method will continue until all acute care staff immunized, including TVM, HSL,
& Vets
• Each department should keep a priority list on hand in the event of staff shortages
and reallocations, they are the best to know where their staff will be assigned
The most challenging scenario for the administration of vaccine is how we proceed if we do not
get sufficient vaccine to immunize everyone on the HCW and ESP list simultaneously. While
everyone agrees in principle that they still want to proceed simultaneously, we cannot do so if it
causes the health care system to break down. First and foremost we need to ensure that does not
happen, however the situation is equally critical for the community. We must support the first
responders, because if that system fails, then all of us as members of our communities are at
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increased risk. Again, this demonstrates that all departments and identified essential service
provider agencies must be prepared to clearly define their cut-off point, their minimum number
required to provide essential service. Clearly establishments such as grocery stores or pharmacies
will certainly not get all staff immunized unless we get the full expected amount of vaccine; they
will also need to do internal prioritizing. In principle we still agree to proceed simultaneously,
with the caveat that we cannot allow the health care system to collapse, neither can we allow our
community first responders to also be rendered incapable of functioning. Based upon the issue as
described here and in the event of an extreme vaccine shortage, the immunization of the HCWs
will begin with those listed in the first priority group and the immunization of the ESPs will
begin after Intensive Care unit has been immunized. The immunization of the ESPs will be
restricted to those identified as essential for health and safety, e.g Fire Department Medical First
Responders and all Police/RCMP.
3.2.1.4b Essential Service Providers
[ESPs], will be immunized by Public Health Nurses under the guidance of a clinic manager from
PHS at clinics established exclusively for the ESPs.
The total number of Essential Service Providers [ESP] has been collected for each
municipality within each DHA. See Appendix E 01. The ESP list details the agencies
or department that are considered to be essential to the community, the names of the
primary contact individuals and phone numbers for each agency and the total number
of workers essential to each agency. The agencies are listed in descending priority
based upon the work done by the agency. First Responders are first on the list
followed by agencies, utilities, and services critical to sustain the community and
residents therein.
The HCWs and the ESPs will be immunized simultaneously beginning at the top of each list
3.2.1.4d The public
Will be immunized as per the recommendation of NACI and the national pandemic influenza
committee based upon the collected surveillance results, which will indicate which population
group is considered to be most high risk for morbidity and mortality. The current suggested
priority list is documented in the national pandemic plan, but is subject to change based upon
epidemiology of the pandemic influenza.
3.2.1.5 Public Vaccine Clinics
(Also refer to NS Department of Health Mass Immunization Plan in Shared Directory.
Based on population figures, traditional travel patterns and road conditions, communities have
been designated in which to hold public vaccination clinics.
Supplies for the vaccine clinics will be delivered from the Materials Management Division of the
DHAs as each clinic is scheduled. The estimated number of individuals for vaccination at each
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clinic will be provided by Public Health, based on the identified target group and the population
numbers, using the spreadsheets in Appendix C06 as a guide. See also Appendix J for Materiels
Management information for public clinics.
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For the Clinic Facility:
• Washrooms, secure storage, open area, location known by public, parking, accessible
by ambulance, telephone.
• Immunization area for 10+ nursing stations with room for staff and public to move
between. A nursing station is one 8 foot table with 2 nurses.
One box of general supplies for each clinic site shall contain:
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12 Portable partitions [corrugated school display boards are acceptable]
6 individual orange or apple juice boxes
12 pens
12 pencils
1 steno note pad
1 stapler
1 package 2” x 4” post-it notes
1 box large elastic bands [size # 32 ok]
1 box paper clips [size #3 ok]
1 roll of “Scotch” Tape
1 dozen large garbage plastic bags
2 dozen small plastic bags
1 box of small towels [16.5x16.9 with 100 per box]
1 box of large towels [with 15 per box]
1 box of 3 ml syringes
1 box of 5/8 inch needles
1 box of 1 inch needles
4 Sharps container [7.6 litre size]
1 package of Virox wipes [160 sheets per container]
1 box small gloves
1 box of medium gloves
1 box of large gloves
Clinic box for 100 persons shall contain:
*This box will be primarily for adults; if children are expected at the clinic, contact Materials
Management for contents adjustment.
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♦
♦
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1 box of 25 gauge- 1 inch needles
1 package of 2x2 inch non-sterile wipes (100 per pkg)
1 box of alcohol swabs with 200 swabs per box
1 box of Band-aids with 100 per box
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♦
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•
•
•
•
•
•
1 Sharps containers 7.6 litre size
1 box of tissue paper [Kleenex]
2 Pens
2 pencils
1 roll of masking tape
1 apron
1 container of hand sanitizer
2 small plastic garbage bags
2 large towels [in Ziploc bag]
4 small towels [in Ziploc bag]
6 pair of each size of gloves [in Ziploc bag]
1 dozen disposable face cloths [in Ziploc bag]
2 emesis bags per box [in case of nausea and vomiting]
Area for clients to wait 20 minutes after vaccine.
Break area with fridge for staff.
Signage:
o reception, washrooms.
o information sheets.
Furniture
o tables, chairs, drapes for cubicles, cots.
Supplies
o table cloths, paper towels, coolers, ice packs for vaccine, thermometers or
strips, mat for fainters, pens, immunization records, adrenalin dosage chairs,
sharps, containers, paper bags, toys, juice, water, syringes, needles, swabs,
TV, VCR.
Drugs
o vaccine
o adrenaline
Consider:
• The Clinic Inspection Team for SWH is Ruth Davis, Mary Hyland, EHS Coordinator,
Chris Newell, representative from security company.
• Compensation details – adherence to the collective agreement.
• Communication with union.
• Coordinate with other district to avoid calling the same people.
• Recruitment phone line.
• Form for logging of volunteers and scheduling.
• Orientation for all working at clinic.
Human Resources
•
When an influenza pandemic is imminent individuals should be assigned to organize
human resources including staff scheduling, working with Human Resources to
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recruit staff, working with Volunteer Services and Red Cross to identify volunteers
and train.
•
Potential for vaccine administration includes, RN’s (currently or previously licensed),
nursing students, physicians, medical students, pharmacists, veterinarians,
paramedics, LPNs and dentists.
Roles may include:
•
•
•
•
•
•
•
•
•
A team leader to oversee the running of the clinic (site manager).
A transportation courier to transport clinic supplies.
Clinic clerical staff (volunteers) to do registration, to direct people and to greet and
answer people’s questions.
Volunteers for the waiting area (both the waiting area before vaccine and the waiting
area following the administration of vaccine).
Volunteers to stay with the individuals who have fainted or who are ill.
Volunteers to fill in immunization record and ensure the individuals receive the
record.
A volunteer to act as a runner to replenish supplies to do a tally every 2 to 3 hours of
the supply status.
A person responsible for the collection and disposal of sharps containers.
A person responsible to ensure supplies are available.
Training for Immunization
The individual who is providing the orientation should be knowledgeable on all aspects of
vaccines and immunizations and use the current NS Certification package. Education should
include:
•
•
•
•
•
•
•
•
•
•
Information on the epidemiology of influenza.
Influenza vaccine:
o include the composition and mechanism
o priority groups and rationale
o pre-immunization assessment
Informed consent.
Adverse reactions, anaphylaxis and treatment.
Policies for the mass clinics.
Immunization technique.
Cold chain and how long vaccine can be kept once drawn up.
Documentation.
Handling of sharps and their disposal.
Strategies for dealing with difficult people, especially those demanding vaccine when
they do not qualify, restraint issues and supply management.
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After orientation:
• The following questionnaire is completed.
• The student is observed proficiently administering vaccine.
• A certificate is completed.
Immunization Questionnaire
Date: ________________
Name: ______________________
Please answer the following questions in regard to providing immunizations at the mass
immunization clinics
1.
2.
3.
4.
5.
6.
What influenza vaccine is being used at the clinics and why?
What are the contraindications to receiving this vaccine?
What should be included in your assessment?
What route is used to administer influenza vaccine?
Is it necessary to clean the area with an alcohol swab?
Is it necessary to change the needle after withdrawing the vaccine from the vial (before
injecting)?
7. What is meant by the cold chain?
8. How long before injecting can the vaccine be drawn up?
9. Can the vaccine be drawn up and kept on top of ice packs?
10. How long after receiving vaccine can an individual leave the clinic site?
11. What are the signs of an anaphylaxis?
12. What is the procedure if you believe that someone is having an anaphylaxis?
13. What should be included in your instructions to the person who received vaccine in
regard to side effects, reporting of an adverse event, and returning for a second dose?
14. How would you explain the rational for the priority groups to someone who asks why
certain individuals get vaccine and others do not?
15. What is informed consent? Who can give consent for another individual?
16. How are the immunizations being recorded?
MINI-CERTIFICATION
(For pandemic influenza mass clinics)
Name: _____________________________________
Date: ______________________________________
Certifier:___________________________________
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Documentation
•
•
•
•
•
•
Consent
o Review consent forms and revise to ensure appropriateness.
o Have SWH guidelines for informed consent available.
o Consider feasibility of use of video for informed consent.
Forms for tracking vaccine administration and mode of notification for second dose.
Registration forms (see technical option Appendix T04).
Adverse reaction forms to include: date, name, DOB, priority group, lot #, phone #,
innoculators name.
Confidentiality pledges for new staff and volunteers.
Schedules and logs for staff and volunteers.
Communications
• Work with SWH Communications Director to ensure communication to public (see
section 2).
Communications Plan - Communications plan about vaccines should/may include:
• Identification of spokesperson.
• Information sheets re influenza and vaccine for clinics.
• Public information re self care, clinic locations, dates, times.
• Toll free line – see NS Mass Immunization.
• Notify EHS of clinic schedule.
• Access to wireless communications – i.e. cells phones, internet.
Volunteers - Public Health will work with SWH Volunteer Services & Red Cross to coordinate
Volunteers.
One person should be assigned to represent public health in this effort. Ensure there is a process
for screening volunteers. The volunteer can register clients and complete forms, direct clients
within the clinics, provide basic answers to common questions, direct traffic, organize
refreshments for clients and staff, provide support in the rest area, provide assistance as runners
for supplies, track and replenish supplies within the injection stations.
A training session for volunteers should cover very basic information on pandemic influenza,
how the clinics are structured, who receives vaccine and why and a list of commonly asked
questions and answers provided.
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3.2.2.0 Vaccine Availability Scenarios
ID Biomedical/Vaccine has the contract with Health Canada to produce 6,000,000 doses of
pandemic influenza every month. The population information used to determine these numbers
comes from the 2001 Census reports.
Table 1
Population
DHA 1
DHA 2
DHA 3
Total
63,370
63,123
78,297
Vaccine
100% 50.00% 25.00%
12,671 6336 3168
12,622 6311 3155
15,656 7828 3914
204,790
40,948 20474 10237
Nova Scotia
908,005
Canada
30,007,090
HCW ESP
1909 3724
2000 3094
2426 4161
6335 10979
181,558
6,000,000
3.2.2.1 Scenario 1
The DHAs get the full allotment of 40,948 doses per month. Therefore we can immunize all
HCWs and ESPs within one month, and begin with designated high-risk group[s] in the
community in the following month.
Providing we get the full allotment each month, we can expect to have the entire population of
the 3 DHAs immunized at the end of 10 months. (2 doses X 204,790 = 409,580 / 40,980 = 10
months)
3.2.2.2 Scenario 2
The DHAs get half of the 40,948 doses per month. Therefore we can immunize all HCWs and
ESPs within one month, and begin with designated high-risk group[s] in the community in the
following month.
3.2.2.3 Scenario 3
The DHAs get ¼ or less of the expected allotment of 40,948 doses per month.
Therefore we cannot immunize all of the HCWs and ESPs at once and must work our way down
the lists simultaneously until we run out of vaccine. Please see 3.2.1.4a for the Health Care
Worker priority list, and Appendix C04 for the Essential Services Provider priority list.
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Continue immunization until all identified groups have been offered vaccine. Evaluate the
pandemic immunization program. Assess the impact of the immunization program on Public
Health. Prepare for second wave.
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Section 4 Antivirals
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4.0.1.0 Current Antivirals Drugs
The antiviral agent amantadine (symmetrel) interferes with the replication of type A influenza
viruses. Studies have shown the drug to be 70-90% effective in preventing illness when taken
throughout the period of exposure to the virus in a normal outbreak situation. Antiviral agents
also reduce the severity and duration of illness when taken within 48 hours of illness onset. Most
experts believe that similar levels of efficacy can be achieved with a novel (pandemic) strain of
influenza.
Zanamivir (relenza) and oseltamivir (tamiflu) are medications that have been approved for
treatment of uncomplicated cases of influenza. They have also been proven effective in
preventing influenza. However, Health Canada has not yet approved these medications for
influenza prophylaxis.
4.0.2.0 Indications and Limitations
Several factors are likely to preclude the widespread use of antivirals in a pandemic. These
factors include; side effects, emergence of resistance, and limited supply. Despite the limitations,
antivirals may be expected to play a role in the prevention and treatment of influenza, especially
during the time period when sufficient vaccine supplies are not available.
It cannot be assumed that during a pandemic large supplies of anti-virals will be available.
The indications for the use of the licensed anti-virals in Canada at this time (February 2002):
1.
Amantadine (SymmetrelR)
“Influenza A virus respiratory infections”
May be used for the control of influenza A outbreaks in institutions where high
risk residents (long term care) are exposed
Treatment: Amantadine is also indicated for the treatment of respiratory infections
caused by influenza A
2.
Zanamivir (RelenzaR)
“Treatment of uncomplicated acute illness due to influenza virus in persons 12 years
and older who have been symptomatic for no more than 2 days.”
3.
Osetamivir (TamifluR)
“Treatment of uncomplicated acute illness due to influenza infection in adults who
have been symptomatic for no more than 2 days.”
During a pandemic the major role of the anti-viral drugs will be to control outbreaks.
Under present circumstances, the supply of these drugs would be well below the anticipated
demand during an influenza pandemic. Anti-virals will play only a minimal role in reducing the
impact of the pandemic, and should be reserved only for very high priority groups.
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The following is a prioritized list of individuals and groups to receive anti-viral drugs for
prophylaxis. This list considers the impact anti-viral prophylaxis will have on maintaining
essential services, the role particular individuals have in caring for others, preventing individual
morbidity and mortality, and optimizing the number of potential years of quality life.
Adverse Events Due to Prophylaxis/Treatment
There are a variety of reactions that have been reported with the use of antiviral drugs.
4.1.1.0 Antiviral Management Strategies in the Pre-pandemic Period
See NS Antiviral Clinic Document.
Fact sheets with instructions for the use of antiviral medications and a listing of possible side
effects will be produced for the general public and will be made available on the Health Unit's
web site.
District Antiviral Checklist:
Develop a plan for the distribution of antivirals in institutions and in the community.
Identify individuals in the districts to coordinate:
The receiving of antivirals in the district
Control of inventory
Security of the supply
Sequestering available supply for Public Health use and parkinson disease.
4.2.1.0 Antiviral Medication Priorities
The strategies outlined in this document are based on the assumption that the Department of
Health will provide antiviral medications to local health units for. If this is not the case, the role
of the Health Unit will be to provide information about antiviral medication and where
medications can be accessed.
The National Pandemic Influenza Committee (NPIC) will determine who is eligible for antivirals
in the event of a pandemic. All Canadian jurisdictions will be using the same priority list to
target eligible persons. The National Pandemic Influenza Planning Committee has suggested the
following priority groups, in descending order of priority. The identified groups will need to be
reexamined when the epidemiological data about the pandemic virus are available. It has been
recommended that neuraminidase inhibitors be used for the treatment of ill persons and
amantadine be reserved for prophylaxis to avoid the development of resistance.
Treatment of persons hospitalized for influenza (neuraminidase inhibitors)
Treatment of ill high-risk persons in the community (neuraminidase inhibitors)
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Prophylaxis of health care workers (amantadine)
Control outbreaks in high-risk residents of institutions (amantadine)
Prophylaxis of essential service workers (amantadine)
Prophylaxis of high-risk persons hospitalized for illnesses other than influenza
(amantadine)
Prophylaxis of high-risk persons in the community (amantadine)
Treatment of ill persons who are not high-risk (neuraminidase inhibitors)
4.2.2.0 Antiviral Management Strategies
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Antivirals will be stored at the Health Unit. Local police (or security guards), as outlined
in Appendix L, will provide security for antiviral medications. Quantities received and
issued will be monitored through BIOS.
The Health Unit will maintain a supply of antiviral medications for the purpose of
controlling influenza outbreaks in closed institutions. The Health Unit will screen and
approve all orders for antivirals from institutions experiencing outbreaks.
Records will be kept on all individuals receiving antiviral medications. Data collected on
each person will include: name, gender, date of birth, address, allergies, date issued,
amount issued, lot number and expiry date. The data collection forms for antivirals will
be kept in a binder according to each distribution site.
Community health care workers and essential service providers will receive antiviral
medications at Health Unit distribution sites located in Brockville and Smiths Falls.
Eligibility criteria will be maintained and employment identification will be required.
Public health nurses, under the authority of the Medical Officer of Health, will dispense
medications.
Hospital health care workers will be issued antivirals at the worksite by occupational
health nurses and public health nurses under the authority of the Medical Officer of
Health. Individuals obtaining antivirals must meet the eligibility criteria. Employment
identification will be required.
Communicate to physicians and pharmacists that antiviral medications should only be
prescribed for treatment of seriously ill patients within 48 hours of illness. Physicians will
be required to fax a prescription for seriously ill patients to the Health Unit. The Health
Unit will screen and dispense antivirals to physicians if eligibility criteria are met.
4.3.0.0 Post-pandemic Period
•
•
•
It is expected that antiviral supplies would be depleted at this time. However, if antiviral
medications are still available, the Health Unit will continue to dispense them as outlined.
Evaluate the effectiveness of the antiviral program.
Prepare for the second wave.
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Section 5 Emergency
Preparedness and Response
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5.1.0.0 Emergency Preparedness and Response
An influenza pandemic differs from other emergencies in the following ways:
• Pandemic influenza is widespread with many geographic areas affected simultaneously.
• The scale of the disruption will be greater than a natural disaster and the impact is
expected to be prolonged.
• There will be no capacity for federal assistance on such a wide scale.
• Health care workers and emergency service providers will be just as likely, or even more
likely due to increased exposure, to be infected than the community at large.
It is expected that all localities will be affected within 1-3 months of the introduction of the
pandemic strain to Canada. As well, the emergency response will need to be sustained for a
prolonged period, likely 2-3 months. Attack rates may be as high as 50%, with 1-2% mortality.
The All-Hazards Plan will be essential as a staring point for certain aspects of pandemic
planning.
The pandemic plan will require special emphasis on certain functions that may not normally be
included in all hazards emergency operations plans, such as special surveillance operations,
delivery of vaccines and antiviral agents.
One of the main differences between pandemic influenza and other natural disasters is the
widespread nature of health effects – along with disruption of critical human infrastructure
because of those health effects, which will require expansion of the typical disaster management
team.
Generalized widespread absenteeism in the community, including workers responsible for
critical services, public safety, utility, transportation and food services industries poses a
significant threat during a pandemic. Also, unlike a natural disaster, pandemic response will
have to be maintained over months rather than hours or days. This is further complicated by the
fact that when it occurs the pandemic will not be limited to a single community.
5.2.0.0 Legislation & Government Roles
The Nova Scotia Emergency Measures Act 1990,c.8,s.k.
This Act and supporting regulations detail the statutory emergency duties and powers of
municipalities. This Act takes precedence over all other provincial emergency legislation in the
event of an emergency.
Emergency Preparedness Canada is the federal coordinator for emergency planning. Health
Canada also has a network with emergency health and social service officials in every province
and territory and with non-governmental organizations such as Red Cross and St. John’s
Ambulance.
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According to the Emergencies Act, a public welfare emergency occurs only when the disaster is
beyond the capacity or authority of any one province or territory to deal with. Federal
intervention occurs only when invited by the province or territory or when the situation impinges
on the federal jurisdiction. A national emergency is
• an urgent and critical situation of a temporary nature that seriously endangers lives,
health and safety and
• is of such proportions or nature as to exceed the capacity or authority of a province or
territory to deal with it or
• threatens the ability of the government of Canada to preserve security and
• cannot be effectively dealt with under any other law.
National coordination by the National Pandemic Influenza Committee is necessary because a
pandemic goes beyond local and provincial/territorial concerns; it is a national and international
issue encompassing health, safety and emergency preparedness mandates.
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In 2004-2005 an existing liason group with SWH Emergency Measures from 5 EMO’s, Health
Services/EMO Liason Officers and SWH Management representatives met to plan for
Emergency Preparedness. EMO’s received education about pandemic influenza and its potential
impact. The NS Pandemic Influenza Checklist was used as a guide for planning.
5.3.1.0 Essential Community Services
See Vaccine List Appendix C05 for a listing of essential community services and corresponding
personnel whose absence would pose a serious threat to public safety or would interfere with the
ongoing response to the pandemic.
•
Contingency plans for emergency backup of such services and/or provision of
replacement personnel are the responsibility of the agencies or departments.
See Appendix C05 to 13 for the lists created by each EMC for vaccine.
See Municipal All Hazards Plans for lists outlining all essential services in the community.
See Nova Scotia Pandemic Plan for Essential Service Workers Appendix V.
Further work is required by the province to ensure agencies and organization have developed and
communicated contingency/business continuity plans.
5.3.2.0 Roles and Responsibilities
See Appendix N 01-10 for the roles and responsibilities of each of the community providers, as
adopted from the NS Provincial Plan.
5.3.3.0 Contingency Plans
Contingency plans to provide food, medical and other essential life support needs for persons
confined to their homes by choice or direction from Provincial or District Health Authorities
• Community, neighbours and families are the first and best line of response.
• Continuing Care will approve services as necessary and has contact information for local
Fire Department’s Ladies’ Auxiliaries. Appendix J.
• Volunteers will be required to deliver food.
• Special attention should be paid to identifying isolated seniors – recommend Public
Service Announcements with contact number and a public information line.
5.3.4.0 Identify voluntary organizations to assist during the pandemic
See list in Appendix K.
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5.3.5.0 Environmental Assessment of surge capacity
See Health Services – Section D and Influenza Treatment Clinics in Appendix I.
5.3.6.0 Community Transmission of influenza
EMOs, DHA and province to coordinate and communicate.
5.3.7.0 Mortuary, burial/funeral service plans
As required, refer to the Funeral Service Association of Nova Scotia Disaster Response Plan.
Appendix M01.
5.3.8.0 District plan for social/psychological services for families
See Appendix H01 – Mental Health Services Plan
It is expected that in a pandemic situation (pandemic imminent) that all municipalities will need
to activate their emergency response protocol. When a situation requires an extraordinary
response, the responsibility for coordinating that response as a matter of course is that of the
EMO. It is expected that all geographic areas will be affected simultaneously. The Pandemic
Influenza Response Team and local EMO’s to liase closely.
Existing emergency response plans should be used as a starting point in the event of an influenza
pandemic for certain aspects of the response such as command and control functions,
descriptions and operation of emergency communications systems and hospital and medical care
resources.
5.4.1.0 Emergency Management Strategies.
Activate the District Health Authority’s emergency response plan and the DEOC and
communicate closely with EMO’s for effective response.
•
Activate contingency plans to provide food, medical, and other essential support for
persons confined to their homes.
•
Ensure that human resources and logistics are in place to maintain essential community
services.
Ensure communication with DHAs, Provincial Department of Health and municipalities.
•
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5.5.0.0 Post-pandemic Period
•
Evaluate the impact of the pandemic.
•
Evaluate the district pandemic response.
•
The tasks outlined in 5.3.1.0 will continue in the event of a 'second wave'.
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Section 6
Health Services
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Planning for a pandemic involves consideration of what activities are necessary for optimal
management of each stage of the pandemic.
The Plan consists of an introduction section, followed by the preparedness (pre-pandemic)
response (pandemic) and recovery (post-pandemic) sections, which are consistent with the
general principals of emergency response. Each section aims to assist and facilitate appropriate
planning for the next influenza pandemic.
The health services component of this SWNDHA Response Plan includes the same components
as the public sector plan. These include decision making and coordination, surveillance, vaccine
and anti-viral use, and communication. In addition, the health services component includes
factors affecting the ability to provide quality care – staffing, equipment and supplies, and
strategies to prevent transmission of infection to patients and staff through infection control and
other interventions.
6.1.0.0 Epidemiology of Pandemic Influenza
Please see Section O - Introduction
6.2.0.0 Planning Activities and Responsibilities
Health Services preparedness planning in SWH will address the following:
1. Increasing the system’s capacity to respond by:
• Identifying necessary health services to be provided during a pandemic, and
evaluating existing physical capacity as well as how it can be deployed during
a pandemic
• Determining potential alternative sites for care
• Developing mechanisms to coordinate patient transfers and tracking
• Determining the information required to evaluate the impact of a pandemic on
health services
• Determine how laboratory services will be carried out
• Developing mechanisms for the potential high demand for home care
2. Managing , protecting and preparing human resources by:
• Assessing the skills and capacity of existing health human resources to
respond to a pandemic, and developing deployment/reemployment plans
• Identifying temporary workers and volunteer support who will assist with
health services during a pandemic, and develop deployment plans
• Establish programs to keep health care workers as healthy as possible
• Ensuring health care workers have the information and support to respond to a
pandemic
3. Addressing equipment and supply needs by:
• Developing plans to purchase, store and distribute medical equipment and
supplies
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• Sourcing other supplies needed during a pandemic
4. Preparing for high mortality rates by:
• Confirming the Provincial Multiple Fatality Plan with the Office of the
Medical Examiner
• Developing plans to deal with the impact of high mortality rates.
DEFINITIONS – See Section D.
6.2.1.0 Estimated Impact of an Influenza Pandemic on Nova Scotia
Section 0 of this document (Pandemic Influenza Planning Goals) provides a high level overview
of what Nova Scotia can expect to see during a pandemic (based on 15%, 25%, and 35% attack
rate). One can also observe the projected number of out patient visits, hospitalizations and
deaths by DHA planning area (Estimated Influenza Impacts by District Health Authority).
6.2.1.1. Triggers
Identified triggers for implementation
Local health care resources and local epidemiology (ie. The number of confirmed influenza
cases in the community) will determine the trigger for health services emergency plans.
These triggers will include:
The proportion of emergency room visits attributed to influenza.
The proportion of influenza cases requiring hospitalization.
The capacity of the hospital to accommodate influenza cases.
6.2.2.0 Influenza Response Team
South West Health
Activating & Managing the Pandemic Influenza Plan and Response Team
Health will activate this Pandemic Influenza Plan. Senior Management will convene a SWH
Pandemic Influenza Response Team. This team will meet regularly to share information, identify
issues and send plan or recommended actions. If the District determines that it is necessary to
activate its Emergency Response Plan and sets up
the DEOC, it will link with this South West Health Pandemic Influenza Response Team.
Membership of the SWH Pandemic Influenza Response Team should include the following
internal and external partners:
Queries:
Develop coordinated health care plan for province- work with Dha; share resources; referral and
transfer policies/procedures; N.S. guidelines for postponement of elective, non-critical care.
Internal:
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Senior Management
Infection Control
Occupational Health
Lab
Public Health
Pharmacy
Nursing
Support Services – Security, Environment
Clinical Support
Materiel Management
Food & Nutrition
Communication
Human Resources
Medical Staff
Flu treatment Site Team Leaders
Mental Health
External:
•
•
•
•
•
•
•
•
•
•
•
•
EHS
EMO
Home Care
LTC
Continuing Care
Community Services
Red Cross
Home Support
RCMP
VON
Funeral Homes
First Nations
6.2.3.0 Ethical Considerations
(The following information, along with supporting research documentation forwarded to the
District Ethics Committee for review).
6.2.3.1 Guiding principles:
The goal of influenza pandemic preparedness and response planning for Nova Scotia and
SWNDHA is to reduce influenza morbidity and mortality and minimize societal disruption
among Canadians during influenza by providing access to appropriate prevention, care and
treatment.
When making ethical decisions around healthcare we take into account not only what is
important, but also how our choices will affect the lives of those around us. Ethical thinking or
evaluation allows us to take toll of the values that guide our actions and then ask ourselves
whether what we actually value passes moral scrutiny. The objective of the Canadian health
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system is to help people be better people- to flourish as human beings. This basic value, that of
beneficence, informs much if not all of the decision making in the context of health care. It is
important to be explicit about the values guiding public health initiatives so that these may be
considered and challenged to ensure that they are consistent with the values of the community
that is being served.
Resource allocation is concerned with how to distribute goods in society as well as deciding who
will benefit from the resources we have. When resources are scarce, decisions must be made
about who will benefit when not everyone in need can be accommodated. Resource allocation
issues in pandemic planning include non-essential services (defining, prioritizing, suspending);
stockpiling of food, medicine and/or supplies; who gets scarce resources (influenza,
pneumococcal vaccines/other drugs); access to acute care facility/intensive care unit; and the
human issues of planning for how these decisions will be made in future is uncomfortable for
many of us- seems cold hearted.
There exists a strong ethical duty on anyone who works in the health system to recognize that the
fundamental goal of the health system is that of advancing the well being of those being cared
for. As mentioned earlier, this is the basic moral premise upon which the health care system is
founded. Building ethical health care organizations requires that we recognize that
organizations, like individuals, have ethical values and responsibilities. Organizational ethics is
the process by which organizations are internally arranged so that the behavior of those within
them will conform to certain defined values and principles (Moskovitz, 1999). Embedded within
SWNDHA organizational ethics are the principles of ethical practices of Public Health for South
West Nova Region. Decisions make in the context of Pandemic influenza planning, are based on
the values and beliefs that underlie the principles of the ethical practice of Public Health in Nova
Scotia.
The MISSION of the South West Nova District Health Authority is to work with individuals,
families and partners to promote and improve the health of our communities. Resources are used
wisely to provide access to a broad range of quality health services. This code of ethics states
key principles of the ethical practice of Public Health. The following points list the key values
and beliefs inherent in a Public Health perspective upon which the ethical principles are based.
Public Health is understood within this code as what we, as a society, do collectively to assure
the conditions for people to be healthy.
6.2.3.3 Principles of the Ethical Practice of Public Health
1. Public Health addresses principally health protection and promotion using fundamental
determinants for health to prevent adverse health outcomes.
2. Public Health achieves community health in a way that respects the rights of all
individuals in the community.
3. Public Health policies, programs, and priorities are developed and evaluated through
processes that ensure opportunity for participation of community members.
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4. Public Health advocates and works for the empowerment of all community members,
aiming to ensure that the basic resources and conditions necessary for health are
accessible to all.
5. Public Health seeks the information needed to implement effective policies and programs
that protect and promote health.
6. Public Health agencies provide communities with the information that is needed for
decisions on Public Health-related policies or programs and include consultation with the
community as a whole in program implementation.
7. Public Health agencies act in a timely manner on available information they have within
the resources and the mandate given to them by the public.
8. Public Health programs and policies incorporate a variety of approaches that anticipate
and respect diverse values, beliefs, and cultures in the community.
9. Public Health programs and policies are implemented in a manner that most enhances the
fundamental determinants of health.
10. Public Health agencies protect the confidentiality of information that can bring harm to
an individual or community if made public. Exceptions must be justified on the basis of
legislation or the high likelihood of significant harm to the individual or others.
11. Public Health agencies ensure the professional competence of their employees.
12. Public Health agencies and their employees engage in collaborations and affiliations in
ways that build the public's trust and the agencies’ effectiveness.
Queries:
Ethics: Guidelines for ventilator use; guidelines for resuscitation by EHS; plan to discuss and
resolve ethical issues. Have spoken to ethics committee-they will look at ‘plans to discuss and
resolve ethical issues.
6.2.4.0 Communication
Sharing of timely and accurate information among health care professionals, the media and the
general public will be an important part of the pandemic response. It is essential that
communication networks be established during the pre-pandemic period. See Section 2 and
Appendix B.
6.2.4.1. Draft Communication Tools
Draft tools are available from Appendix B, Communications Office or Pandemic Folder on the
Shared Drive. They include:
Communication Fan out
□ Questions & Answers for public
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□ Employee questions and answers
Letter to Editor
Memo to staff re: planning activities
Community Power Point Presentation
Newsletter articles
Q&A for health care workers
Q&A for public
Letter to media
Letter to targeted business re: surveillance
Posters for flu prevention/handwashing
Fact Sheets on flu prevention, managing flu at home, seeking medical attention,
taking
temperature. (Canada Pandemic Influenza Plan –Pages 246-264)
PSAs (Managing Flu at Home, Flu treatment Clinics, Vaccination Clinics, How you Can
help)
District Status Reports
Information Line Poster
Dealing with Stress - Health Care Workers
Dealing with Stress - Public
Notice of visitor status
To be developed:
Letter to Physicians ( PMoH)
Fact Sheet on Vaccine – Department of Health
Phone messages/scripts - Communications
Pandemic Websites – (Department of Health, Communications)
Info for Staff re: HR Policies such as refusal to work, sick time, etc) – HR
Guidelines for staff re: Isolation Precautions – Infection Control
6.2.5.0 Principles Of Influenza Transmission
Influenza is directly transmitted primarily by droplet contact of the oral, nasal or conjunctional
mucous membranes with respiratory secretions from an infected individual. Influenza is
indirectly transmitted from hands and objects freshly soiled with discharges of the nose and
throat of an acutely ill and coughing individual.
The incubation period for influenza is from 1-3 days. The period of communicability continues
for up to 7 days after the onset of illness. Individuals infected with influenza tend to shed more
viruses in their respiratory secretions in the early stages of the illness. Patients are most
infectious during the 24 hours before the onset of symptoms and during the most symptomatic
period. The period of communicability may vary with pandemic influenza.
6.2.5.1 Routine Practices and Additional Precautions to Prevent The Transmission Of
Influenza
Routine practices (as per Routine Practices and Transmission-based Precautions policy IC-100)
outline the importance of hand washing before and after caring for patients; the need to use
gloves, mask/eye protection, face shields, and gowns when splashes or sprays of blood, body
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fluids, secretions or excretions are possible; the cleaning of patient care equipment, the physical
environment and soiled linen; the precautions to reduce the possibility of HCW exposure to
pathogenic organisms, and patient placement. Routine Practices are the infection prevention and
control practices for use in the routine care of all patients at all times in all health care settings.
Strict adherence to hand hygiene is the cornerstone of infection prevention. Proper hand hygiene
may be the only preventive measure available during a pandemic.
Health Canada guidelines recommend that in addition to routine practices, transmission-based
precautions (droplet and contact precautions) should be taken for pediatric and adult patients
with influenza during the pre-pandemic and inter-pandemic period. (See Routine Practices and
Transmission-based Precautions policy IC-100). Complete adherence to Droplet/Contact
Precautions will not be achievable during a pandemic phase; however every effort to employ
transmission-based precautions should be made.
For Complete Infection Control Plan for Pandemic Influenza Please see Appendix L.
Please see Section 2.0.0.0 for full communication plan
6.2.6.0 Occupational Health Management Of HCW’s (and Health Care
Volunteers) During An Influenza Pandemic
Adherence to the recommendations for vaccine and antivirals for patients / residents, HCWs and
volunteers, as outlined in the Canadian Pandemic Influenza Plan and the vaccine priority list as
noted in South West Health Pandemic Influenza Plan, is necessary.
6.2.6.1 Fit for Work
May work with all patients. May be selected to work in units where patients, if infected with
influenza, would be at high risk for complications.
1. They have recovered from ILI illness during earlier phase of the pandemic.
2. They have been immunized against the pandemic strain of influenza.* (See Annex D
Canadian Pandemic Influenza Plan)
3. They are on appropriate antivirals.* (See Annex E Canadian Pandemic Influenza Plan).
*Subject to daily ILI assessment by/or under direction of Occupational Health before work shift
begins. Whenever possible, well, unexposed HCW’s should work in non-influenza areas.
Asymptomatic HCW’s may work even if influenza vaccine and antivirals are unavailable.
6.2.6.2 Unfit for Work
Ideally, staff with ILI should be considered “unfit for work” and should not work. Due to
limited resources, these HCW’s may be required to work, if they are well enough to do so. In
such cases, they are determined to be “fit for work with restrictions”.
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6.2.6.3 Fit to Work with Restrictions
Symptomatic staff, who are considered “fit to work with restrictions” should only work with
patients with ILI. Symptomatic HCW’s who are required to care for non-exposed patients (noninfluenza areas) should wear a surgical mask if they are coughing and pay meticulous attention
to hand hygiene.
Symptomatic HCW’s who are well enough to work should not care for the following types of
patients: intensive care areas, nurseries or units with severely immuno compromised patients, eg.
transplant recipients, hematology/oncology patients, patients with chronic heart or lung disease,
or patients with HIV/AIDS and dialysis patients.
6.2.6.4 ILI Assessment Tool to Monitor HCW’s/Volunteers
ILI Assessment Tool
Please check the following.
ILI in the general population is determined by the presence of 1, 2 and 3 and any of
4., a – c, which could be due to influenza virus:
___ ( ) 1. Acute onset of respiratory illness
___ ( ) 2. Fever (>38_ C)*
___ ( ) 3. Cough
4. One or more of the following:
___ ( ) a. sore throat
___ ( ) b. arthralgia
___ ( ) c. myalgia or prostration
* May not be present in elderly people
Adapted from the ILI surveillance definition currently used by FluWatch for the 2002-2003
season8.
All HCW’s, who have recovered from ILI during an earlier phase of the pandemic are considered
immune and are not subject to ILI assessment.
All other HCW’s, even those who have been immunized against the pandemic strain, will be
monitored daily before their shift, using the ILI Assessment Tool. HCW/volunteer ILI
Assessment will be under the direction of Occupational Health, but not necessarily conducted by
OH. All cases of HCW/Volunteer ILI will be reported to OH for determination of “fitness to
work”. For Complete Occupational Health Plan for Pandemic Influenza please see Appendix L.
6.2.7.0 HUMAN RESOURCES
6.2.7.1 Staffing
Recruitment of additional health care workers (retirees) along with other registered health care
volunteers is currently being compiled. Please see Appendix K 03 for retiree lists for the district
and Appendix F06 for registered health care facility volunteers.
It is important to establish a method for assessing qualifications and competence during the
pandemic when people are being hastily recruited. Within reasonable limits of clinical
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competency, registered nurses and other health care providers currently serving in administration
positions may also be available to provide patient care.
Additional staffing may be available due to temporary suspension of some services.
All hospital employees are considered essential services in the event of a Pandemic. All staff
scheduled to work will report to their areas of responsibility until directed elsewhere. All non
scheduled employees will report to a designated site (still to be determined).
Human Resource/ Staff Coordination area will be managed by Human Resources
and Departmental Managers in each location.
ITC are an extension’s of SWH and will be managed by designated site
administrators, who will direct the other managers and employees.
On arrival to the Human Resource/ Staff Coordination area, staff will sign in, be
assessed for skill mix and assigned to an area of need, including Non Traditional
Clinics.
All managers should be encouraged to keep current records of staff which include
their skill set, areas of experience and expertise for reference in the event of a
disaster.
6.2.7.2 Education for Health Care Workers
1. Educational information for Health Care workers (HCW), will be provided during the prepandemic planning phase and again as soon as WHO Pandemic Phase 0 Level 1 is declared (see
section 0.3.1.0) and repeated at frequent intervals to all staff levels and during all shifts.
At the completion of the first draft of the DHA pandemic plan, all staff within the DHA will be
educated on the plan and how the DHA intends to manage a pandemic. During this education, all
staff will understand their potential role and responsibility during a pandemic of influenza. PHS,
Clinical resource nurses, and acute care nurse managers will do education. Education will
continue as needed immediately prior and during a pandemic.
2. The educational information prepared and provided for workers will include:
(a) An explanation that pandemic influenza is a novel strain of influenza and what a
pandemic is;
(b) The facility-specific pandemic influenza plan;
(c) Information regarding triage settings (see Section--), self care (see Section --), And
temporary influenza hospitals (see Section --).
(d) The difference between an upper respiratory infection and influenza (see the Introduction
to the Preparedness Section of the Canadian Pandemic Influenza Plan);
(e) The mode of influenza transmission (see Section --);
(f) The criteria for determining, influenza-like-illness (ILI) (see glossary for definition and
Appendix IV for an ILI Assessment Tool) and influenza (see glossary for definition);
(g) The risk of infection and subsequent complications in high-risk groups such as residents
of Long Term Care Facilities.
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(h) The message that strict adherence to hand washing/hand antisepsis recommendations is
the cornerstone of infection prevention and may be the only preventative measure
available during early phases of the pandemic.
(i) Information about the importance of hygienic measures to minimize influenza
transmission because influenza immunization and/or prophylaxis may not be available
until later in the pandemic;
(j) Information indicating that, during the early phase of an influenza pandemic, it may be
feasible for HCWs to wear masks when face-to-face with coughing individuals to
minimize influenza transmission (particularly when immunization and antivirals are not
yet available) but not practical or helpful when transmission has entered the community.
Masks may be worn by HCWs to prevent transmission of other organisms from patients
with undiagnosed cough;
(k) Who will be given the highest priority for immunization when vaccine is available?
(l) The importance of being immunized and safety of immunization.
(m) Who will be given what priority for prophylaxis when antivirals are available, the
importance of prophylaxis and safety of prophylaxis.
3. The pandemic influenza information will be appropriate to the audience and be provided using
a variety of methods. e.g., postings in elevators, at facility entrances, brochures, newsletters and
web sites.
4. Information about the importance of routine practices and additional precautions to
prevent the transmission of infection during the delivery of health care in all health care
settings during a pandemic. This information will include the caveat that some
routine practice and additional precaution recommendations may be achievable only in
the early phases of the pandemic and other recommendations may not be achievable as
the pandemic spreads and resources (equipment, supplies and workers) become scarce.
5. HCWs will be provided with the recommendations for Occupational Health
Management of workers during a pandemic (Please see Section 6.).
6.2.7.3 Training Program to cross-train staff:
• Develop Survey for managers – done Marilyn
• Collate data with managers following receipt of results
• Meet with managers to establish needs and action plan
Meet with union to review plan and obtain feedback and suggestions
6.2.7.4. Temporary Licenses
College of Registered Nurses of Nova Scotia (CRNNS) make note that retired nurses will not be
licensed unless they can meet the regular requirements for licensing as required for all RNs. That
means no retirees can provide care that falls under the scope of practice for RNs unless they can
prove their competency to practice. They can act as highly trained volunteers and the district
would need to develop a policy as to what we are prepared to allow them to do for liability
purposes i.e... vital signs, bed baths, etc.
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November 2005 Provincial discussions underway to address:
** Who can provide care and administer vaccines and/or antivirals?
**What are the minimum training standards?
**What legislation or temporary licensing arrangements are needed and would this be allowed?
**Develop protocols for temporary licensing of retired and other skilled but currently
unqualified persons.
**Will flu vaccine or antivirals be mandatory for HCW’s to continue working?
**Union/legal issues. Provincial guideness/consistency required.
**Consider options for health care workers required to work who have ill family at home.
**Terms of employment during pandemic- discussion with professional associations and unions.
**Physicians- Agreements with CPSNS (other professional associations) re: provision of
services (at Influenza Treatment Clinics). Funding expectation, role of specialists-education and
planning.
**Fit Testing Human Resources Appendix
6.2.7.5 Volunteers
The value of the volunteers cannot be overstated – See Appendix K04 for further information on
vaccines..
6.3.0.0 Health Services
6.3.1.0 Plan for increasing surge capacity:
Options to increase bed capacity have been identified as follows:
******Check code purple protocol****
Reducing/Tempory suspension of elective surgeries (to increase bed capacity and
potentially increase staffing). Decreasing elective utilization of health care facilities
during a pandemic will increase bed availability, allow redistribution of staff and
equipment, and may decrease the elective patient’s exposure to influenza infected
persons.
Notify Home Care Services re: need to implement prioritization of existing clients
(Please see Appendix O03 for contact name and numbers)
Contact LTC Facilities/residential beds for total beds available (Please see Appendix O01
for contact name and numbers).
Discharge planner and Home Care liaison to implement protocols and requirements for
early discharge (See Table 2 below)
Department managers unit assessment tool (assesses clients for possible early discharge
and current unit status). Please see further details in Appendix D.
Hospital Admissions, Transfers and Discharges
Transfers
Please see section 6.5.7.5 for Patient activity restrictions within acute care.
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Inter-Facility Transfers- Planning assumption is that transfers between facilities for emergency
care will continue; for example ICU clients requiring emergency cardiac caths; obstetrical clients
requiring tertiary care and orthopedic services at Valley Regional.
Transfers from other districts/institutions should be assessed for possible exposure to influenza
and managed in a designated area.
Inter-district Transfers
Neighbouring districts will almost certainly be affected by influenza at the same time. It is most
unlikely that admissions will be diverted.
Coordinate clinical care and health services plans with bordering districts to avoid
migration to centers of perceived enhanced service:
This is a provincial issue and is not being looked at in a District level. The communications
distributed to the public from District 2 will include influenza symptoms and clinic locations the
patient should access closest to their area. This information will have to be added to the
communications plan once the clinics are known. Patients could not be turned away without
being assessed.
If patients need to be transferred to other areas of Nova Scotia (where influenza may not yet have
reached) the clinical staff and infection control team at the receiving hospital should be informed
before the transfer takes place that the patients may have been exposed to influenza.
Discharges
Patients will be assessed promptly and regularly by their responsible clinician for suitability for
discharge. Since community resources will be stretched, it may not be possible to discharge some
individuals who need significant community support.
Careful liaison with Community Nurses and Social/Community Services before discharge
will be essential. Please see Appendix F 07 Discharge planning checklist.
November 2005 Discussions at Provincial level:
NS Surveillance plan- database, data collection, data collection instructions and infrastructure.
Data to include health facility ILI, sentinel physician, school and workplace absenteeism,
deaths,, adverse reaction to vaccine and antivirals.
Screening tools.
What and how information is communicated between DOH and DHA.
6.3.2.0 Patient Flow (Acute Care)
Influenza Like Illness (ILI) Assessments
Guidelines for separating influenza cases from non-influenza cases:
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Triage Objectives:
1. Identify persons clients who have pandemic disease and separating them from others to
reduce the risk of infection
2. Triage officer to manage patient flow, including referral to local physician office or
Influenza Treatment Clinic when ER not required.
3. A separate triage and waiting area should be established for persons presenting with
febrile or respiratory disease (remember that some persons with Influenza, particularly
children, will present with high fever and no respiratory illness).
4. Because not every patient wit these symptoms will have influenza, provision of masks to
persons who are coughing and posters displaying cough etiquette.
5. Reserve in-patient bed to those most in need
6. May need Home Care follow-up
7. (Guidelines for Patient Triage/Cohorting taken from Occupational Health and Infection
Control for Pandemic Influenza Section 6.17.05)
When Pandemic Phase 2 is declared, open the following specified cohort areas/units in the
appropriate hospital:
1. Triage: Triage ILI patients promptly to a separate designated influenza assessment area
on site.
2. Level One Triage: Each facility will have an initial triage area set up to determine if the
patient should be seen within the ER or transferred to the Non Traditional Clinic. These
initial triage areas will be an initial assessment utilizing the ILI assessment form. Patients
will be directed to ER for further assessment related to Non ILI related illness or critical
ILI site or the Nearest Non Traditional Clinic.
3. Non ILI Assessment Area: These patients require acute care assessment for conditions
other than influenza. Triage to specific non ILI waiting and examining areas physically
separate from the ILI assessment area.
4. Suspected ILI/Confirmed Influenza Unit: Not Exposed/Immune* to Influenza:
5. Not Exposed to ILI but at very high risk of complications i.e. ICU patients, nurseries
or units with severely immuno-compromised patients (transplant recipients,
hematology/oncology patients, patients with chronic heart or lung disease or patients with
HIV/AIDS and dialysis patients)
6. Quick look chart
YRH
DGH
RWH
Level 1 Triage
Building C (Old front entrance). Level 1 Main Entrance
triage physio/hall.
ER Triage
Physio office and exercise room.
Waiting area in
NTC Triage
Maple Grove School
Digby Elementry
Hillcrest
Pubnico High School
ILI Areas for Admission
4 North as has separate elevator access
Non ILI areas for admission
*Immune are those recovered from the pandemic strain of influenza or those immunized
against the pandemic strain of influenza.
Page 93
6.3.2.1 Surveillance in Triage
In the Triage room:
1. The triage RN uses the Daily Surveillance Tally Worksheet (appendix A) for Influenza
Like Illness (ILI), and records Health Card number of patient, relevant symptoms,
immunization status, onset, and age; the RN keeps a running tally
2. 2. When the Daily Surveillance Tally Worksheets are full, they are inserted in a binder in
the triage room
3. A new Daily Surveillance Tally Worksheet is started every midnight, whether the sheet is
full or not
4. The daily Surveillance Worksheets are accessible to the Infection Control Practitioner, or
designate, within the facility
In the Emergency Room or Observation Room:
5. The RN, who initially triages the patient upon arrival to the Emergency Department, will
document patient on the Daily Surveillance Tally Worksheet as written above
6. The Daily Surveillance Tally Worksheets will be updated by the RN who is in charge of
the patient after initial Triage and /or the RN in charge of the patient at the time of
disposition of the patient, regarding admission, discharge, transfer or referral information
The Ward Clerk (or designate):
7. The ward clerk collects the Daily Surveillance Tally Worksheets first thing in the
morning and adds any additional information that is missing such as admission, referral,
transfer, or discharge status
8. The ward clerk uses the Daily Surveillance Tally Sheets to complete the Surveillance
Data Summary Worksheet (appendix B), and then faxes (902 742-6062) the completed
worksheet to the CDC nurse in Public Health every morning.
9. Both the Daily Surveillance Tally Worksheet and the original Surveillance Data
Summary Worksheet will remain in a binder in the Emergency Department
Page 94
Hospital
Services
Emergency/OPD
6.3.3.0 Intensive Care Services
Demands for intensive care beds may be high due to patients developing respiratory failure. ICU capacity will
need to be maximized within existing resources. Operating Theatres, Recovery and Day Surgery may be used as
additional areas for ventilatory support, subject to staffing and equipment availability (please see section 1.2.2.1
for OHS Surveillance for ventilator availability. Other wards and departments will assist by facilitating speedy
transfer of patients out of ICU whenever appropriate.
6.3.4.0 Clinical Care Guidelines
Clinical Care Definition:
When influenza is circulating in the community, the presence of fever and cough of acute onset are good
predictors for influenza. The positive predictive value increases when fever is higher than 38ºC and when the
onset of the clinical illness is acute (less than 48 hours after the prodromes). Other symptoms, such as sore
throat, rhincorhea, malaise, rigors or chills, myalgia and headache, although non-specific, may also be present.
6.3.4.1 Most Common Clinical Presentations (Adults)
The typical clinical presentation of uncomplicated influenza is tracheobronchitis with some small airway
involvement. The onset of disease is usually abrupt: headache, chills and dry cough, followed by fever of 3840ºC that may peak as high as 41ºC within the first 24 hours, together with myalgia, malaise, and anorexia.
Physical signs include hot and moist skin, flushed face, injected eyes and clear nasal discharge. Some patients
also have nasal obstruction, sneezing, pharyngeal inflammation, excessive tearing and mild cervical
adenopathy.
Most Common Clinical Presentations (Children)
The highest rate of influenza-related serious illness in children occurs in the 6-12 months old age group, after
the waning of maternal antibodies. Although uncomplicated influenza may be similar to the disease in adults,
there are some age related differences in toddlers and infants.
1.
2.
3.
4.
5.
6.
7.
Young children usually develop higher temperatures (over 39.5ºC) and may have febrile seizures.
Unexplained fever can be the only manifestation of the disease in neonates and infants.
Influenza viruses are an important cause of laryngotracheobronchitis (croup), pneumonia and
pharyngitis-bronchitis in young children. Both types, A and B, are significant causes of low
respiratory tract infections.
Gastrointestinal manifestations, such as nausea, vomiting, diarrhoea and abdominal pain, are found
in 40-50% of patients, with an inverse relation to age (mainly in 3 years old or younger).
Otitis media and non-purulent conjunctivitis are more frequent in young ages.
A variety of central nervous system findings, including apnea, opisthotonos and seizures may appear
in as many as 20% of the infants. Children may also present with symptoms suggestive of
meningitis, e.g., headache, vomiting, irritability and photophobia.
Myositis is a complication in young children, especially after infection with influenza B.
In children over 5 years and adolescents the most frequent symptoms are fever, cough, non-localized throbbing
headache, chills myalgia and sneezing. The fever is usually in the 38-40ºC range and a second peak, without
Page 95
bacterial
superinfection, may occur around the fourth day of illness. Backache, sore throat, conjunctival burning with
watery eyes and epistaxis may be present, but gastrointestinal symptoms are infrequent. Chest auscultation is
usually normal, but occasionally course breath sounds and crackles may be heard.
Special Populations: High Risk Conditions
The Canadian National advisory Committee on Immunization (NACI) considers the following groups to be at
“increased risk for complications from influenza”:
• Adults and children with chronic cardiac or pulmonary disorders (including bronchopulmonary
dysplasia, cystic fibrosis and asthma) severe enough to require regular medical follow-up or hospital
care. Chronic cardiac and pulmonary disorders are by far the most important risk factors for influenzarelated death.
• People of any age who are residents of nursing homes or other chronic care facilities.
• People ≥ 65 years of age.
• Adults and children with chronic conditions.
• Children and adolescents (6 months to 18 years of age) with conditions treated for long periods with
acetylsalicylic acid (e.g., Kawasaki disease, juvenile rheumatoid arthritis, acute rheumatic fever and
others. This therapy might increase the risk of Reye’s syndrome after influenza.
• Women who will be in the second or third trimester of pregnancy during the influenza season (fall or
winter).
• Women with influenza infection in their second and third trimesters of pregnancy are at increased risk of
hospitalization for cardio-respiratory disorders.
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Patient
Factors which may delay recovery from influenza infection and facilitation the development of
influenza-related complications
High-risk conditions: (Co-morbidity)
Age: 2 or 65 years
Pregnancy (2nd and 3rd trimesters)
Cardiovascular diseases: congenital, rheumatic, ischemic heart disease, congestive heart failure
Bronchopulmonary diseases: asthma, bronchitis, bronchiectasis, emphysema, cystic fibrosis
Metabolic diseases: diabetes
Renal diseases
Malignancies
Immunodeficiency, AIDS, immunosuppression, transplant recipients
Diseases of the blood, anemia, hemoglobinopathy, oncologic disorders
High-risk conditions: (Co-morbidity)
Hepatic diseases, cirrhosis
Long-term salicylate therapy and younger than 18 years of age (Kawasaki
disease, rheumatoid arthritis, acute rheumatic fever, others)
Complications of Influenza
Complications of
Influenza
Respiratory
•
•
•
•
•
Cardiovascular
Muscular
Neurologic
Systemic
•
•
•
•
•
•
•
•
•
•
•
•
Major Clinical Category
Upper respiratory: Otitis media, sinusitis,
conjunctivitis
Acute laryngotracheo bronchitis (croup)
Bronchitis
Bronchiolitis
Pneumonia: Primary viral, secondary bacterial,
combined
Complication of pre-existing disease
Pericarditis
Myocarditis
Complication of pre-existing disease
Rhabdomyositis
Rhabdomyolisis with myoglobinuria and renal failure
Encephalitis
Reye’s Syndrome
Guillain-Barre
Transverse myelitis
Toxic shock syndrome
Sudden death
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6.3.4.2. Patient Management – See Assessement Forms Appendix D
Objectives of triage include identifying persons who may have pandemic disease and separating them from
others to reduce the risk of transmitting infection, and identifying the type of care they require. Because not
every patient with these presenting symptoms will have influenza, infection control within the triage area should
include provision of masks to persons who are coughing, availability of posters or other displays emphasizing
cough etiquette and hand washing facilities.
Triage of Adults (> 18 years)
Hospital1
EmergencyDepartment1
Triage Centre1
Doctor’s office
Walk-in clinic
Other
Symptoms consistent
with influenza-like
illness (Table 2-1-1)
No
Assess
non-flu area
2
Stable
No co-morbid illness3
Yes
Initial Clinical
Assessment
(Table2-1-2)
2
Needs further assessment
Local triage centre1
Non-traditional and
Community centres
Stable
Co-morbidity3
Emergency Department1
Secondary Clinical assessment
(Table 2-1-3)
Home with self-care
(Table 2-1-4, appendix 2.10)
Observe/Reassess
Home
Sub-acute care4
Non-traditional
health-care setting
Reassess4
Phone
Visit
48 hr
Pneumonia, no co-morbidity
Functional impairment
(unable to cope)
Pneumonia & Co-morbidity
Acute confusion
Metabolic derangement
Respiratory failure
Acute cardiac deterioration
Admit
Evaluation not
definitive
Sub-acute care5
Non-traditional
health-care setting
Hospital Observation
* See legend next page.
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Legend:
1) Triage centres may be located at doctor’s offices, clinics, and in Influenza Treatment Clinics or hospitals
when a special “emergency” area for the triage, secondary assessment and treatment of influenza patients,
avoiding the passage of these patients through the regular Emergency Department.
2) Stable: Patient with (L) but without abnormalities meeting the criteria for secondary assessment (Table C)
3) Co-morbidity:
65 yr
Pregnancy
Chronic lung disease (e.g. chronic obstructive pulmonary disease, cystic fibrosis, asthma)
Congestive heart failure
Renal failure
Immunosuppression (due to underlying disease or therapy)
Haematological abnormalities (anemia, haemaglobinopathies)
Diabetes
Hepatic disease
Socially unable to cope (i.e. without personal support at home, such patients may need an alternative
centre of care). An alternate care arrangement may also be considered if a high-risk individual lives in
the same household as the influenza patient.
Patients on long-term acetylsalicylic acid therapy (increased risk of Reye’s syndrome).
4) Some individuals may not be able to self-care at home and will therefore need community support or an
alternate care centre.
5) In addition to providing sub-acute care, some local NT sites may be able to handle patients more critically
ill. (Please see Non-traditional site Site Guidelines, Annex R.)
Symptoms consistent with Flu like illness:
Adults (18 years)
a) Systemic
Fever
Chills
Headache
Aching muscles and joints
Stiffness
Weakness
b) Respiratory
Cough
Sore throat
Hoarseness
Stuffy or runny nose
Shortness of breath (patients with influenza and shortness of breath should undergo chest radiography)
Chest symptoms: thoracic pain when taking a deep breath, retrosternal trachea pain, pleuritic pain
Red and/or watery eyes
Earache
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c) Digestive (seen mainly in children and elderly)
Vomiting
Diarrhea
Abdominal pain
d) Neurological
Confusion, drowsiness
Convulsions
Symptoms suggestive of meningitis (mainly in children)
6.3.4.3. Initial Influenza Illness Assessment
Initial influenza illness assessment (≥ 18 years)
Primary Assessment
Temperature
Pulse
Blood pressure
Respiratory rate
Skin colour (lips, hands)
Chest signs or symptoms
Mental status
Function
Oxygen saturation
Results Requiring Secondary Assessment
35°C or 39°C
New arrhythmia (irregular pulse)
>100 beats/min (if 16 years)
100 systolic
Dizziness on standing
24/minute (tachypnea)
Cyanosis
Any abnormalities on auscultation or chest
pain
New confusion
New inability to function independently
Persistent vomiting (2-3 times/24hr)
90% room air
If no abnormality and no co-morbidities are found: send home with instructions for self-care Appendix
If no abnormality, but co-morbidity: send home with instructions for self-care (Appendix and with
reassessment after 48 hrs, or send to non-hospital domicile. Follow-up.
Co-morbidities: > 65 yr, pregnancy, chronic lung disease, congestive heart failure, renal failure,
immunocompromised, haematological abnormalities, diabetes, neoplastic disease, hepatic diseases,
socially unable to cope (i.e. non supportive household)
If secondary assessment is required, and the patients are sent to another centre/ward for complementary
evaluation, each individual should be provided with a summary of the clinical/laboratory data. Some
triage centres may have the facilities to perform secondary assessment and treatment without transferring
patients.
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6.3.4.4. Secondary Influenza illness assessment
Secondary Influenza illness assessment (≥ 18 years)
When the patient’s secondary assessment has to be completed in a different setting, a new clinical evaluation to
confirm the diagnosis at the primary triage centre should precede laboratory studies. Not all the tests mentioned
below will be needed for all patients, and clinical assessment should determine which procedures are done,
particularly if resources are scarce:
Complementary laboratory studies
CBC (core battery, if appropriate)a
Electrolytes
BUN, creatinine
Glucose
CPK (only in patients with severe muscle pain)
Blood gases, O2 saturation
(see Appendix 2.111)
Chest x-ray (CXR)a
EKG (clinical criteria)
Results requiring supervision or admission
Hgb 80 g/l
WBC 2.500 or 12.000
Bandsb > 15%
Platelets 50,000/ L
Na 125 meg/L or 148 meg/L
K 3 meg/L or 5.5 meg/L
BUN 10.7 mmol/L
Creatinine 150 mol/L
3 mmol/L or 13.9 mmol/L
CKMB 50%
Total CK 1,000/ L
Blood gases pO2 60% room air
O2 saturation 90% room air
Abnormal, consistent with pneumonia or with
congestive heart failure
Evidence of ischemia, new arrhythmia
a) Under optimal circumstances, blood work and CXR should be obtained before admission. If resources are
limited, priority should be given to patients with co-morbidity or suspected complications (i.e. pneumonia,
etc.). Patients with normal gases and normal chest auscultation do not need CXR. Likewise, when the
clinical diagnosis of pneumonia is unquestionable and the resources are scarce, no CXR need to be taken
unless there is suspicion of a complication of the pneumonia (i.e. emphysema). If antibiotics are limited,
however, CXR may be indicated to confirm pneumonia before prescribing any drug. Conversely, if
pneumonia is suspected but the radiology resources are limited, antibiotics may be prescribed without
radiological confirmation.
b) An increase in the number of circulating neutrophil-bands (i.e. immature neutrophils, with an elongated
non-segmented nucleus) suggests bacterial infection. Mean normal values of bands are 12.4% (range 9.515.3 %)200. In a typical acute bacterial infection, the ratio bands/segmented neutrophils may go up to values
of 16-17%200.
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6.3.4.5. Microbiologic Diagnostic
Microbiologic diagnostic tests (bacteriologic and/or virologic) may be appropriate for secondary assessment.
They will be performed depending on the clinical presentation and availability of resources. Once the pandemic
strain is confirmed in a community, virologic tests will be needed only to confirm diagnosis in atypical cases
and for surveillance purposes. Rapid tests are useful for diagnostic and treatment decisions (see Appendix ).
Isolation and culture of the virus is needed for surveillance purposes.
Ideally, purulent sputum will be analyzed by Gram straining and culture to identify infecting bacteria and their
susceptibility. In a pandemic, these studies should be reserved for patients admitted to hospitals, especially
those in intensive care or those failing initial antibiotic therapy. If culture is not possible, Gram straining should
be attempted.
Ideally, blood cultures should be obtained prior to antibiotic therapy in patients with pneumonia. If resources
are scarce, blood cultures will be reserved for patients who are very ill, with toxic signs and low blood pressure;
for patients who fail to recover after 48 hours of treatment with antibiotics; or for patients admitted to intensive
care units.
Sample
Sputum (purulent)
Blood (only for very ill patients or for patients
who do not respond to 48hr of treatment with
antibiotics)
Nasopharyngeal aspirate (only for atypical
cases or for surveillance)
Test
Bacteriologic: Gram and culture
Bacteriologic: Culture
Virologic: Virus antigens, RNA, culture
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6.3.4.6 Pediatric Triage
This algorithm was designed to help medical and healthcare staff, as well as lay persons with minimal
knowledge and experience, to manage children with influenza-like illness during a pandemic. Triage centres
may be located at the doctor’s offices, clinics, hospitals, and in non-traditional care settings (schools, churches,
community centres. Military field hospitals, etc.). The numbers in each of the following boxes refer to sections
within this document where additional information can be found.
Primary triage center
Home with parental
education
24hr
Reassess
Phone
Visit
Child with acute
respiratory illness
Urgent medical
evaluation and
management
Initial assessment
Yes
Hospital
Observation
Danger signs
present
No
Admission
Clinical assessment
for evidence of lower
respiratory tract
infection
(LRT1)
Yes
Physician assessment
Yes
No
Assessments for
Co-morbidity (no
signs of LRT1)
No
Home with parental
education
Sub-acute care
Care in Non-traditional
settings
* See legend next page.
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Legend for Pediatric Triage
Child with acute respiratory illness (ARI,107) (i.e. one respiratory symptom and fever)
The most common presentation of influenza in children is fever and cough of sudden onset. The term ARI is
preferred for children since most distinguishing features in adults are not characteristic in children until the
second decade. Young infants (less than 2 months old) can become ill and progress to severe illness rapidly.
They are much less likely to cough with pneumonia and frequently have only non-specific signs such as poor
feeding, apnea, and fever or low body temperature.
Systemic:
Fever (38 C core temperature)
Apnea
Respiratory symptoms:
Cough
Nasal congestion and/or rhinorrhea (second most common presentation),
Difficulty breathing (including chest retractions, stridor, etc.)
Fast breathing* (tachypnea)
Hoarse voice
Earache
*Definitions of fast breathing (tachypnea)222
<2 months = > 60 breaths per minute
2-12 months = > 50 breaths per minute
> 12 months to 5 years = > 40 breaths per minute
> 5 years = > 30 breaths per minute
Associated non-respiratory symptoms:
Not feeling well, malaise
Low energy, lethargic
Not playing
Needing extra care
Poor feeding
Vomiting, diarrhea
Irritability, excessive crying, fussy
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Initial Influenza illness assessment (< 18 years)
Primary Assessment
Temperaturea
Respiratory rate
Results Requiring Secondary Assessment
C or 9°C
Skin colour and temperature (lips, hands)
Cyanosis, sudden pallor, cold legs up to the knee
Chest signs and symptomsb (pain may be
Chest indrawing, wheezing, grunting, inquire for
difficult to detect in young children)
chest pain
Mental status
Lethargic or unconscious, confusedc
Function
Unable to breastfeed or drink, persistent vomiting
(> 2-3 times/24hr)d
Inability to function independentlyc
Neurologic symptoms and signs
Convulsions, full fontanelle, stiff neck,
photophobia
e
Oxygen saturation
0% room air
Danger signs (pediatrics): (2 months to 5 years old)222
Difficulty breathing (chest indrawing or nasal flaring or grunting or stridor or fast breathing)
Cyanosis
Unable to breastfeed or drink
Vomiting everything (continuous vomiting)
Lethargic of unconscious or confused
Convulsions/seizures
Full fontanelle
Stiff neck, photophobia
When these danger signs are present in infants younger than 2 months, they suggest very severe disease and
may be life threatening. These children should always be referred immediately for physician assessment.
Additional danger signs in children under 2 months include:
The child stopped feeding well (less than half of the usual amount of fluids)
Fever or low temperature (high fever can represent a serious infection, but low temperature may also be
present
Wheezing
Grunting or stridor when calm
Severe chest indrawing
Abnormally sleeping or difficult to wake
Poor circulation: sudden pallor, cold legs up to the knees
Less than four wet diapers in 24 hours
Signs of pneumonia (pneumonia in young infants is considered very serious and these children should be
referred urgently to a hospital for evaluation
Urgent medical assessment (pediatrics)
While a primary care provider may give first aid, children with danger sign must be seen by a physician
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Secondary assessment (< 18 years)
When the patient’s secondary assessment has to be completed in a different setting, a new clinical evaluation to
confirm the primary assessment should precede laboratory studies. Not all tests will be needed for all patients,
and clinical judgment should be used, particularly if resources are scarce.
Complementary laboratory studies
CBC (core battery, if appropriate)a
Electrolytes
BUN, creatinine
Glucosef
CPKf (only in patients with severe muscle
pain)
Blood gases, O2 saturation
Chest x-ray (CXR)a
Results requiring supervision or admission
Hgbb 8.0 g/dL
WBCc 2,500 or 12,000 cells/l
Bandsd > 15 %
Plateletse 0,000/l
Naf 25 meq/L or 148 meq/L
Kf 3 meq/L or 5.5 meq/L
BUNf 0.7 mmol/L
Creatininef 50 mol/L
3mmol/L or 13.9 mmol/L
CKMB 0%
Total CK 000 mol/L
Blood gases pO2
0% room air
0% room air
O2 saturation
Abnormal, consistent with pneumonia
Values of WBC for young children are age related. Normal values for different ages are157:
Age
Birth
24 h
1 month
1-3 years
4-7 years
8-13 years
> 13 years
Cells/uL (limits)
9,000 – 30,000
9,400 – 34,000
5,000 – 19,500
6,000 – 17,500
5,500 – 15,500
4,500 – 13,500
4,500 – 11,000
Value normal for infants/children157
Analyte
Age ranges
Sodium
Infants
Children
Thereafter
Potassium
< 2 months
2-12 months
> 12 months
BUN
Infant/child
Thereafter
Creatinine
Infant
Child
Adolescent
Glucose
Child
Reference values (SI) 109 cells/L
9.0 – 30.0
9.4 – 34.0
5.0 – 19.5
6.0 – 17.5
5.5 – 15.5
4.5 – 13.5
4.5 – 11.0
Normal values
139 – 146 mmol/L
138 – 145 mmol/L
136 – 146 mmol/L
3.0 – 7.0 mmol/L
3.5 – 6.0 mmol/L
3.5 – 5.0 mmol/L
1.8 – 6.4 mmol urea/L
2.5 – 6.4 mmol urea/L
18 – 35 mol/L
27 – 62 mol/L
44 – 88 mol/L
3.3 – 5.5 mol/L
Page 106
Clinical assessment of evidence of LRTI (pediatrics)
a) Clinical assessment
Crackles
Wheeze
Tachypnea (fast breathing), use of accessory muscles
Consolidation
Poor air entry
Any young infant (< 2 months) with pneumonia has a severe, life threatening infection. The most
important signs to consider when deciding if a young infant has pneumonia are:
Breathing rate (60 times/minute)
Severe chest indrawing, use of accessory muscles
b) Secondary assessment (laboratory):
Chest radiograph (CXR)
Respiratory tract specimen for diagnosis (e.g. nasopharyngeal aspirate, sputum on children over 7
years of age)
Blood work
Other diagnostic tests (as required)
Determine if patient has co-morbidity of concern
(No evidence of lower respiratory tract infection)
According to NACI, patients at “high risk for complications from influenza” include152:
Chronic cardiac or pulmonary disorder (bronchopulmonary dysplasia, cystic fibrosis, asthma) severe
enough to require regular medical follow up or hospital care,
Chronic conditions such as diabetes and other metabolic diseases,
Cancer,
Immunosuppression (due to underlying disease and/or therapy)
Renal disease,
Anemia, hemoglobinopathy
Residents of chronic care facilities,
Patients on long-term acetylsalicylic acid therapy (increased risk of Reye’s syndrome).
Asthma and diabetes are the most frequent co-morbidities found in young children. Premature babies and lowweight infants should also be included in this list. All children younger than 2 years of age may be considered
as high-risk patients29.
Socio-economic issues such as age and education of the parents, single parents, multiple young siblings, support
at home by other family members, etc., should also be taken into account when sending a child back home.
Similarly, whether other individuals at home have high risk of influenza associated complications (siblings with
chronic diseases, elderly grandparents, etc.) should be evaluated.
6.3.5.0 Laboratory
Laboratory Services Pandemic Planning
In the event that a pandemic influenza strain is expected then the initial identification
Page 107
In the event
of Pandemic Influenza outbreak the Pathologists and the Laboratory Manager would make the decision on the
level of regular service that would occur on consultation with Senior Management of South West Nova District
Health, Department of Health and any other external agencies involved in the situation. The plan would evolve
on a day-to-day basis or maybe hourby- hour depending on severity of the situation and the Laboratory’s ability
to cope with any internal staff illness as well as that of their families.
Actions that may be considered:
1.Doctor’s offices requested to limit ordering non-urgent Lab tests
2. All outside clinics will be cancelled
3. Laboratory services limited to Inpatient only
4. Staff may be transferred from site to site if illness starts to take toll
5. Blood collection may be done off site to prevent the spread of the virus in-house. This
will depend on the amount of staff not affected by the illness.
6. Only one Lab in District operating
For Complete Laborotory Service Pandemic Plan please see Appendix F.
6.3.6.0 Pharmacy
Looking at the worst case scenario of a 35% to 50% infection rate it is prudent to assume that the pharmacy
department will take a significant hit. It is also reasonable to assume that there will shortages of medications
and/or delays from suppliers. If available, some services will be provided remotely (computer access from
another site). The option chosen will depend on the staffing situation. Please see Appendix G for possible
staffing options and complete Pharmacy Plan.
6.3.6.1 Hospital Antiviral Policy and Procedure:
POLICY: All antivirals used in the prophylaxis or treatment of influenza will be
received by pharmacy personnel and stored in the pharmacy department.
PROCEDURE:
1.
The company shipping antiviral medication will report directly to the pharmacy
department.
2.
The pharmacy department will receive antiviral medication as per the Narcotic and
Control Drug Policy.
3.
All antiviral medication received will be stored under lock and key in the pharmacy
department.
DISPENSING OF ANTIVIRALS
POLICY: All oral or inhaled antivirals used in the prophylaxis or treatment of
Influenza will be treated as per the Narcotic and Control Drug Policy.
PROCEDURE:
1. Antivirals will be dispensed in their original foil packaging, or in a drug scanner to all
wards requiring said drugs.
2. The immediate supply and the number of patients requiring the drug will determine
the quantity dispensed to a given ward.
3. The quantity of drug given to a given ward will be noted in the pharmacy antiviral
drug registry and the pharmacy antiviral delivery record.
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4. Phar
macy personnel will deliver the antiviral drug to the requesting ward.
5. The antiviral drug will be stored in the narcotic and control drug drawer on each cart,
or cupboard on wards not having drug carts.
6. Pharmacy personnel delivering the antiviral drug will note in the nursing antiviral
drug registry the quantity delivered to the ward and the total count.
7. The pharmacy personnel delivering the drug and the nurse receiving the drug will
sign the nursing antiviral drug registry.
8. The nurse receiving the drug will sign the pharmacy antiviral delivery record.
ADMINISTRATION OF ANTIVIRALS
POLICY: All oral or inhaled antivirals administered for prophylaxis or treatment of
influenza will be noted in the nursing antiviral drug registry.
PROCEDURE:
1.
Nursing personnel administering antiviral drug medication will note in the antiviral
drug registry the patient name, dose, date and time administered.
2.
The nurse administering the antiviral will sign out each dose administered.
3.
All administered doses of antiviral medication will be countered signed by another
health professional.
4.
Wasted doses will be countered signed by another health professional.
5.
The Pharmacy Department will be notified of any wasted antiviral dose in a time
efficient manner.
Please see Appendix G 05 for Adverse Drug and Vaccine Reactions Reporting Form.
November 2005 – Discussions at Provincial Level.
Guidelines for prescribing, dispensing and administration of antivirals by nurses-CPSNS, CNNS, Pharmacists
and Medical Society.
Develop a system to collect vaccine and antiviral administration and database.
Provincial confirmation of vaccine and antiviral priority groups. Communication and consistency with DHA’s.
Development of informed consent guidelines.
Methodology for management of second dose.
Security and protection of vaccine/medications and staff during transport.
Pneumococcal vaccine for those in high risk groups.
Identify sites for mass immunization clinics.
6.3.7.0 Mental Health
Please see Appendix H for complete Mental Health Pandemic Plan
6.3.8.0 Support Services
6.3.8.1. Material Management Services Pandemic Plan (Also see Appendix J)
•
Inventory levels will not be increased beyond normal levels prior to a pandemic flu
Page 109
•
If
there is any indication of an impending pandemic flu, inventory levels of supplies
required will be increased
•
Quota carts in effected departments will be adjusted accordingly to meet demand
•
Additional totes to include FTC and vaccine clinics will be utilized for transporting
of supplies
•
Existing van schedule to all facilities within DHA will be maintained
•
Additional van schedule will be implemented to include FTC and vaccine clinics
•
Weekend and holiday distribution schedule will be implemented to include DHA
facilities, FTC, and vaccine clinics
•
Requisitioning process will remain the same. Educational guidelines will be
provided to FTC and vaccine clinics.
•
Request for supplies from FTC and vaccine clinics will be faxed to (902-742-1947)
•
Quota carts will be set up and maintained on a scheduled basis by MM staff
November 2005 Discussions at Provincial Level
** Supplies – Where will they be stockpiled (Vaccines, antivirals, syringes, etc), located and how can the
DHA’s access?
** Purchase and distribution plans. Role of Public Health- nursing as gatekeeper for vaccines and antivirals
** Process for requesting supplies, transport of supplies, receiving. Etc.
Patient Portering Pandemic Flu Plan at YRH
• Patient portering will be available 10 hours per day/ 5 days per week and 7.5 hours
per day on weekends and holidays
• Porter services will focus mainly on patient and visitor portering needs
• Daily scheduled runs will be provided at 8:00am, 10:00am, and 2:00pm
• Mail distribution will be provided when possible
Please see Appendix H for complete Materials Management Pandemic Plan
6.3.8.2 Food and Nutrition Services
Scope of Responsibilities
Provide appropriate food service to inpatients, staff, volunteers at
o District facilities – YRH; DGH; RWH
o Five non-traditional clinics (NTC)
o Immunization Clinics
Meet special food requirements for high-risk groups, as able.
Facilitate the provision of food for communities or high risk clients at home.
Assumptions & Influencing Factors
Forty percent (40%) of Food & Nutrition Services Staff may be ill.
Emergency situation may last 6 - 8 weeks.
Pandemic Flu will spread rapidly but there will be some notice.
Staff & Volunteers will need significant support related to meals / nourishments.
District plan allows for reduction in ambulatory care clinics & surgery, but bed numbers are expected to
be maintained or increased and fully occupied.
Diabetes Education & Clinical Nutrition outpatient clinics will be cancelled.
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District Food and Nutrition Services
Yarmouth Regional Hospital; Digby General Hospital; Roseway Hospital
1. Meals / Menus
Food Service will be available 11 hours per day / 7 days per week
Meals will continue to be served three times per day, at approximately the same time
Selective menus will be discontinued
Therapeutic menus will be minimized to those absolutely necessary
Nourishments will continue to be supplied to patient units.
Disposable dishes, utensils will be utilized as much as possible.
2. Staffing
Minimal Staffing requirements – assuming food being prepared at all three
sites & ITC food preparation is ………and Immunization clinics is…..
Volunteers will be required for delivery/pick-up of meals; runners; additional assistance in meal prep
depending on day-to-day staffing.
Staffing levels will be reassessed on day-to-day basis & will be dependent on availability of
volunteers.
Staff will be re-deployed to ITC as needed????
Diabetes Nurse Educators will be re-deployed to nursing units as needed.
Secretary will be utilized by Food Service or re-deployed to employee pool.
3. Supplies
Food supplies will not be stocked beyond normal levels prior to a pandemic flu.
Food suppliers will be notified as soon as there is any indication of an impending pandemic flu.
Encouraged to supplier list up to date. Supplies will be stocked ASAP.
Additional supplies required.
Please see Section 6.18.10 Food and Nutrition Services for Influenza Treatment Clinics
6.3.8.3 Environmental Services
Provide appropriate environmental service to
o District facilities – YRH; DGH; RWH
o Five non-traditional clinics (NTC)
o Immunization clinics
Services will include
o Appropriate cleaning of all areas
o Laundry/ linen services
o Garbage collection and removal, including biomedical waste.
Forty percent (40%) of Environmental Services Staff may be ill.
Emergency situation may last 6 -8 weeks.
Pandemic Flu will spread rapidly but there will be some notice.
Page 111
Cleaning requirements will be stringent to minimize the spread of flu virus.
District plan allows for reduction in ambulatory care clinics & surgery, but bed numbers are expected to
be maintained or increased and fully occupied.
Ambulatory Care area and clinics will not maintain normal operations, however, these areas may be
utilized for patient care and therefore, require servicing by environmental services.
Central Laundry will be able to maintain present level of services.
DISTRICT FACILITIES
Yarmouth Regional Hospital, Digby General Hospital, Roseway Hospital
1.
Cleaning
2. Staffing
Services will be provide 16 hours per day, 7 days per week
Minimal Staffing requirements to maintain minimal services at the facilities
YRHDGH RWH Staffing levels will be reassessed on day-to-day basis & will be dependent on availability of
volunteers
Staff will be re-deployed in NTC as needed
3. Laundry
Sufficient linens will be available to meet the demands of the three facilities
o Linens not utilized in the ambulatory care clinic will be redirected to additional patient care
areas & NTC
Additional supplies required and supplier’s list and contact numbers
6.4.0.0 Influenza Treatment Clinic
The Primary management approach is to establish Influenza Treatment Clinic sites in order to minimize the
demand on established facilities and meet these main objectives:
• Leave hospital resources available for serious non-influenza patients
• Leave hospital resources available for most serious influenza patients
• Minimize exposure of non-influenza hospital patients
• Minimize spread of influenza through hospitals.
• ITC’s are extensions of SWH and will be managed by designated site administrators.
Influenza Treatment Clinics will be set up throughout District 2 to allow for patient with Influenza Like Illness
(ILI) or confirmed illness to be cared for. These clinics will provide triage, assessment, holding, treatment, and
palliative care. The extent to which this can be done, will depend on human resource, and supply availability.
6.4.1.0 The Influenza Treatment Clinics sites – See Appendix I
•
Digby – Digby Elementary 24 hour clinic
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•
Shel
burne – Hillcrest Academy 24 hour clinic
• Yarmouth – Maple Grove 24 hour clinic
• Clare – Joseph Dugas, Church Point. 12 hour clinic
• Barrington/Argyle – Pubnico West 12 hour clinic
Please see Appendix I for individual school plans, required clinical care requirement and required support
services.
Queries:
How decisions are made re: SCHOOL CLOSURE
What are the legal and environmental ramifications for inpatient facilities.
Memorandums of agreement
Access to supplies from stockpiles and storage for clinics.
Control and distribution if/when shortages occur.
6.4.2.0 Activation of Clinics
Triggers for implementation of Influenza Treatment Clinics:
Local health care resources and surveillance activities will determine the triggers for health services emergency
plans.
These triggers will include:
• The proportion of emergency room visits attributed to influenza
• The proportion of influenza cases requiring hospitalization
• The capacity of the hospital to accommodate influenza cases
•
•
Clinic activation will be by call out.
DHA will initiate call-out system
Specific clinics will be activated in turn. The best scenario is once a known pandemic is declared, the DHA
has 2 weeks to set up in the school. Institutions will designate points at which the following specific actions are
taken:
1. Changing staffing ratios, job duties
2. Reduce surgical slates, admissions
3. Consolidating services Procuring additional supplies
4. Calling on alternate staff
5. Re-routing of ambulances
It will be important for staff at ITC’s to sign in and for managers to keep accurate records of staff hours.
6.4.3.0 Care provided in Influenza Treatment Clinics
The care provided at ITC site will depend on the needs of the community and the resources available. ITC sites
will be used for three main purposes:
Influenza diagnosis and triage
Providing medicine and a short course of treatment and instructions for home recovery
Page 113
Short
term clinical care
Holding area for patients requiring transfer to hospital
Palliative care
6.4.4.0 Triage and Patient Flow (Influenza Treatment Clinic)
Triage sites will need to be organized to provide streamlines and efficient service. The following table is
provided for planning purposes and suggest how a site might be organized.
Zone
Service
Training Required
Registration Zone
Register in-coming patients
Trained non-medical workers
Waiting Zone
Awaiting Primary Assessment
Primary Assessment
Zone
Vital signs
Chest auscultation & assessment
Secondary Assessment
Zone
Advanced First Aid &
Transfer Zone
On-Site Lab Tests
Secondary assessment
Service to patients who arrive in
distress includes oxygen, suction, etc.
while they await transfer to
emergency department
Education resources and advice
Medical professionals with
trained non-medical workers
Trained non-medical
Medical Professional
(Physician or Nurse)
Physician
Advanced First Aid
Education Zone
6.4.5.0 Staffing Influenza Treatment Clinics
District Health Authority will provide medical support services to clinics:
Please see Appendix K for possible service providers including retired physicians and nurses and list of nurses
who will be relieved of duties due to curtailment of services, as well as support personnel. See clinic
requirements below. Currently being constructed.
FUNCTIONS
Site Administrator
Medical Management
SKILL SETS/PERSONNEL
Management/Admin. (staff scheduling, support, leadership) Will liaise
with Red Cross Volunteer coordinator as needed (non-medical nature) as
well as Human resource coordinator (HRC) for health care worker
volunteer support. HRC and management team will be responsible for
appropriate volunteer personnel to cover acute care; Influenza Treatment
Clinics and triage centers (volunteer supports that require previous health
care knowledge). Managers will provide HRC with available resources
and skill sets on a daily basis. Site administrator will monitor patient flow
and availability of supplies
Physician or Nurse with Physician backup
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Medical triage
Patient Care
Physiotherapy/Respiratory Care
Pharmacy Services
Spokesperson
Health Records Management
IT resource
Medical Equipment and
housekeeping
Food Services
Social
services/Psychology/Pastoral
care/Grief counseling
Care for children/family members
of workers
Emergency social services
Transportation of corpses
Preparation and storage of corpses
Transportation of patients/Staff
Transportation of Dangerous
goods (eg. Oxygen/medical waste)
Transportation of
supplies/Laundry/Lab Tests
Laboratory Services
Maintenance
Communication services and
equipment support
Security (public order/personal
safety/protection of site
Nurse; ideally with ER training; education and discharge planning
experience
Instructed in nursing care: rehydration, feeding, ambulation, bathing,
vitals signs monitor, give meds (LPN). Linkage with the existing acute
care facility will facilitate establishment of nursing protocols and patient
care guidelines.
Family Support training may be carried out at the time of the pandemic for
patient in NTS as well as Home Care and Long Term Care.
It is our understanding that Red Cross (Coordinator of community
volunteers) will not be involved with volunteers who may provide direct
patient care either in clinics, Influenza Treatment Clinics and acute care.
HCW will be required to supervise volunteers and other staff in clinics
and that training for health care workers, volunteers (eg. Retirees) and
family members may be carried out at the time of the pandemic
Trained in chest physio/Trained in oxygen delivery, patient monitoring,
equipment monitoring (cross training made available)
Pharmacist at Hospital. **Volunteers required to transport medication
Refer to hospital (communications) or site admin.
Clerical skills (including computer skills), confidentiality agreement
Knowledge of IT systems and problem solving skills
Basic Infection control knowledge
Transport of equipment for sterilization (Infection control knowledge).
Dietician at hospitals. Delivery of meals on wheels (home care and
workers’ meals) Basic food safety training. . This still needs to be
worked out in partnership with respective department heads.
Liaison social worker/mental health staff/religious leaders/support groups
(Please see appendix O)
Training or experience in child care (criminal records check/child abuse
registry)
Community services/Red Cross
Drivers License
See N.S. Funeral Directors Association plans for Pandemic Influenza
Appendix H
Class 4 license
Appropriate licenses and liability Insurance
Drivers license/Criminal records check
Laboratory services at hospital
Knowledge of plumbing/Electrical, etc Snow Removal
IT department
See Securitas Plan Appendix Q
Page 115
6.4.6.0 Criteria for Discharge from an Influenza Treatment Clinic
Given the anticipated demand for beds, it is important to clearly define those who are clinically stable and can
be discharged. Patients are generally regarded as clinically stable when, for the preceding 24 hours:
mental status has returned to normal (or baseline), and
are able to eat and
vital signs have remained within a specified threshold
6.4.7.0 Transportation (to and from ITC)
6.4.8.0 Supplies for Influenza Treatment Clinics
Please see Appendix I for supply list for Influenza Treatment Clinics
6.4.9.0 Pharmacy for Influenza Treatment Clinic Sites
POLICY: The pharmacy department will supply all auxiliary drugs to the Palliative Care sites. Auxiliary drugs
will be bulk packaged.
PROCEDURE:
1.
A set list of drugs (Appendix G 08) will automatically be supplied to all sites.
2.
Additional supply of drugs found on the list will be requisitioned by the nurse manager when needed.
3.
Additional supplies of Narcotic, Control and Benzodiazepine drugs will also need a prescription from a
physician.
4.
Materials management or bonded courier will deliver all auxiliary drugs.
5.
The receiving nurse or physician will enter all Narcotic, Control and Benzodiazepine drugs into a
control drug registry (Sample - Appendix C1 & C2).
6.
Standard protocols regarding the dispensing and storage of Narcotic and Control drugs (this will also
apply to Benzodiazepines) will be followed.
7.
Delivery times will be based upon the availability of transportation.
8.
Drugs requisition will be based upon the pharmacy departments operating hours.
VRH – Monday through Friday 0800 to 1700 hrs, weekends and holidays 0900 to1630 hrs.
YRH - Monday through Friday 0830 to 1630 hrs, weekends and holidays 1015 to 1400 hrs.
SSRH – 25 SE 04, Revised 7 OC 04
6.6.9.1 Pharmacy – Pandemic Influenza Antiviral drugs- Patient Education
POLICY: All triage sites involved with the dispensing of antivirals will be supplied with patient education
leaflets.
PROCEDURE:
1. With the first shipment of antiviral drugs to a triage site a supply of Antiviral Patient Education leaflets
(Amantadine, Oseltamavir, Relenza) will be sent. 8 OC 04
PLEASE SEE APPENDIX G 10 ANTIVIRAL POLICY AND PROCEDURE
PLEASE SEE APPENDIX G 8 FOR DISBURSEMENT OF ANTIVIRALS TO INFLUENZA TREATMENT
CLINICS
Page 116
FOR LIST
OF AUXILIARY DRUGS FOR INFLUENZA TREATMENT CLINICS, PLEASE SEE APPENDIX G 08a
PLEASE SEE APPENDIX L FOR SWH Vaccine & Antiviral Security/Safety Plan
6.7.0.0 MORTUARY SERVICES: MULTI-DEATH DISASTER SITUATIONS
MORTUARY SERVICES: MULTI-DEATH DISASTER SITUATIONS.
The mortuary response team focus is to establish the means and methods for the sensitive, respectful care and
handling of deceased human remains in multi-death
situations. The mortuary response team is assigned to be available to aid in sanitation
and preservation (i.e. preparation or embalming as authorized), notification of next of
kin, counseling as well as facilitating the release of remains to next of kin or their
representative under the direction of authorized persons.
SCOPE OF OPERATIONS:
When multiple deaths occur, and when requested by the Medical Examiner's office, the
mortuary teams will aid in establishing a temporary morgue site and provide sanitary
preservation in preparation for final disposition as directed by the Medical Examiner.
Necessary information about each victim will be compiled and processed for the
Medical Examiner.
Please see Appendix M for complete Mortuary Services Plan and South West Health Funeral Home Directory.
Page 117
Residential Long Term Care Facilities
Long Term Care Facilities (LTCF) have in place, policies to support appropriate management of
residents and personnel within their own facility. These policies include:
1) An institutional policy for the management of influenza outbreaks including
surveillance, infection control and policies regarding visitors (please also see section
6.17.26 for Health Canada Guidelines).
2) Immunization of residence and staff; Pneumococcal vaccination of all residents; if a
pandemic is declared, pandemic vaccine priorities will be considered (Please see vaccine
priority list).
3) Advanced directives for all residents which are consistent with provincial legislation
and institutional policy;
4) If a requirement for more acute care is needed (e.g., parenteral therapy and oxygen
therapy) Home Care Nova Scotia (HCNS) and Oxygen vendors will be consulted as
ordered and needed. (HCNS 1-800-225-7225; for oxygen venders, please see Appendix ---It is important to be aware of the potential limited support from HCNS as they too will
be operating with decreased human resource availability.
Goals for a Long Term Care Facility in a pandemic situation include:
1) Prevention of Influenza illness;
2) Timely diagnosis and management of an influenza outbreak within the LTCF;
3) To manage patients within the Facility without transferring them to the acute care
facility.
Symptoms consistent with flu like illness in Long-term care facility residents:
The clinical presentation of any infectious illness in an elderly impaired long-term care facility
resident may be non-specific, and non-classical.
Influenza infection of elderly residents in a log-term care facility may present with:
a) Fever (could be only a low grade fever) or hypothermia.
b) Anorexia
c) Vomiting
d) Increased confusion or decreased functional status e.g., a decreased ability to walk
independently.
e) White cell count may be normal, with or without a shift to the left.
General Management
The goals of general management are to maintain comfort, to preserve functional status, and to
limit complications. Specific aspects of management for influenza and its complications include:
1. Maintenance of hydration. This may be obtained through oral fluids or if necessary
parenteral fluids (Accessed through Home Care Nova Scotia may be available/ EHS may
be able to provide assistance here.).
2. Oxygenation. Patients with an oxygen saturation of <90% on room air should have
oxygen supplementation. ****
3. Antipyretics and analgesics
Page 118
4. Diagnostic tests as required (e.g., chest x-rays, blood tests, urine analysis, nasopharyngeal aspirate, blood cultures. (It is important to be aware that diagnostic testing
may not be available during a pandemic; ie. Transportation difficulties to and from
LTCF’s).
5. Antibiotics for the management of presumed or diagnosed secondary pneumonia.
Patients will be considered clinically stable when, in the preceding 24 hours:
They are not acutely confused
They are able to fed orally or by naso-gastric tube
Their vitals signs are stable; (e.g., Oxygen saturation >90%, heart rate
<100/minute, respiratory rate < 24/minute, blood systolic pressure > 90mmHg,
temperature < 38 degrees C).
Once an outbreak is confirmed, all Health Care Personnel should take all the measures required
to control the propagation of the virus within the facility (among the residents, and to personnel
and visitors).
Infection Control Guidelines for Long Term Care
1. To prevent health care-acquired (i.e.nosocomial) infections, long term care facilities should
adhere to published guidelines, including Health Canada Infection Control Guidelines Routine
Practices and Additional Precautions for Preventing the Transmission of Infection in
Health Care.
2. Additional Precautions
Although droplet and contact precautions are recommended in preventing the transmission of
influenza during an interpandemic period, these precautions may not be achievable during a
pandemic.
Management of Staff
Provide education as outlined below:
Recommendations
1. Educational information for workers will be provided during the pre-pandemic planning phase
and again as soon as WHO Pandemic Phase 0 Level 1 is declared (see Appendix II) and repeated
at frequent intervals to all staff levels and during all shifts.
2. The pandemic influenza information should be appropriate to the audience and be
provided using a variety of methods, e.g., postings in elevators, at facility entrances,
Brochures, newsletters and web sites.
3. The educational information prepared and provided for workers will include:
(a) An explanation that pandemic influenza is a novel strain of influenza and what a
Pandemic is;
(b) The facility-specific pandemic influenza plan;
(c) Information regarding triage settings (see Section--), self care (see Section --)
And temporary influenza hospitals (see Section --).
Page 119
(d) The difference between an upper respiratory infection and influenza (see the
Introduction to the Preparedness Section of the Canadian Pandemic Influenza Plan);
(e) The mode of influenza transmission (see Section --);
(f) The criteria for determining, influenza-like-illness (ILI) (see glossary for definition and
Appendix IV for an ILI Assessment Tool) and influenza (see glossary for definition);
(g) The risk of infection and subsequent complications in high-risk groups such as residents of
Long Term Care Facilities.
(h) The message that strict adherence to hand washing/hand antisepsis
Recommendations is the cornerstone of infection prevention and may be the
Only preventative measure available during early phases of the pandemic.
(i) Information about the importance of hygienic measures to minimize influenza transmission
because influenza immunization and/or prophylaxis may not be available until later in the
pandemic;
(j) Information indicating that, during the early phase of an influenza pandemic, it may
Be feasible for HCWs to wear masks when face-to-face with coughing individuals to
minimize influenza transmission (particularly when immunization and antivirals are
not yet available) but not practical or helpful when transmission has entered the
community. Masks may be worn by HCWs to prevent transmission of other organisms from
patients with undiagnosed cough;
(k) Who will be given the highest priority for immunization when vaccine is available?
(l) The importance of being immunized and safety of immunization.
(m) Who will be given what priority for prophylaxis when antivirals are available, the
Importance of prophylaxis and safety of prophylaxis.
4. Information about the importance of routine practices and additional precautions to
Prevent the transmission of infection during the delivery of health care in all health care
Settings during a pandemic. This information will include the caveat that some
routine practice and additional precaution recommendations may be achievable only in
The early phases of the pandemic and other recommendations may not be achievable as
The pandemic spreads and resources (equipment, supplies and workers) become scarce.
5. Education about Routine Practices in Long Term Care settings, as outlined in Health
Canada Infection Control Guidelines Routine Practices and Additional Precautions for
Preventing the Transmission of Infection in Health Care, 1999, will be ongoing.
6. HCWs will be provided with the recommendations for Occupational Health
Management of workers during a pandemic (See Section below).
Queries:
Long term care report forms.
Contingency plans re: ill staff and education/support from family/volunteers.
Additional Information:
Home Care Nova Scotia, Long term Care and Acute care along with their supports will prioritize
care delivered and will be educating/training family member volunteers available at time of
Pandemic. Health Care workers will be required to supervise volunteers.
Page 120
Appendix A Surveillance
Page 121
Appendix A01 Contact Information
1.1.3.1 Reporting
All surveillance collected in the District Health Authority is to be forwarded to the local
Communicable Disease Prevention and Control [CDPC] Nurse or back-up. The surveillance
for the district will be collated and forwarded to the CDPC Manager and copied to the
Directors, Communication or Public Affairs of the respective DHA. In the absence of the
CDPC manager, all surveillance is to be forwarded to the Biological Coordinator in the Same
office as the CDPC Manager for forwarding to the Department of Health, via the Provincial
Medical of Health Office [PMOH].
− [MOH] will be available 24 hours a day, 7 days a week. To contact the local MOH
during normal working hours Monday to Friday, call 542-6310 or via e-mail @
rgould@avdha.nshealth.ca. To contact the MOH on call outside of normal working
hours call the QE11 locating service @ 473-2222 and request the MOH on-call.
−
• In SWH, all surveillance is to be forwarded to the CDPC Nurse, Ruth Davis via fax @
742-6062 or by e-mail @ rdavis@swndha.nshealth.ca
o In Ruth’s absence, all surveillance is to be forwarded to the CDPC Back-up
Nurse, Mary Hyland by fax @ 245-5517 or by e-mail @
mehyland@swndha.nshealth.ca
• Add MOH contact information.
1.1.4.5 Industrial workplace surveillance:
In SWH: Register Dot.Com, Hebron Industrial Park, Yarmouth County, 749-2702 Contact
Person: Debbie Roberts
Page 122
Appendix A02 Surveillance Data Summary Worksheet
SURVEILLANCE DATA SUMMARY WORKSHEET
For Influenza Like Illness
Date: ___________________
ER/OPD: _____________________________________
Non-Traditional Clinics: __________________________
Total number of patients registered: _____________________________
Number of patients:
•
•
•
•
•
•
•
Discharged home:
__________________
Discharged home with a Home Care referral:__________________
Admitted to Clinic:
__________________
Admitted to Clinic (Palliative):
__________________
Admitted to Hospital:
o YRH: ______________
o DGH: ______________
o Roseway: ___________
Expired:
__________________
Immunized:
__________________
Symptoms:
•
•
•
•
•
•
•
•
•
•
Elevated fever > 38:
Cough:
Congestion:
Sore Throat:
Arthragia:
Myalgia:
Prostration:
Diarrhea:
Vomiting:
Other:
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Page 123
Age:
•
•
•
•
•
•
•
0-5 ___________________
5-16 ___________________
16-20 ___________________
21-49 ___________________
50-65___________________
66-70___________________
>70 ___________________
Onset of symptoms
within last 2-14 days
Male
Female
_________________________
_________________________
_________________________
Data submitted by: _____________________________
Please submit Surveillance Data Summary Sheets to CDC Nurse, Public Health in
Yarmouth Regional Hospital once every 24 hours.
Notes:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Page 124
Appendix A03 Surveillance Tally Worksheet
DAILY SURVEILLANCE TALLY WORKSHEET
For Influenza Like Illness
Date: ___________________
ER: _____________________________________
Flu Treatment Clinics: __________________________
Case Definition: “ Acute onset of respiratory illness with fever and cough and with one or more of the
following–sore throat, arthralgia, myalgia, or prostration which could be due to influenza virus”. In children
under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and over, fever may not be
prominent. (LCDC Influenza Surveillance Program, Health Canada)
Health Card
#
Elevated
fever >38
Cough
Chills
Congestion
Sore throat
Arthragiaaching joints
Myalgiamuscle pain
Prostrationexhaustion
Diarrhea
Nausea
Vomiting
Otherplease
specify
Immunized?
Onset of
symptoms
within last
2-14 days
Page 125
Age: 0-5
5-16
16-20
21-49
50-65
66-70
>71
Male
Female
Discharged
home
Discharged
home with
Home Care
referral
Admitted to
Clinic
Admitted to
Clinic
(palliative)
Admitted to
hospital:
YRH
DGH
Roseway
Other
Expired
Notes: ___________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Page 126
Appendix A04 Draft letter to schools
Appendix A05 Draft letter to daycares
Appendix A06 Surveillance Form for LTC
Page 127
Appendix A07 Draft letters to employers re. pandemic influenza
DRAFT
Dear employer
As part of our efforts to prepare for a potential influenza pandemic, South West Health is
carefully monitoring the incidence of flu-like illness in our community. You can help us gather
important information related to flu-related absenteeism within your organization by asking your
employees to voluntarily report flu-related illness.
Influenza is an infectious disease caused by a virus that attacks the respiratory system. The virus
is spread by droplets, direct contact with contaminated surfaces and possibly, through airborne
exposure. A pandemic results when the flu virus takes an abnormal shift causing the sudden and
unpredictable emergence of a new influenza virus to which the population has little or no
immunity. A pandemic is essentially an outbreak occurring over a large geographical area
affecting an exceptionally high proportion of the population with elevated rates of death and
illness.
The symptoms of pandemic influenza are the same as the flu virus. Influenza generally causes
two or three of the following:
• fever
• aches and pains
• fatigue
• headache
• cough
• sore throat
• stuffy or runny nose
Protecting yourself against pandemic influenza is similar to protecting yourself against other
infectious diseases.
• Practice good basic personal hygiene. Handwashing is the single most effective way of
preventing the spread of illness.
• Avoid contact with infected family and friends.
• Do not share eating or drinking utensils.
• Avoid crowds and enclosed spaces.
• Get a good nights rest and eat a healthy diet.
It is estimated that as many as 73% of our population will be infected with influenza during a
pandemic. This will create a huge stress on the health care system and other vital services within
our communities. Contingency planning is underway to help prevent illness and death and reduce
societal disruption by providing access to appropriate prevention, care and treatment. We
appreciate your support in strengthening our surveillance activities, which is an important
component of our pandemic planning.
Page 128
Dear employer:
The World Health Organization has declared an influenza pandemic. To date, X cases have been
identified in (China, Hong Kong, North America).
In response, South West Health will be stepping up our surveillance activities and activating our
Pandemic Response Plans as appropriate. We will need to continue to monitor the level of flulike illness in our community and appreciate your ongoing support and co-operation in gathering
important information related to flu-related absenteeism within your organization. Your
employees can assist by voluntarily reporting flu-like illness to appropriate personnel.
An influenza pandemic occurs when the virus takes an abnormal shift causing the sudden and
unpredictable emergence of a new influenza virus to which the population has little or no
immunity. A pandemic is essentially an outbreak occurring over a large geographical area
illness.
Influenza is an infectious disease caused by a virus that attacks the respiratory system. People
who have the flu generally experience two or more of the following symptoms.
• fever
• aches and pains
• fatigue
• headache
• cough
• sore throat
• stuffy or runny nose
The virus is spread by droplets, direct contact with contaminated surfaces and possibly, through
airborne exposure. Protecting yourself against pandemic influenza is similar to protecting
yourself against other infectious diseases.
Should you become ill, treat your symptoms by getting plenty of rest and drinking lots of fluids.
Seek medical attention if..
Information about community clinics…
Page 129
Draft Workplace Employer Letter
Date
Dear Employer:
As part of our efforts to prepare for a potential influenza pandemic, South West Health is
carefully monitoring the incidence of Influenza-like illness (ILI) in our community. You can help
us gather important information related to influenza-related absenteeism within your
organization by asking your employees to voluntarily report influenza-related illness.
Influenza- like illness is an acute onset of respiratory illness with fever and cough and with one
or more of the following: sore throat, headache, arthralgia, myalgia, and extreme fatigue. In
children under 5 or in individuals older than 65, fever may not be prominent. Children under 5
may also experience gastrointestinal symptoms.
Please ask your employees to voluntarily provide information on influenza-like illness to your
Occupational Health Nurse. Attached is an Influenza Fact Sheet, which you may choose to
distribute to your employees.
Public Health Services requires statistics on a weekly, and possibly more frequent, basis. Please
send your report to the Communicable Disease Prevention & Control Nurse at Public Health
Services at 742-6062 (fax). If you have any questions, please do not hesitate to contact the
CDPC Nurse by phone at 742-7141
(letter initiated by CDC Nurse)
DRAFT
Page 130
Draft Workplace Employee Letter
Date
Dear Employee:
We are cooperating with Public Health in monitoring the incidence of influenza this season.
Please refer to the attached Influenza Fact Sheet describing the signs and symptoms. If you are
experiencing any of these symptoms, we ask that you please report to Occupational Health
Services or xxxxxx? @ xxx-xxx. If you are absent from work and have seen a physician for
influenza-like illness, please submit your physician’s documentation to Occupational Health
Services or xxxxx.?
Protecting yourself against influenza includes:
• Immunization
• Practice good basic personal hygiene. Hand-washing is the single most effective way of
• Do not share eating and drinking utensils.
Please note that the only information released to Public Health will be numbers of individuals
with probable influenza. All health information remains on your confidential health file with
Occupational Health Services or xxxxx ?.
This information will help our District to be better prepared to assist us in an increase in the
number of cases of Influenza.
If you require assistance please call Occupational Health Services or xxxxx at xxx-xxxx.
DRAFT
Page 131
Appendix A08 Surveillance DATA SUMMARY WORKSHEET
For Influenza Like Illness-Employees
Date: ___________________
Total number of employees :
_____________________________
Number of employees:
•
•
•
•
•
•
•
•
At home:
__________________
Seen by physician:__________________
Admitted to Clinic:
__________________
Admitted to Clinic (Palliative):
__________________
Admitted to Hospital:
o YRH: ______________
o DGH: ______________
o Roseway: ___________
Expired:
__________________
Immunized:
___________________
Prophylaxis (Antivirals)
__________________
Symptoms:
•
•
•
•
•
•
•
•
•
•
Elevated fever > 38:
Cough:
Congestion:
Sore Throat:
Arthragia:
Myalgia:
Prostration:
Diarrhea:
Vomiting:
Other:
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Age:
Page 132
•
•
• Under 21_______________
21-49 ___________________
50-65___________________
Onset of symptoms
within last 2-14 days
Male
Female
_________________________
_________________________
_________________________
Data submitted by: _____________________________
Please submit Surveillance Data Summary Sheets to CDC Nurse, Public Health in
Yarmouth Regional Hospital.
Notes:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Page 133
Appendix A09 Letter to Managers re. Employee Absenteeism for ILI
Date
In view of recent influenza activity and possible influenza pandemic, we are helping Public
Health monitor influenza activity in our communities.
We are asking you to collect information each day as it relates to employee absenteeism due to
influenza – like – illness (ILI).
Surveillance sheets will be issued to all who normally take “sick” calls from employees.
When we establish our pandemic “Hot Line”, all calls will be forwarded to the intake person.
At the end of each day (1500 hours) all line listing information from the previous 24 hours
should be forwarded to Human Resourses.
The Human Resources secretary will compile the information and forward the “Daily Summary
Worksheet to Public Health.”
Thank you for your cooperation.
If you have questions about completing these work sheets you may call:
Human Resources – 742-3542 EX:307
Occupational Health Yarmouth – 742-3542 EX:340
Shelburne – 875-3011 EX:252
Digby 245-2502 EX:3222
Page 134
Appendix A10 Staff Respiratory Illness Line Listing
Staff Respiratory Disease Line Listing:
Date: ________________
Name
Last:
First:
Age
Department
Date
symptoms
began
Temp 38°
or more
Cough
Chills
Congestion
Sore throat
Joint ache
Muscle ache
Exhaustion
Diarrhea
Vomiting
Nausea
Flu vaccine
Anti virals
Seen by
Physician
Swab taken
Admitted
Comments:
Page 135
Appendix B Communication
Tools
Page 136
Appendix B01 Communication Fan-out
Telephone Fan-out
October 2005
In the case of an emergency, notification of the SWH Duty Officer occurs through the Yarmouth
Regional Hospital switchboard (742-3541). The Department of Health Duty Officer, SWH
Managers or EMC’s, EHS…(?other) can request a contact number to speak directly with the
Duty Officer.
Duty officer contacts CEO and
notifies Board Chair, District
Chief of Staff, Vice President of
Operations and Site Managers
CEO contacts VP of
Clinical Care and VP
of Community Health
Both the person in charge of the facility and the SWH Duty Officer have authority to
individually or jointly authorize initiation of fan out calls. Communication to staff maybe for
call back, standby or alert.
Additional staff may be assigned or called back to assist with call back.
As directed Yarmouth Switchboard calls:
Roseway & Digby Switchboards
call:
•
•
•
•
Senior Management
Directors & Department Managers
Physicians
Clergy
Staff, Physicians & Clergy
as per Facility Emergency
Response Plan
Call:
Staff as per Departmental Fan Out
List
message,
Page 137 of 448
Comments key – L/M left
able to reach, NA – no answer
List 1 - Senior Management
Confidential information removed.
Page 138 of 448
List 2 – Nursing Fanout
After first person is contacted and information is relayed, skip to next call list. Nursing has own
call list and will continue the fanout.
Page 139 of 448
List 3 – Departmental support
Page 140 of 448
List 4- Physicians, etc.
Will be done by Switchboard after they have completed their initial duties.
Yarmouth Physician’s
List 5 – Other supports (Yarmouth)
This list would be activated by Shift Coordinator or Senior Management as needed.
Page 141 of 448
Appendix B02 Notice & Fact Sheet re Influenza
ATTENTION ALL EMPLOYEES
The World Health Organization (WHO) has confirmed that there has been person to
person spread of a new influenza type virus. Due to this new threat, we are now
stepping up surveillance for this new virus in our community and are asking for your
co-operation.
If you experience any of the following symptoms, please call the number at the bottom
of this page. You will be asked a series of questions regarding your illness. The
information you give is very important to us.
The symptoms are:
sudden onset of illness with fever over 38º
cough
sore throat
headache
myalgia
fatigue
All health care workers will be monitored daily, before your shift. The results will tell
us whether or not you should be at work that day.
Attached is an influenza fact sheet. It will give you information to help protect you and
your family from influenza.
The following number has been provided for your convenience for “sick calls” during
this surveillance period.
XXX-XXXX
Page 142 of 448
INFLUENZA FACT SHEET
Influenza (commonly known as the flu) is a serious respiratory infection caused by the
influenza virus. It can be spread easily through coughing, sneezing or through
contaminated surfaces on objects like toys, eating utensils or unwashed hands.
Influenza can be prevented by practicing good hand washing and getting the flu shot
every year.
Pandemic influenza is an outbreak of flu that quickly spreads around the world.
Pandemic influenza occurs when a new, and highly infectious strain of influenza
appears.
Pandemic flu outbreaks occur every few decades and international disease experts say
that the world is overdue for the next outbreak. With the growing volume of
international travel, the virus can spread rapidly throughout the world.
Once a pandemic flu virus is identified, a special vaccine will have to be developed. It
may take several months to make a new vaccine and a longer period to distribute it.
There will be worldwide demand for the vaccine and it may be in short supply.
To avoid the flu and reduce the spread of infection:
Wash your hands
Cover your nose and mouth when you cough or sneeze
Stay home if you are sick, don’t spread your germs
Keep your immunizations up to date. It will help your immune system stay
healthy and prevent you from getting sick with a vaccine preventable illness.
Page 143 of 448
Appendix B03 Possible Q&As for Health Care Workers
Note: Some answers are samples and should be reviewed with OHN/ICP’s and pandemic
planning committees to ensure it fits with your district.
What is influenza?
is spread by droplets, direct contact with contaminated surfaces and possible airborne exposure.
What is Pandemic influenza?
A pandemic results when the flu virus takes an abnormal shift causing the sudden and
unpredictable emergence of a new influenza virus to which the population has no immunity. A
pandemic is essentially an outbreak occurring over a large geographical area, often worldwide,
illness.
What are the symptoms of pandemic influenza?
Fever
cough
aches and pains
fatigue
headache
cough
sore throat
stuffy or runny nose
How is influenza spread?
The virus is spread through the air by coughing and sneezing or on hands, cups, cutlery, tissues
or other objects that have been in contact with an infected mouth or nose.
How will we know when pandemic arrives?
There will be a formal declaration of pandemic by WHO.
How often do pandemics occur?
Pandemics occur approximately every 30 years. There have been three major influenza
pandemics in the 20th century, resulting in over 20 million deaths.
When can we expect the next pandemic?
We are overdue.
Why do we need to plan for Pandemic Influenza?
The timing and pattern of pandemic influenza is unpredictable. Contingency planning is essential
for an effective response.
Page 144 of 448
What percentage of our communities will be impacted by pandemic influenza?
It is estimated that:
75% of people will be infected
15 – 38% will be clinically ill
6.8 – 17% will require outpatient care
0.1– 0.3% will require hospitalization
0.03 – 0.1% will die
In Nova Scotia, this would mean approximately;
705,000 will be infected
141,000 – 357,000 will be clinically ill
64,000 – 160,000 will require out-patient care
1,000-3,000 will require hospitalization
300 – 1,000 will die
How will health services be impacted by pandemic influenza?
There will be a huge burden on the health care system, as large numbers of people seek medical
care, which could last several months. We can expect:
shortages of ICU beds, medical equipment & staff
shortages of antivirals and antibiotics
need for secondary/offsite treatment centres
high demand for mortuary/funeral services
wide spectrum of illness with large numbers of persons ill
Mild – community
Moderate – ambulatory
Severe – institutional
Can quickly overwhelm current system
Am I at risk?
Everyone is susceptible to pandemic strains of influenza, not just the traditional high risk groups.
By the very nature of their roles, health care workers and first responders are at an increased risk
of exposure and illness.
How can I protect myself?
Practice good basic personal hygiene. Handwashing is the single most effective way of
Avoid contact with infected family and friends.
Do not share eating or drinking utensils.
Avoid crowds and enclosed spaces.
Get a good nights rest and eat a healthy diet.
Follow infection control guidelines when caring for patients with pandemic influenza.
Page 145 of 448
Is there a vaccine for pandemic flu?
A vaccine will be developed as soon as the strain has been identified. It will be at least four to six
months before any vaccine will be available. Initially there will be shortages of the vaccine and
prioritization will be necessary. Health care workers will be a top priority for immunization.
What are the isolation precautions?
If a patient with influenza is in an examining room, how should we treat the room
after the patient leaves?
Following the patient’s visit, the following measures should be taken in the examining room:
Any equipment that was used on the patient must be properly disinfected with a hospital grade
disinfectant.
If there is a possibility that the affected patient may have touched magazines or toys, discard
them.
Disinfect patient furniture and environmental surfaces using hospital grade disinfectant.
Soiled Linen: Routine precautions are sufficient. Linen should first be placed in a leak resistant
bag, then placed in the regular soiled linen bag.
Waste: Routine precautions should be applied to handling waste. Routine sharps precautions
should be followed. Double bagging of waste is not necessary.
Environmental Services has a specific cleaning procedure to follow for patient rooms. This
procedure is posted in each janitor’s closet.
Should a patient with influenza wear a mask at all times?
If the patient has symptoms that are suspicious of influenza then the patient should be
immediately instructed to wear a surgical mask. This mask should remain on while they are
escorted through the hospital to an appropriate isolation room. Once the patient is admitted to a
negative pressure or isolation room, it is not necessary for the patient to wear a mask.
Should staff wear N95 masks?
A regular surgical mask is sufficient since influenza is spread through droplets – it is not
airborne.
What is the incubation period for Pandemic Influenza?
Does South West Health have any cases of pandemic influenza?
There are (no or insert #) cases of pandemic flu in Nova Scotia.
What is being done to protect staff?
Healthcare teams are briefed and up-to-date on infection control procedures, including isolation
and appropriate gowning, gloving and masking. Staff will receive daily information about the
pandemic issue and will be notified of any actions that need to be taken.
Page 146 of 448
Should all staff be wearing masks?
No. Only those health care workers who are in contact with a patient with flu should wear masks
and protective clothing. Only those who work within 1-2 meters of a patient require masks.
What is being done to protect patients?
Patients who are suspected of having influenza will be isolated from other patients in accordance
with infection control procedures.
What is being done to protect staff, physicians and volunteers?
Information binders have been placed in key areas of our hospitals, physicians and staff have
received information and protocols, flu kits are available in each ER/OPD department. Daily
meetings are held to discuss issues around Pandemic Influenza and regular updates are provided
to staff and physicians.
How many people have presented themselves in our emergency departments
(throughout the district) with flu?
What should we tell our family and friends who are worried that we may be
exposed to pandemic influenza?
You can remind your friends and family that healthcare workers are well prepared to deal with
infectious diseases and that the symptoms and history of a flu patient is very specific.
What can we do to reduce our risk of infection?
We can minimize the spread of influenza, or any other viral infections, by washing our hands
often and promptly disposing of any tissues or other articles that come in contact with fluid from
your nose, mouth or eyes.
On the news we have seen medical clinics in N.S. that are posting signs and
asking patients who suspect they may have influenza to wear a protective mask.
Are we going to take this precaution?
Yes. Signs and masks are being provided at all South West Health emergency departments.
If we receive a phone call from someone who feels they may have flu, or may
have been exposed to flu, how should we direct that phone call?
If a patient who suspects they may have flu presents somewhere other than at the
ER for example at the reception desk of the hospital – how should we handle this
patient?
The patient should be sent to the nearest Emergency Department. Provide the patient with a
surgical mask. Please take the patient’s name and phone number and call ahead to the
Emergency Department to let them know the patient is coming.
Is there a vaccine available?
There will be a delay in receiving vaccine (insert details). As soon as it is ready, clinics will be
established for health care workers, a high priority group.
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I’m sick. What should I do?
If you are at home, contact your supervisor and report your symptoms. If you are at work, put on
a mask and report your symptoms to your supervisor.
I’m sick and can’t come to work. Will I be paid?
My family’s sick and can’t come to work, what do I do? I’m on holidays.
Can I refuse to work?
Is it safe to travel outside the country?
How is pandemic diagnosed?
What should I do if I think I have the flu?
Treat the symptoms by drinking lot of fluids, resting and consulting your pharmacist for over the
counter medications. Seek medical care if necessary.
How do I access medical care?
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Appendix B04 Letter to Parents/Guardians re. schools as clinics
April 27, 2005
Dear Parent/Guardian:
You are probably hearing news stories about pandemic influenza. South West Health is
developing plans to manage a future outbreak of pandemic influenza. While no one knows when
the next pandemic will occur, historically pandemic influenza outbreaks have occurred 2 to 3
times each century. Many experts believe we are overdue for an outbreak.
An influenza pandemic is basically a worldwide outbreak of a new and especially strong flu
virus that will cause more widespread and severe illness than the regular flu season. Because it is
a new flu strain, everyone will be susceptible. This will place a huge strain on health and
community resources.
Pandemic planners are using a formula provided by influenza experts to estimate the possible
impact of a flu pandemic. The formula is based on our population and following are the
estimated numbers for the tri-county area:
49,966 people could be infected with the flu
9,393 to 23,796 could be clinically ill
4,258 to 10,645 may require outpatient care
62 to 187 may require hospitalization
18 to 62 may die
As you can imagine, this will be more than our hospitals can manage because hospital services
will still be required for trauma cases, heart attack victims, etc. South West Health plans to
establish influenza clinics (flu treatment clinics) in our communities where needed to manage
people with influenza, thus leaving the hospital for emergency care and for those who are most
ill with influenza.
The purpose of the clinics will be to:
provide a place for influenza diagnosis and triage
provide medicine and a course of treatment and instructions for home recovery
short term medical care
holding area for patients requiring transfer to a facility offering a higher level of care
palliative care
...2/
Page 149 of 448
Page 2
Letter to Parents/Guardians re. schools as NTS
April 27, 2005
Schools have been identified as good locations for these clinics because they are well known
locations, they are accessible to wheelchairs & strollers, they have many rooms of various sizes,
they have large parking lots, the buildings are regularly inspected (Fire, Food Safety, etc), they
have large kitchens and they are wired for electronics. Chosen schools will only be used as
clinics when children are not present – either because school is closed or the students would
attend school elsewhere. We have worked together to choose the best schools that meet the
criteria of both the school board and the health authority.
Identified schools are as follows:
Digby Elementary School or Digby Regional High School
Plymouth Consolidated School or Meadowfields Community School
Hillcrest Academy or Shelburne Regional High School
Forest Ridge Academy
Inspections will take place at each school in June and one school will be chosen for each area to
become a clinic when the pandemic occurs. During a flu pandemic, when the chosen schools are
notified that the clinics need to be set up, school staff will move all materials (books, furniture,
etc.) to a designated area. This area and the materials will be sealed off from the area that will be
used as a clinic.
Once the health authority is finished with the clinic, expert housekeeping staff from the local
hospital will thoroughly clean and disinfect the building before it is handed back to the school
board.
Our best approach is to plan and prepare for pandemic influenza by setting procedures and
processes to manage health care services. This will ensure that throughout a pandemic influenza
outbreak, health care services are maintained to help our families, our friends and our neighbors.
If you have questions about pandemic influenza, please contact Barbara Johnson, South West
Health at 749-0517 or by email bjohnson@swndha.nshealth.ca or Phil Landry at 749-5682 or by
email plandry@tcrsb.ca.
Sincerely,
Blaise MacNeil
CEO
South West Health
/bj
Phil Landry
Superintendent
Tri-County Regional School Board
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Appendix B05 Communications Software/Hardware Inventory
March 8, 2005
Hardware
1.
Two digital cameras
a. Olympus – requires a USB port
b. Sony – uses floppy disks
(communications office)
(communications site secretary)
2.
Flat Bed Scanner
(community site secretary)
3.
MFU (shared)
(administrative 5 floor)
4.
Laptop & docking station
5.
Color Printer
6.
TV/VCR
(administrative conference room)
7.
Cell phone (740-3239)
Software
1.
Adobe Acrobat Writer
2.
Adobe Pagemaker
3.
Adobe Photoshop Elements
4.
MS Office Suite
5.
MS Frontpage (for web development)
6.
WS FTP (for transferring files to web)
7.
Olympus Camedia
All software is loaded on the communications director’s laptop.
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Appendix B06 Distribution Lists
Fax:
Local media
Provincial media
Community pharmacies
Health centers
MLAs
Councils
CHBs
LTC
DHA board members
Email:
Public Relations Working Group (PRWG)
Newsletter Distribution List
(see communications toolkit)
EMOs
SARS Committee
SARS Contacts (excludes staff)
CHBs
DHA members (excluding Ron Horrocks, CEO secretary faxes emails to him)
Media
Managers
Western Regional Health Centre
MLAs
Town and Municipal Councils (excluding Yarmouth Town…prefer fax)
Recreation Directors – Tri-County
Shared Services
Sr. Management
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Appendix B07 How To Issue A News Release
Once news release has been finalized determine how quickly the news release must be issued to
media, etc.
1.
2.
3.
4.
Send first by email to South West Health Distribution List & Shared Services
Managers, blind copy DHA members and indicate when news release will be issued
to media (will be issued shortly to media, later this afternoon, etc. doesn’t have to be
exact). Sheila Thomas, Colette Perham and Nicole Delaney will make hard copies as
directed.
Copy and paste news release into an email and blind copy to CHBs, Media,
Newsletter Distribution List, Media, MLAs, Town and Municipal Councils.
Print copy of news release and fax appropriate groups: local media (this includes
many community groups as well as caucus offices, councils, chbs, etc.), provincial
media, community pharmacies
Next save news release as an .html document and then add to our news and index
pages of our web – then post the new files.
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Appendix B08 Notes
Website:
HR secretaries have access to load job postings, they have Frontpage & WS FTP.
To update district website hosted by the government (www.gov.ns.ca) ID and password can be
accessed through communications site secretary or HR.
Government IT contacts are Corey Kaye (424-1852 or kayec@gov.ns.ca) or Ed Milligan
milligae@gov.ns.ca .
Passwords:
Office phone, Novell and email passwords can be accessed through communications site
secretary.
Page 154 of 448
Appendix B09 Sample District Update (daily, biweekly, or weekly??)
Update #:
Date :
Time Issued:
Issued By:
Are there any reported cases of Pandemic Influenza in Nova Scotia?
Are there any reported cases of Pandemic Influenza in the District?
Status of District Services.
All District programs and services are continuing as scheduled.
OR
The following programs and services have been cancelled until further notice.
Status of Volunteer Access
Status of Visitor Access
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Appendix B10 Sample Public Service Announcements
Public Service Announcement
Clinics to treat people with influenza have been set up in the following locations:
Insert street address, insert community
If you have influenza symptoms and require medical care, please go to the nearest clinic.
Public Health staff will hold vaccination clinics for the following high-risk groups … (examples:
chronically ill, age ?? to ??, etc.) as follows
Some place, some town, some date, some time
Managing your influenza at home
***Public Health to approve***
•
•
•
•
•
Rest and drink plenty of fluids.
Take acetaminophen or ibuprofen, if needed, for aches and pains. Note: Children and
teenagers with influenza SHOULD NOT take ASA (aspirin), as this ahs been linked to
the development of Reye’s Syndrome, a serious condition affecting the brain and liver.
Avoid contact with others, especially people who have lower resistance to infections, eg.
those with cancer, chronic heart/lung disease, seniors and young children – remember
you are contagious from 24 hours before to 3-5 days after peak symptoms appear.
Cover your cough and dispose of tissues immediately.
Wash your hands often – handwashing is the most important way of preventing the
spread of germs.
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When to seek medical help:
People with flu symptoms sometimes develop other serious infections, such as pneumonia,
bronchitis, sinusitis or ear infection. You should consult your doctor (or influenza clinic)
immediately if:
• You are coughing up thick, coloured or bloody mucous
• You have symptoms such as recurring fever, chest pain, facial swelling, severe pain in
the face or forehead or earache.
How you can help
Volunteer
Check on your neighbors and friends and help them as needed
Page 157 of 448
Appendix B11 Newsletter article pre-pandemic
Pandemic Influenza: What’s all the fuss?
Each year our healthcare system encourages people to have an influenza vaccination to protect
themselves, their loved ones and to those they give care. Annual influenza infects 20-30% of the
population with approximately 1500 deaths per year in Canada. Influenza is a very infectious
disease caused by a virus that attacks the respiratory system. It is spread through droplets, direct
contact with contaminated surfaces and possible airborne exposure. People infected with
influenza are contagious from the day before the onset of symptoms up until seven days later.
An influenza pandemic is basically a worldwide outbreak of a new and especially strong flu
virus that will cause more widespread and severe illness than the regular flu season. Because it is
a novel or new strain, everyone is susceptible. This will place a huge strain on health and
community resources.
There have been three major influenza pandemics in the 20th century and generally they occur
every 30 years. It has been more than 30 years since the last pandemic - the Hong Kong Flu in
1968. Many health professionals believe that we are overdue. That’s why health care
organizations around the world have been preparing for the possibility of a flu pandemic.
While there’s no reason to believe a flu pandemic will occur this year, we feel it’s important to
be prepared. South West Health has been working with a wide variety of community partners
including the Emergency Measures Organization, Emergency Medical Services, Community
Services and Municipal Units to develop plans that would help us manage and maintain essential
services during a pandemic to help our family, friends and neighbours. Our Plan is consistent
with Health Canada’s Influenza Pandemic Preparedness and Response Plan and Nova Scotia’s
current planning activities and is intended to reduce the impact on our community.
Vaccine will be developed, but may not be available at the beginning of the pandemic and all
individuals will require two doses of immunization – initially there will be shortages so priority
groups will be developed.
Part of our planning includes identifying areas in our communities where we can set up clinics
for both vaccination and treatment of people with the flu.
Our best approach is to prepare for pandemic influenza by setting procedures and processes to
manage health care services. This will ensure that throughout a pandemic influenza outbreak
health care services are maintained to help our family, friends and neighbors.
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Pandémie de grippe : Pourquoi toute cette agitation?
Chaque année, notre système de soins de santé encourage les gens à se faire vacciner contre la
grippe afin de se protéger, de protéger leurs proches et de protéger les personnes à qui ils offrent
des soins. Chaque année, de 20 à 30 pour cent de la population contracte le virus de la grippe, et
environ 1 500 personnes en meurent au Canada. La grippe est une maladie très infectieuse causée
par un virus qui s'attaque au système respiratoire. Le virus se transmet par des gouttelettes, un
contact direct avec des surfaces contaminées et possiblement par l'exposition aux microbes
aérogènes. Les personnes qui ont contracté la grippe sont contagieuses à partir du jour qui
précède l'apparition des symptômes, et ce, pendant une période de sept jours.
Une pandémie de grippe a lieu lorsque le type de virus change de façon considérable; ce
changement est une mutation antigénique. Les critères d'une pandémie incluent un cas de
personne ayant contracté un virus qui a subi une mutation antigénique, une population vulnérable
qui a très peu ou aucune immunisation, des preuves manifestes de transmission d'une personne à
une autre, ainsi que des taux élevés de maladie et de mortalité dans une région géographique
étendue.
Trois pandémies de grippe importantes se sont produites au cours du XXe siècle et en général,
elles ont lieu tous les 30 ans. Une pandémie est donc imminente! Puisque la grippe pandémique
est causée par une nouvelle souche du virus, tout le monde est vulnérable.
On estime que plus de 70 pour cent de notre population pourrait contracter la grippe au cours
d'une pandémie, ce qui créera une énorme augmentation de la charge de travail dans notre
système de soins de santé. De nombreuses personnes auront besoin de traitements offerts par
l'entremise d'un séjour à l'hôpital ou d'une visite aux services d'urgence. Les services essentiels
au sein de nos communautés seront probablement touchés puisque les employés seront
également atteints de la grippe.
Un vaccin sera créé, mais ne sera peut-être pas disponible au début de la pandémie. De plus,
toutes les personnes devront recevoir deux doses d'immunisation, ce qui signifie qu'il y aura des
pénuries. Il faudra donc établir des priorités.
Dans le système de soins de santé, on peut s'attendre à une pénurie de lits dans les unités de soins
intensifs, d'équipement médical et de personnel. Des pénuries d'antiviraux et d'antibiotiques sont
également possibles et il sera nécessaire d'établir des centres de traitement au sein des
communautés. La demande de services mortuaires ou funèbres sera également plus élevée.
Un plan canadien de préparation et d'intervention en cas de pandémie de grippe a été élaboré par
Santé Canada. À titre de district, nous améliorons régulièrement tous nos plans d'urgence de
façon à ce que nous puissions gérer une situation d'urgence. Actuellement, notre district travaille
en collaboration avec nos partenaires pour élaborer un plan détaillé qui nous aidera à gérer une
pandémie de grippe.
Récemment, le SRAS, bien qu'il ne s'agisse pas de la grippe, nous a permis d'établir des relations
plus étroites avec les autres organismes de soins de santé et les organisations de soutien
Page 159 of 448
communautaire qui peuvent aider nos communautés en cas de situation d'urgence en matière de
soins de santé. Ces relations pré-établies et l'inclusion de ces organismes dans l'élaboration de
nos plans constituent un avantage inestimable. Les participants ont ainsi l'occasion de pratiquer
des activités de prévention et de résolution de problèmes afin qu'ils soient prêts à intervenir en
cas de pandémie de grippe.
L'approche la plus efficace est de se préparer à une pandémie de grippe en établissant des
procédures et des processus de gestion des services de soins de santé. C'est ce qui permettra le
maintien des services de soins de santé au cours d'une pandémie de grippe afin d'aider nos
familles, nos amis et nos voisins.
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Newsletter Article During Influenza Pandemic
At ?? on ??, the World Health Organization declared an influenza pandemic. To date, X cases
have been identified in (China, Hong Kong, Taiwan).
We are preparing for the possibility of seeing cases of influenza pandemic in our communities.
A committee is reviewing our plan so that it can be implemented as soon as it is required. We
expect a large percentage of our communities will be ill with flu, which will mean an increase in
hospitalizations, ER visits and ICU care.
People presenting with Pandemic Influenza will experience the same symptoms as the annual
strains of the flu. Fever over 38 degrees and a cough plus one other of aches/pains, fatigue,
headache, sore throat, stuffy or runny nose are the indicators for influenza. If you experience
these symptoms please notify your supervisor.
Health care workers have been identified as one of the high priority groups to receive flu
vaccine. Staff flu immunization clinics have been organized as follows:
If you have questions please contact the influenza pandemic line ???????.
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Article du bulletin d'information – Durant une pandémie
Pandémie de grippe
Le ?? à ??, l'Organisation mondiale de la Santé a déclaré une pandémie de grippe. Jusqu'à
présent, X cas ont été recensés (Chine, Hong Kong, Taïwan).
Nous nous préparons en vue de la possibilité d'une pandémie de grippe dans nos communautés.
Un comité évalue actuellement notre plan de façon à ce qu'il puisse être mis en œuvre dès qu'il
sera nécessaire. Nous prévoyons qu'un important pourcentage de nos communautés sera atteint
de la grippe, ce qui signifie un plus grand nombre d'hospitalisations, de visites aux services
d'urgence et d'admission aux unités de soins intensifs.
Les personnes touchées par la pandémie de grippe présenteront les mêmes symptômes que ceux
qui sont causés par la souche annuelle de la grippe. Les indicateurs de la grippe sont une fièvre
de plus de 38 degrés et une toux, en plus d'un des symptômes suivants : douleurs, fatigue, mal de
tête, mal de gorge, congestion ou écoulement nasal. Si vous éprouvez ces symptômes, veuillez
aviser votre superviseur.
Les travailleurs de la santé ont été identifiés comme l'un des groupes à priorité élevée pour
l'administration du vaccin antigrippal. Des cliniques de vaccination contre la grippe pour le
personnel ont été organisées comme suit :
Si vous avez des questions, veuillez communiquer avec la ligne d'information sur la pandémie de
grippe en composant le ???????.
Page 162 of 448
Appendix B12 Letter to Editor re. Pandemic Planning
October 12, 2004
To the editor,
Over the past few years, there has been a lot of national and international media attention related
to the possibility of a worldwide pandemic influenza. Basically, this is a potential worldwide
outbreak of a new and especially strong flu virus that will cause more widespread and severe
illness than the regular flu season. It will place a huge strain on health and community resources.
NO ONE knows when the next pandemic flu will occur, but historically, flu pandemics have
occurred every 30 years. It has been more than 30 years since the last pandemic flu - the Hong
Kong Flu in 1968. Many health professionals believe that we are overdue. That’s why health
care organizations around the world have been preparing for the possibility of a flu pandemic.
South West Health is no exception. We have been working with a wide variety of community
partners including the Emergency Measures Organization, Emergency Medical Services,
Community Services and Municipal Units to develop plans that would help us manage and
maintain essential services during a pandemic flu to help our families, friends and neighbours.
Our Plan is consistent with Health Canada’s Influenza Pandemic Preparedness and Response
Plan and Nova Scotia’s current planning activities and is intended to reduce the impact on our
community.
While there’s no reason to believe a flu pandemic will occur this winter, we feel it’s important to
be prepared. We have been meeting with community groups and organizations to gather input
and share components of the plan. We will continue to meet with groups in order to gather input.
As a result of these meetings, you may hear more about this in your community. Please do not
hesitate to contact our Communications Office at 749-0517 if there are questions or concerns you
feel need to be addressed. Communication is an important part of our plan. In the event of a
pandemic flu, we have developed a number of ways to share important information with you, our
community.
While no one knows when the next pandemic flu will occur, the regular flu season is fast
approaching. The flu can cause serious illness, hospitalization and death among certain high-risk
groups. Having your flu shot is the best way to protect yourself and your loved ones from the
virus. Visit a clinic or talk to your doctor about having a flu shot. Vaccine is provided free of
charge to people who are at high risk of developing complications including anyone over age 65
years of age, residents of long-term and other chronic care facilities, adults and children with
chronic health conditions such as heart, lung or kidney disease, AIDS, diabetes and cancer, and
children between six and 23 months old. The vaccine is also free to people with a potential to
spread the virus to high-risk individuals, including those who live in the same house, staff and
volunteers at hospitals and long-term care facilities, home care workers, paramedics, doctors and
their staff.
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During this flu season, wash your hands regularly and thoroughly and please do not visit patients
or clients in hospitals or long-term care facilities if you are ill.
Blaise MacNeil, CEO
South West Health
Lettre ouverte au rédacteur en chef au sujet de la grippe pandémique
Au cours des dernières années, les médias nationaux et internationaux ont beaucoup parlé de la
possibilité d'une pandémie de grippe à l'échelle mondiale. Essentiellement, il s'agit d'une
épidémie mondiale potentielle d'un nouveau virus particulièrement robuste de la grippe qui
causera des symptômes plus graves dans une région plus étendue que la grippe habituelle. Une
pandémie mettra à rude épreuve les ressources de la santé et de la communauté.
PERSONNE ne sait à quel moment la prochaine pandémie de grippe aura lieu, mais à travers
l'histoire, les pandémies de grippe se sont produites tous les 30 ans. Plus de 30 ans se sont
écoulés depuis la dernière pandémie de grippe, celle de Hong Kong en 1968. De nombreux
professionnels de la santé croient donc qu'une autre pandémie est imminente. C'est pourquoi les
organisations de la santé partout dans le monde se préparent en vue de la possibilité d'une
pandémie de grippe.
South West Health ne fait pas exception. Nous travaillons avec une vaste gamme de partenaires
communautaires, y compris l'Organisation de mesures d'urgence, les Services médicaux
d'urgence, les Services communautaires et les unités municipales pour élaborer des plans qui
nous aideront à gérer et à maintenir les services essentiels au cours d'une pandémie de grippe afin
de venir en aide à nos familles, nos amis et nos voisins. Notre plan est conforme au plan de
préparation et d'intervention en cas de pandémie de grippe de Santé Canada ainsi qu'aux activités
de planification actuelles de la Nouvelle-Écosse, et il vise à réduire l'impact sur notre
communauté.
Bien qu'il n'y ait aucune raison de croire qu'une pandémie de grippe se produira au cours de
l'hiver, nous sommes d'avis qu'il est important de bien se préparer. Nous avons rencontré des
groupes et des organismes communautaires afin d'obtenir leurs suggestions et de partager les
éléments du plan. Nous continuerons à obtenir les suggestions et les commentaires de ces
groupes. En raison de ces rencontres, vous entendrez peut-être parler de cette situation dans votre
communauté. N'hésitez pas à communiquer avec notre service de communications au 749-0517
si vous avez des questions ou des préoccupations qui devraient être abordées. La communication
est un élément important de notre plan. En cas de pandémie de grippe, nous avons élaboré
différentes façons de partager l'information importante avec vous, notre communauté.
Bien que personne ne sache à quel moment la prochaine pandémie de grippe se produira, la
saison régulière de la grippe approche à grands pas. La grippe peut causer des symptômes
graves, une hospitalisation ou même un décès dans certains groupes à risque élevé. La meilleure
façon de vous protéger et de protéger vos proches contre la grippe est de vous faire vacciner
contre la grippe. Rendez-vous à une clinique ou parlez à votre médecin pour obtenir le vaccin
Page 164 of 448
antigrippal. Le vaccin est offert gratuitement aux personnes qui courent un risque élevé de
complications, y compris les personnes âgées de plus de 65 ans, les résidents d'établissements de
soins de longue durée et de traitement de maladies chroniques, les adultes et les enfants atteints
de maladies chroniques telles que les maladies du cœur, des poumons ou des reins, le sida, le
diabète et le cancer, et les enfants de six à 23 mois. Le vaccin est également offert gratuitement
aux personnes qui ont la possibilité de transmettre le virus à des personnes à risque élevé, par
exemple les personnes qui vivent sous le même toit qu'une personne à risque élevé, le personnel
et les bénévoles des hôpitaux et des établissements de soins de longue durée, les fournisseurs de
soins à domicile, le personnel paramédical, les médecins et leur personnel.
Pendant la saison de la grippe, lavez-vous les mains régulièrement et à grande eau, et abstenezvous de visiter des patients ou des clients dans les hôpitaux ou les établissements de soins de
longue durée si vous avez la grippe.
Page 165 of 448
Appendix B13 Memo to staff, physicians and volunteers re. Pandemic Flu
Planning
MEMO
TO:
All staff, physicians and volunteers
FROM:
Blaise MacNeil, CEO
RE:
PANDEMIC INFLUENZA PLANNING
DATE:
October 12, 2004
As most of you know, South West Health has been working on a Pandemic Influenza Plan as part of our
District Disaster Planning activities. We have been meeting with a number of community groups,
organizations and individuals to develop plans that would help us manage and maintain essential services
during a pandemic and reduce the impact of a flu pandemic on our community.
This type of consultation and planning process has, and will likely continue to, generate questions from
our communities. I’ve attached a copy of a Letter to the Editor that has been sent to local papers in hopes
of addressing some of the basic questions about pandemic influenza and why we feel it’s important to
plan in advance. I’ve also outlined some points, which might help you respond to questions from your
patients, clients and neighbours.
•
•
•
•
A Pandemic Influenza will occur when there’s an outbreak of a new flu virus that will cause more
widespread and severe illness than the regular flu season. Because it’s a new strain of the virus, the
general population will have little or no immunity from the virus.
It will place a huge strain on health and community resources. Our plans are intended to help us manage
and maintain essential services during a pandemic.
While there’s no reason to believe a flu pandemic will occur this winter, we feel it’s important
to be prepared. NO ONE knows when the next influenza pandemic will occur, but historically, flu
pandemics have occurred approximately every 30 years. It has been more than 30 years since the last flu
pandemic - the Hong Kong Flu in 1968. That’s why health care organizations around the world have
been preparing for the possibility of a flu pandemic.
In the event of a pandemic flu, we have developed a number of ways to share important information
with the community.
The first draft of our Pandemic Influenza Plan is nearing completion. Education sessions will be
scheduled to ensure you know what your roles and responsibilities are during a pandemic. In the
meantime, if you receive a question that you feel you cannot answer, please direct them to Barbara
Johnson in Communications at 749-0517, Dr. Richard Gould the Medical Officer of Health at 542-6310
or Nancy Blackmore, Public Health at 742-7141.
Page 166 of 448
Appendix B14 Letter to Media re. pandemic influenza
Dear ??:
Health organizations around the world have been preparing for the possibility of a pandemic
influenza. This is essentially a worldwide outbreak of a new and especially strong strain of the
flu virus that will cause more widespread and severe illness than the regular flu season. Larger
than normal numbers of the population will be ill, including health care and other essential
services providers. That’s why we feel it’s very important to develop a plan that will help us
manage and maintain health services during a pandemic.
No one knows when the next pandemic will occur, but historically, flu pandemics have occurred
every 30 years. It has been more than 30 years since the last pandemic - the Hong Kong Flu in
1968. Many health care professionals believe we are overdue.
To prepare, South West Health has been working with a wide variety of community partners
including the Emergency Measures Organization, Emergency Medical Services, Community
Services and Municipal Units. Our goal is to reduce the impact of a pandemic on our community.
As part of our planning, we have identified your organization as a critical partner. There will be a
great need for accurate and timely information within our communities during a pandemic, but
we also believe it’s important to create a general level of understanding and awareness among
our residents before a pandemic occurs.
If you would like to learn more about pandemic influenza or if there is information we can
provide in advance for your files that might be helpful, please contact >>>>
In the interim, attached is a Q&A document on pandemic influenza.
Page 167 of 448
Lettre aux médias au sujet de la pandémie de grippe
Monsieur, Madame,
À l'échelle mondiale, les organismes de santé se sont préparés en vue de la possibilité d'une
pandémie de grippe. Il s'agit essentiellement d'une épidémie mondiale d'une nouvelle souche
particulièrement robuste du virus de la grippe qui causera des symptômes plus graves et à plus
grande échelle que la grippe régulière. Une proportion plus élevée que la normale de la
population sera atteinte de la grippe, y compris les travailleurs de la santé et les autres
fournisseurs de services essentiels. C'est pourquoi nous sommes d'avis qu'il est très important
d'élaborer un plan qui nous aidera à gérer et à maintenir les services de santé pendant une
pandémie.
Personne ne sait à quel moment la prochaine pandémie aura lieu, mais dans l'histoire, des
pandémies de grippe se sont produites tous les 30 ans. La dernière pandémie, celle de la grippe
de Hong Kong en 1968, a eu lieu il y a plus de 30 ans. De nombreux professionnels de la santé
croient qu'une pandémie est imminente.
Pour se préparer en conséquence, South West Health a travaillé avec une vaste gamme de
partenaires communautaires, y compris l'Organisation de mesures d'urgence, les Services
médicaux d'urgence, les Services communautaires et les unités municipales. Notre objectif est de
réduire les répercussions d'une pandémie sur notre communauté.
Dans le cadre de notre planification, nous avons identifié votre organisme à titre de partenaire
essentiel. Il sera nécessaire de fournir de l'information précise et opportune à nos communautés
au cours d'une pandémie, mais nous croyons également qu'il est important d'assurer une
sensibilisation et une compréhension générales chez nos résidents avant une pandémie.
Si vous voulez obtenir plus d'information sur la pandémie de grippe ou si nous pouvons vous
faire parvenir des renseignements qui vous seraient utiles, veuillez communiquer avec >>>>.
Entre-temps, vous trouverez ci-joint un document de questions et de réponses sur la pandémie de
grippe.
Page 168 of 448
Appendix B15 General Q&As for the Public re. Pandemic Flu
Question & Answer Document
Pandemic Influenza
August 27, 2004
General
Information for
Public and
Partners
Get your influenza vaccine annually, so you are familiar with the procedure before a pandemic
influenza arrives in our province.
What is influenza?
is spread by droplets, direct contact with contaminated surfaces and possible airborne exposure.
What is Pandemic influenza?
A pandemic results when the flu virus takes an abnormal shift causing the sudden and
unpredictable emergence of a new influenza virus to which the population has no immunity. A
pandemic is essentially an outbreak occurring over a large geographical area, often worldwide,
illness.
What are the symptoms of pandemic influenza?
− Fever
- Aches and pains
− Fatigue
- Headache
− Cough
- Sore throat
− Stuffy or runny nose
How is influenza spread?
The virus is spread through the air by coughing and sneezing or on hands, cups, cutlery, tissues
or other objects that have been in contact with an infected mouth or nose.
How will we know when pandemic arrives?
There will be a formal declaration of pandemic by the World Health Organization.
How often do pandemics occur?
Pandemics occur approximately every 30 years. There have been three major influenza
pandemics in the 20th century, resulting in over 20 million deaths.
When can we expect the next pandemic?
….3/
Page 169 of 448
Why do we need to plan for Pandemic Influenza?
The timing and pattern of pandemic influenza is unpredictable. Contingency planning is essential
for an effective response. .
What percentage of our communities will be impacted by pandemic
influenza?
It is estimated that:
• 75% of people will be infected
• 15 – 38% will be clinically ill
• 6.8 – 17% will require outpatient care
• 0.1– 0.3% will require hospitalization
• 0.03 – 0.1% will die
How will health services be impacted by pandemic influenza?
There will be a huge burden on the health care system, as large numbers of people seek medical
care, which could last several months. We can expect:
• shortages of ICU beds, medical equipment & staff
• shortages of antivirals and antibiotics
• need for ancillary treatment centres
• high demand for mortuary/funeral services
• wide spectrum of illness with large numbers of persons ill
o Mild – community
o Moderate – ambulatory
o Severe – institutional
• Can quickly overwhelm current system
How will essential services like EMOs, RCMP, Fire Fighters, Municipal
Workers be affected?
Because many will be affected by influenza, essential services must have contingency plans in
place to ensure their work continues. Because of the huge demand on the health care system,
these partners, especially EMO, RCMP and First Responders will be required to assist during
this event.
Am I at risk?
Everyone is susceptible to pandemic strains of influenza, not just the traditional high-risk groups.
By the very nature of their roles, health care workers and first responders are at an increased risk
of exposure and illness.
2 of 3
Page 170 of 448
How can I protect myself?
• Follow infection control guidelines when caring for patients with pandemic influenza.
Is there a vaccine for pandemic flu?
A vaccine will be developed as soon as the strain has been identified. It will be likely be at least
four to six months before any vaccine will be available. Initially there will be shortages of the
vaccine and prioritization will be necessary. Essential service workers will be a top priority for
immunization.
What can we do to reduce our risk of infection?
We can minimize the spread of influenza, or any other viral infections, by washing our hands
often and promptly disposing of any tissues or other articles that come in contact with fluid from
your nose, mouth or eyes.
For more information contact: Barbara Johnson at 902-749-0517 or by email
bjohnson@swndha.nshealth.ca
3 of 3
Page 171 of 448
Questions et réponses
Pandémie de grippe
Le 27 août 2004
Information
générale destinée
au public et aux
partenaires
Faites-vous vacciner contre la grippe chaque année. De cette façon, vous connaîtrez déjà la
procédure avant qu'une pandémie de grippe n'ait lieu dans notre province.
Qu'est-ce que la grippe?
La grippe est une maladie infectieuse causée par un virus qui s'attaque au système respiratoire.
Le virus se transmet par des gouttelettes, par un contact direct avec des surfaces contaminées et
possiblement par l'exposition aux microbes aérogènes.
Qu'est-ce qu'une pandémie de grippe?
Une pandémie se produit lorsque le virus de la grippe subit une mutation anormale, causant une
émergence soudaine et imprévisible d'un nouveau virus de la grippe contre lequel la population
n'est pas immunisée. Une pandémie est essentiellement une épidémie qui se produit dans une
région géographique importante, qui touche une proportion exceptionnellement élevée de la
population et qui entraîne des taux de mortalité et de maladie élevés.
Quels sont les symptômes d'une pandémie de grippe?
Les symptômes d'une pandémie de grippe sont les mêmes que ceux qui sont causés par le virus
de la grippe. La grippe entraîne habituellement deux ou trois des symptômes suivants :
• fièvre
• douleurs
• fatigue
• maux de tête
• toux
• maux de gorge
• congestion ou écoulement nasal
Comment la grippe se propage-t-elle?
Le virus se propage dans l'air par la toux et les éternuements, ou sur les mains, les verres, les
ustensiles et tout autre objet qui a été en contact avec une bouche ou un nez infecté.
Comment saurons-nous qu'une pandémie se produit?
Une déclaration officielle de pandémie sera effectuée par l'Organisation mondiale de la Santé.
À quelle fréquence les pandémies se produisent-elles?
Les pandémies se produisent environ tous les 30 ans. Trois importantes pandémies de grippe ont
eu lieu au XXe siècle, causant la mort de plus de 20 millions de personnes.
À quel moment pouvons-nous prévoir la prochaine pandémie?
Page 172 of 448
Pourquoi un plan relatif à la pandémie de grippe est-il nécessaire?
Le moment où la pandémie se produira et les tendances de la pandémie de grippe sont
imprévisibles. La planification d'urgence est essentielle pour assurer une intervention efficace.
Quel pourcentage de nos communautés sera touché par la pandémie de grippe?
Il est estimé que :
• 75 % de la population contractera le virus
• 15 à 38 % de la population sera cliniquement malade
• 6,8 à 17 % de la population nécessitera des soins en clinique externe
• 0,1 à 0,3 % de la population nécessitera une hospitalisation
• 0,03 à 0,1 % de la population mourra
De quelle façon les services de santé seront-ils touchés par une pandémie de
grippe?
Le système de soins de santé devra traiter une énorme charge de travail puisque de nombreuses
personnes voudront obtenir des soins médicaux, et ce, pendant plusieurs mois. Nous pouvons
prévoir :
• des pénuries de lits dans les unités de soins intensifs, d'équipement et de personnel;
• des pénuries d'antiviraux et d'antibiotiques;
• la nécessité de centres de traitement d'appoint;
• une demande élevée de services mortuaires ou funèbres;
• une grande variété de maladies et un grand nombre de personnes atteintes
o Bénin – communautaire
o Modéré – ambulatoire
o Grave – institutionnel
• que le système actuel peut rapidement devenir surchargé.
De quelle façon les services essentiels tels que l'Organisation de mesures
d'urgence (OMU), la Gendarmerie royale du Canada (GRC), les services
d'incendie et les travailleurs municipaux seront-ils touchés?
Puisque de nombreuses personnes seront atteintes de la grippe, les services essentiels doivent
élaborer des plans d'urgence pour assurer la continuité des services. En raison de l'énorme charge
de travail du système de soins de santé, ces partenaires, particulièrement l'OMU, la GRC et les
premiers intervenants devront offrir leur aide pendant cet événement.
Est-ce que je suis à risque?
Tout le monde est sensible aux souches pandémiques de la grippe, non seulement les groupes à
risque élevé traditionnels. En raison de la nature de leur rôle, les travailleurs de la santé et les
premiers intervenants courent un risque accru d'être exposé au virus et de le contracter.
Comment puis-je me protéger?
Pour vous protéger contre la grippe pandémique, prenez les mêmes précautions que pour vous
protéger contre d'autres maladies infectieuses.
• Prenez des bonnes mesures d'hygiène personnelle de base. Se laver les mains est la façon
la plus efficace de prévenir la transmission de la maladie.
Page 173 of 448
•
•
•
•
•
Évitez d'entrer un contact avec des membres de la famille ou des amis qui ont contracté la
maladie.
Ne partagez pas les verres ou les tasses, ni les ustensiles.
Évitez les foules et les endroits clos.
Reposez-vous bien durant la nuit et adoptez un régime alimentaire sain.
Suivez les lignes directrices relatives à la prévention des infections lorsque vous soignez
des patients atteints de la grippe pandémique.
Existe-t-il un vaccin pour la grippe pandémique?
Un vaccin sera mis au point dès que la souche aura été identifiée. Il faudra attendre au moins de
quatre à six mois avant qu'un vaccin ne soit offert. Initialement, il y aura des pénuries de vaccins
et il sera nécessaire d'établir des priorités. Les fournisseurs de services essentiels pourront
recevoir le vaccin en priorité.
Que pouvons-nous faire pour réduire le risque d'infection?
Nous pouvons minimiser la transmission de la grippe ou de toute autre infection virale en se
lavant les mains fréquemment et en jetant au rebut tout mouchoir ou autre article qui entre en
contact avec les sécrétions du nez, de la bouche et des yeux.
Pour obtenir plus d'information, communiquez avec Barbara Johnson au (902) 749-0517 ou par
courriel à l'adresse bjohnson@swndha.nshealth.ca.
Page 174 of 448
Appendix B16 Draft Notices Re. Limitations on Visitation
STOP!
For the health of our patients:
• Hospital visits are open to immediate family
members only.
• Children are discouraged from visiting since
the influenza virus may persist longer in
children and this year they are being
significantly impacted by influenza.
• Family members do not visit if you have a
cough, sneezing, runny nose, sore throat or
other symptoms.
If you must be in the building to visit or for
an appointment:
• Use waterless hand sanitizer
• Cover your cough
• Wash hands often
• Please limit your visit to that area
Page 175 of 448
STOP!
For the health of our patients:
• The hospital is closed to all visitors.
• Compassionate visits may be permitted,
contact the ?? for permission.
• If you must visit do not do so if you
have a cough, sneezing, runny nose,
sore throat or other symptoms.
If you must be in the building for an
appointment:
• Do not visit patients
• Use waterless hand sanitizer
• Cover your cough
• Wash hands often
• Please limit your visit to that area
Page 176 of 448
Flu poster content:
ARRÊTEZ!
Pour la santé de nos
patient :
•
•
•
L'hôpital est fermé
à tous les
visiteurs.
Les visites pour des
raisons de
compassion peuvent
être autorisées;
communiquez avec
le coordonnateur
des équipes.
Si vous êtes
autorisé à visiter un
patient, veuillez
vous abstenir si
vous toussez, si
vous éternuez, si
vous avez une
congestion ou un
écoulement nasal
ou tout autre
symptôme.
Si vous devez vous
rendre à l'hôpital
pour un rendez-vous :
• Ne visitez pas les
patients.
• Utilisez le
désinfectant sans
eau pour les mains.
•
•
•
Couvrez votre
bouche lorsque vous
toussez.
Lavez-vous les
mains souvent.
Veuillez limiter
votre visite à cet
endroit.
ARRÊTEZ!
Pour la santé de nos
patients :
•
•
•
Les visites sont
permises par les
membres de la
famille immédiate
seulement.
Il n'est pas
recommandé de
laisser des enfants
visiter les patients
puisque le virus de
la grippe peut
persister plus
longtemps chez les
enfants et, cette
année, les enfants
sont
particulièrement
touchés par la
grippe.
Membres de la
famille : abstenezvous de visiter un
patient si vous
toussez, si vous
Page 177 of 448
éternuez, si vous
avez une
congestion ou un
écoulement nasal,
un mal de gorge ou
tout autre
symptôme.
Si vous devez vous
rendre à l'hôpital
pour un rendez-vous :
• Utilisez le
désinfectant sans
eau pour les mains.
• Couvrez votre
bouche lorsque vous
toussez.
• Lavez-vous les
mains souvent.
• Veuillez limiter
votre visite à cet
endroit.
PLEASE GIVE A COPY TO EACH PATIENT.
Notice About
Visitors
Notice About
Visitors
DATE
Flu activity has increased.
South West Health is
closing ?? Hospital to all
visitors effective
immediately. This is to
protect you and other
patients from influenza.
This closure will be
reviewed on ??. At that
time flu data will be
assessed and a decision
will be made whether to
reopen to visitors.
People wanting to visit for
compassionate reasons
must call the hospital at ??
and ask for the ?? to
receive permission to visit.
We know visitors are
important to you but it is
even more important that
you and other patients are
protected from the flu.
Notice About
Visitors
DATE
DATE
visitors effective
visitors effective
reopen to visitors.
If you have questions,
please talk to a nurse.
Page 178 of 448
reopen to visitors.
Avis au sujet des visiteurs
DATE
L'activité grippale est en hausse.
South West Health a décidé de fermer l'hôpital ?? à tous les visiteurs à compter d'aujourd'hui.
Cette mesure vise à vous protéger et à protéger les autres patients contre la grippe.
Cette fermeture sera révisée le ??. À ce moment, les données sur la grippe seront évaluées et une
décision sera prise en ce qui a trait à la réouverture de l'hôpital aux visiteurs.
Les personnes qui souhaitent visiter un patient pour des raisons de compassion doivent
communiquer avec le ?? de l'hôpital au numéro ?? pour recevoir la permission de visiter le
patient.
Nous savons que les visiteurs sont importants pour vous, mais il est encore plus important que
vous, ainsi que les autres patients, soyez protégés contre la grippe.
Si vous avez des questions, veuillez vous adresser à une infirmière.
Page 179 of 448
Appendix B17 Notice for ERs re. Pandemic Info Line
Post in ER Department
Pandemic
Influenza
Provincial Toll
free # (0800 –
2200)
1-800-???-????
Page 180 of 448
APPENDIX C
VACCINES
Page 181 of 448
Appendix C01 Estimate of Vaccine Dose Requirements
Department- YRH
100% 250 Doses-10% 812 Doses-30% 1290 Doses-50%
A-4 med/surg
58
0
20
58
A-4 North
22
12
15
22
A-Clinical Resource
4
A-ALCU
21
A-EHS
77
A-Amb. Care Psych. Docs
4
0
21
20
40
3
0
A-Emerg. Docs
14
2
7
14
A-Emergency
25
8
20
25
A-Float Pool
10
3
10
10
A-ICU
24
8
24
24
A-Infection Control
1
1
1
1
A-Internists
3
3
3
3
A-Lab
A-Maternal/Child
41
A-Medical 3 East
33
3
3
10 see below
8
25
41
15
33
3
3
A-Nurse Practioner
3
A-O.P.Clinic
3
A-Oncology
4
2
3
4
A-Occupational Health
1
1
1
1
A-Other Physicians
27
A-RDU
12
1
0
27
A-Security
A-Respiratory
7
3
6
12
3
6
6
1
3
7
B-Addictions
Bone Densitometery
1
C.T. Scan
2
Clinical Nutrition Dietitians
5
Community Health Board
4
Day Surg
7
Detox
8
Di Mammo Screening
2
1
11
Page 182 of 448
2
Di. General
13
2
4
13
Diabetes Education
3
Dietary-Non Pat Food
9
Discharge Planner
1
E.K.G.
5
0
Early Ident/Intervnt
1
0
Educ BN Nursing
13
0
Enviromental Serv
53
5
Executive Director
4
Executive Offices
2
Facility Management
8
1
Finance
4
0
2
Foundation
1
28
0
10
HSL/Housekeeping
2
0
2
HSL/Vocational
2
0
Human Resources
I/P Acute Psychiatry
(Psych)
7
0
19
Information Systems
8
Inservice Education
1
HSL/General
4
12
30
1
1
12
15
3
Laboratory
49
Landry
18
Library
2
Mammography
2
Marilyn Pothier
1
Mat Mngt Stores
9
Medical Director
1
Medical Records
Mental Health
Administration
13
Nuclear Medicine
5
1
Nursing Administration
7
1
Nutr Ser-Pat Food +9
66
O.R.
20
2
5
35
6
10
1
4
6
3
7
Page 183 of 448
25
45
Occupational Therapy
5
Pharmacy
7
Physiotherapy
9
2
2
7
11
1
2
8
Plant Operations
5
1
1
4
Porters
8
1
2
8
PreNatal clinic
1
Primary Health Care
1
Psych Clare Salaries
2
2
Psych Mental Health
6
2
Psych Mental Health-Adult
5
4
Psych Mental Health-Child
6
Public Relations
1
1
Radiology
4
4
Recovery Room
5
2
Recreation
3
ReDevelopment
2
Plant Maintenance
Registration
15
3
Security
S.P.D./C.S.R.
1
12
Telehealth
1
TVM/Main.
1
TVM/Physio
1
TVM: TVM General
10
2
15
6
4
64
12
18
TVM:Activity
4
TVM:TVM/Admin.
3
1
14
5
TVM:TVM/Housekeeping
Ultrasound
6
Utilization Management
1
Vet'sUnit
22
Water Front Resource
2
Roseway
A- Nursing:ER regular
RN's
9
6
4
A-Physicians
1
Page 184 of 448
9
9
A-Nursing:InptRN,LPN,Ward Clerk
31
5
20
20
A-OH/IC
1
1
1
1
B-Addictions
1
0
0
Business Office/Payroll
1
0
0
Diabetes Education
2
0
Food and Nutrition
15
1
Health Records
2
0
Housekeeping
6
1
IS
1
0
Laboratory
M-Administration
(management)
7
Maintenance/Operations
7
7
3
3
1
4
4
7
1
3
3
10
1
3
5
Pharmacy
2
1
1
1
Public Health Services
3
Rehab Services
3
0
10
1
5
5
2
1
2
2
Mental Health
S- Admitting /Switchboard
X-Ray/EKG
2
Digby General Hospital
A- Nurse Practitiners
2
A-Nurse Manager
1
A-Nursing -Emergency
1
13
5
A -ER Physician
A-Nursing -Medical
13
13
1
35
4
20
20
A-OHN-ICP
1
1
1
1
B-Addictions
1
0
Central Registry
6
1
3
3
Consultant's Clinic
Diabetes Education
Center
1
0
1
0
Diagnostic Imaging
4
1
2
2
EKG
5
1
1
5
5
Environmental Services
Finance
10
1
1
0
Page 185 of 448
Food & Nutrition Services
9
1
Health Records
1
0
Information Services
1
0
Laboratory
7
1
Laundry
M-Administration
(management)
3
Mental Health Services
5
5
4
4
1
1
2
12
1
4
6
Pharmacy
2
1
1
1
Physiotherapy
3
Plant service
6
1
2
2
3
Social Work
1
125
406
645
Tenants
Early Interventins
1
HCNS
2
Hospice
NSS&H
physicians
6
VON
Total
1187
Page 186 of 448
Appendix C02 SWH LTC, HC, VON Employee List
Pandemic Planning Public Health
Page 187 of 448
Appendix C03 Pharmacy Staff Priority List For Influenza Vaccination
Latest update: October 2004
Assumption: Immunized staff will be sent to provide services to the wards and unimmunized
staff will maintain services in the pharmacy department.
Prepandemic Staffing Complement:
1 FTE Pharmacist
Pandemic First Priority List:
1 FTE Pharmacist
Roseway Hospital
0.5 FTE Pharmacist
0.7 FTE Pharmacy Technician
0.7 FTE Pharmacy Technician
0.5 FTE Pharmacist (also works at Queens)
Yarmouth Regional Hospital
1 FTE Pharmacist Manager
3 FTE Pharmacists (1.5 FTE vacancies)
4 FTE Pharmacy Technicians
2 FTE Clinical Pharmacists
2 FTE Pharmacy Technicians who mix
chemotherapy
Pandemic Second Priority List:
1 FTE Pharmacy Manager
1 FTE Pharmacist
2 FTE Pharmacy Technicians
Page 188 of 448
Appendix C04 Essential Service Providers Priority List for Vaccine
Essential Service Providers Priority List for Vaccine
1.
2.
3.
4.
5.
Emergency Health Services – unless done in the Health Care Workers List
Fire Department Emergency Medical Responders
Royal Canadian Mounted Police – Town Police (includes dispatchers)
Fire Departments – all remaining personnel (includes dispatchers)
Community Services
a. Emergency Social Services
b. Red Cross
i. Field Representatives
ii. Volunteers – depending on placement
c. Radio – local first
6. Emergency Measures Organizations
a. Coordinators
b. Controllers
c. EOC group
d. Amateur radio operators
7. Municipal government
a. Mayors
b. Wardens
c. Band Chiefs ?
d. Chief Administrative Officers
e. Clerks
f. Water workers
g. Sewer Workers
8. Pharmacists and dispensing clerks
9. Ground Search and Rescue
10. Food dispensers
a. Major chains / stores
b. Minimal staff – enough to ensure continued service
c. Exclude pharmacy staff – see #8
11. Utilities (in the following order)
a. Electrical power and home propane service
b. Telephone service providers
c. Garbage collection
d. Snow plow operators (season dependent)
e. Gas and diesel providers – for transportation
f. Home heating fuel – season dependent
12. Funeral Directors and Embalmers
13. Newspapers (local first), local TV staff & internet providers
14. Municipal skeleton support staff and finance
15. Employment Insurance providers
16. Banks and Financial Institutions
17. Transportation
Page 189 of 448
a. Buses
b. Island ferries
c. Truckers
d. Air traffic controllers
e. Pilots
18. Sheriffs and Justice workers
19. Veterinarians
20. SPCA workers and animal control officers
21. chicken and pig farmers if necessary
Page 190 of 448
Appendix C05 Municipal Units
DHA 1
01 District of Lunenburg
02 Town of Lunenburg
03 Town of Bridgewater
04 District of Chester
05 Town of Mahone Bay
06 Region of Queens
DHA 2
01 Shelburne
02 Town of Shelburne
03 Town of Clarks Harbour
04 Town of Lockeport
05 Municipality of Barrington
06 District of Yarmouth
07 Town of Yarmouth
08 District of Argyle
09 Clare
10 District of Digby
11 Town of Digby
DHA 3
01 County of Annapolis
02 Town of Annapolis Royal
03 Town of Bridgetown
04 Town of Middleton
05 County of Kings
06 Town of Berwick
07 Town of Kentville
08 Town of Wolfville
Page 191 of 448
Appendix C06 Essential Service Providers Totals
Appendix E03
Essential Service Providers Totals
Priority
DHA 1
1 to 5
1
46
2
3
68
4
513
5
86
6
147
7
8
231
9
10
634
11
347
12
33
13
90
14
317
15
68
16
185
17
158
18
25
19
20
21
Total
2948
DHA 2
DHA 1 1 to 5 6,7
14
60
0
18
36
55
86
87 600 406 179
19 105
5
45 192
20
26
88
29
67
88
56 287
21
41
26
25
0
209 843
92 184
121 468
72 114
18
7
51
13 103
11
317
10
68
37 222
15
44 202
73
45
7
11
24
32
0
0
0
6
776 3724
834
760
8
9
11
165
3
14
25
46
6
57
327
6
96
5
15
24
49
66
3
10
14
15
3
306
Page 192 of 448
DHA 3
10,11 DHA 2 1,2
36
0
0
33 141
28
215 1061 303
26
36
49 110
45
44 143
15
70 170
25 101
3
273 644
65 317
14
10
21
20
10
67 154
121
35
0
0
0
867 3094
444
3
4
5
6
16
38
25
40
8
34
1
17
25
5
15
30
12
72
64
7
46
451
50
30
92
132
50
547
379
3
22
14
40
109
401
191
7
6
50
8
16
67
18
DH
13
42
40
79
35
37
71
5
2
4
47
25
14
1
12
131
19
183
389
15
2
137
291 2540
177 4
Appendix C07 ESP Priority List for Vaccination - Form
Municipality of X
Essential Service Providers Priority List for Vaccination
Priority Service
Emergency Health
1
Services
Fire Department
2
Police
3
4
Fire Departments
5
Community Services
6
Emergency Measures
Organisations
7
Municipal
Government
8
Pharmacists &
Dispensing Clerks
Notes
Contact Information
Emergency
Social
Services
Red Cross
Local Radio
Coordinators
Controllers
EOC Group
Amateur
Radio
Warden
CAO
Clerks
Water
Sewer
Page 193 of 448
Appendix C08 ESP Priority List for Shelburne County
Municipality of Shelburne County
Priority Service
Emergency Health
1
Services
Fire Department
2
3
Police
4
Fire Departments
Notes
Contact Name
Emergency Medical
Responders Only
RCMP- Barrington
RCMP - Shelburne
Sable River
Volunteer Fire
Department
Lockeport
Volunteer Fire
Department
Little Harbour
Volunteer Fire
Department
Jordan
Volunteer Fire
Department
Shelburne
Volunteer Fire
Department
Gunning Cove, Carleton
Village Volunteer Fire
Department
Middle & Upper Ohio
Volunteer Fire
Department
Ingomar Roseway
Volunteer Fire
Department
Northeast Harbour
Volunteer Fire
Department
Page 194 of 448
Phone #
Vaccine #
637-2325
875-2490
875-3544
31
656-2216
875-3544
875-3544
875-2991
875-3544
875-3544
875-3544
875-3544
406
5
6
7
Community
Services
Emergency
Measures
Organisations
Municipality of
Shelburne
Municipality of
Barrington
Town of Lockeport
Port Clyde
Volunteer Fire
Department
Port LaTour
Volunteer Fire
Department
Barrington Head
Volunteer Fire
Department
Island & Barrington
Volunteer Fire
Department
Shag Harbour
Volunteer Fire
Department
Woods Harbour
Volunteer Fire
Department
Dispatch
Emergency Social
Services
Red Cross
Local Radio
Coordinators
637-2015
637-2015
637-2015
637-2015
637-2015
637-2015
Roseway Hospital
Karl White
875-3011
637-2335
5
4
See Bridgewater
& Yarmouth
JSB – EMO
875-3544
Barrington/Clark’s 637-2015
Hrb
1
Controllers
EOC Group
Amateur Radio Operators Dick d’Entremont
Warden
CAO
Clerks
Water
Sewer
Warden
CAO
Clerks
Water
Sewer
Mayor
CAO
Clerks
Water
Sewer
Page 195 of 448
875-2222
875-3544
637-2015
656-2216
3
17
Town of Shelburne
Town of Clarke’s
Harbour
8
Pharmacist &
Dispensing Clerks
Mayor
CAO
Clerks
Water
Sewer
Mayor
CAO
Clerks
Water
Sewer
Heather Pharmacy
Lawton’s Drugs
Shopper’s Drug Mart
Sobey’s Pharmacy
Superstore Pharmacy
9
10
GS&R
Food Dispensers
TLC Pharmacy
Ground Search & Rescue
Air - Marine
Barrington GS & R
Atlantic Superstore
Utilities
745-2390
Lockeport
Shelburne
Barrington
Passage
Barrington
Passage
Barrington
Passage
Shelburne
Federal
Electricity
Mike Hopkins
Barrington
Passage
Clark’s Harbour
Lockeport
Shelburne
Shelburne
Lockeport
Bear Point
Lockeport
Pantry Shelf
Shelburne
NSPI
Propane
Telephone
Aliant
Foodtown
Lydgate Corner Store
Save Easy
Sobey’s Inc.
Town Market
Food Banks
11
875-2991
Garbage Collection
Snow Plow Operators
Page 196 of 448
Burke Harris
Shelburne
DM Snow
Barrington
Department of
Transportation &
PW
656-2211
875-3007
637-3211
21
637-3541
637-3529
875-4852
911
732-2995
637-3512
26
92
745-2060
656-2258
875-2775
875-2458
656-2131
723-2175
656-3216
875-3484
1-800-4286230
6
1-800-5089464
875-3663
13
18
637-2410
875-3017
23
12
13
14
15
16
17
18
19
20
21
Funeral Directors
& Embalmers
Local Media
Gas & Diesel Stations
Home Heating Fuels
Huskilson’ Funeral
Homes (3)
Newspapers
TV stations
Internet providers
Municipal Skeleton
Staff & Finance
Employment
Insurance Providers
Banks & Financial CIBC
Intitutions
Scotiabank
Royal Bank
Transportation
Sheriffs & Justice
Workers
Veterinarians
SPCA & Animal
Control
Chicken & Pig
Farmers
Buses
Island Ferries
Truckers
Air Traffic Controllers
Pilots
Other
Sheriff’s Office
Lock Up Facility
Page 197 of 448
Dexter’s Esso
875-2259
12
Clifford Huskilson 875-2368
7
Eastlink
Eastlink
9
2
265-3588
265-3588
10
Shelburne
Barrington
Shelburne
Lockeport
Barrington
Clark’s Harbour
School Board
Garage
875-2388
637-2212
875-3115
656-2212
637-2040
15
1-800-9150113
875-4930
42
Harold Newell
637-2243
31
875-3404
875-3432
11
Appendix C09 ESP Priority List for Yarmouth Town
Municipality of Yarmouth
Town of Yarmouth
Priority Service
Emergency Health
1
Services
Fire Department
2
3
Police
4
Fire Departments
5
Community Services
6
Emergency Measures
Organisations
7
Town of Yarmouth
Notes
Emergency Medical
Responders Only
RCMP
Carleton Fire Department
Kemptville & District Fire
Department
Lakes & District Fire
Department
Lake Vaughn Fire
Department
Port Maitland Fire
Department
Valley & District Fire
Department
Yarmouth Fire Department
Dispatch Fire
Emergency Social Services
Red Cross
Local Radio
Coordinators
Controllers
EOC Group
Amateur Radio Operators
Mayor
CAO
Clerks
Water Public Works
Sewer
Page 198 of 448
Contact Information
Numbers
Yarmouth Town
Detachment (902)
742-8777
Yarmouth Rural
Detachment (902)
742-9106
PSAP (902) 742-1323
(902) 742-3147
(902) 742-3147
55
175
(902) 742-3147
(902) 742-3147
(902) 742-3147
(902) 742-3147
(902) 742-3147
(902) 742-3147
902 742-0034
4
12
Joint EMO Committee
(902) 742-8558
26
(902) 742-8565
(902) 742-7525
21
23
Municipality of
Yarmouth
8
Pharmacists &
Dispensing Clerks
9
10
Ground Search &
Rescue
Food Dispensers
11
Utilities
Warden
CAO
Clerks
Water Public Works
Sewer
City Drug Store
Lawtons Drugs
Pharmasave
Shoppers Drug Mart
Atlantic Superstore
Zellers Pharmacy
Atlantic Superstore
Dayton Red & White
Kemptville Corner Store
Needs Food Store
Sobeys Inc.
Yarmouth Fresh Mart
Yarmouth Food Bank
Electricity
Propane
Irving Propane
Superior Propane
Telephone
Garbage Collection
Recycle
Snow Plow Operators
DOT
Gas & Diesel Stations
Irving Gas Station
Main St. Ultramar
Ohio ESSO
Petro Canada
Reigh’s Service Centre
Shell Gas Station
Page 199 of 448
(902) 742-7159
(902) 742-7150
21
2
(902) 742-3579
(902) 742-1900
(902) 742-7825
(902) 742-3523
(902) 742-3493
(902) 742-1078
(902) 742-1323
8
8
12
7
3
3
25
(902) 742-3392
(902) 742-4362
(902) 742-2286
(902) 742-9169
(902) 742-2882
(902) 742-8894
Bill Carter (902)
742-2314
65
18
8
18
55
16
4
(902) 310-1924
877 873-7467
4
6
Duffus Remove-all
(902 742-2512
Cosman’s Garbage
Disposal (902) 7427715
Rolex Sanitation (902)
742-3490
H&H Recovery LTD.
(902) 742-3490
(902) 742-2416 or
(902) 742-2415
(902) 742-8296
15
(902) 742-5011
(902) 742-8626
(902) 742-1444
(902) 742-4927
(902) 742-4353
6
6
6
6
6
6
10
12
25
6
Home Heating Fuels
12
13
14
15
16
17
18
19
20
21
Funeral Directors &
Embalmers
Local Media
Municipal Skeleton
Staff & Finance
Employment Insurance
Providers
Banks & Financial
Institutions
Transportation
Sheriffs & Justice
Workers
Veterinarians
SPCA & Animal
Control
Chicken & Pig Farmers
Newspapers
TV stations
Internet providers
Buses
Island Ferries
Truckers
Air Traffic Controllers
Pilots
Other
Sheriff
Correctional Centre
Page 200 of 448
(902) 749-5175
45
(902) 742-3221
(902) 742-4211
12
12
Appendix C10 ESP Priority List for Municipality of Argyle
Municipality of Argyle
Priority Service
Emergency Health
1
Services
Fire Department
2
3
Police
4
Fire Departments
Notes
Contact Information
Emergency Medical
Responders Only
RCMP
RCMP Yarmouth Department
Telecom Centre 742-1323
Rural Office
742-9106
East Pubnico Fire
Chief:
Department
Joe d’Eon 762-0155
Deputy Chief
West Pubnico Fire
Department
Eel Brook Fire
Department
Lake Vaughan Fire
Department
Kemptville Fire
Department
Quinan & District
Fire Department
Islands & District
Fire Department
Chief
Gordon Amiro 762-2098
Deputy Chief
Devin d’Entremont 762-2751
Chief
Hector Babin 648-3014
Deputy Chief
Donnie Warner 648-2391
Chief
Earl Raynard 648-2546 (h);
740-3473 (c); 742-8782 (w)
Deputy Chief
Michael Newell 648-3269
Chief
Ken deMolitor 761-2077
Deputy Chief
Ian Gates 761-2290
Chief
Steven Doucette 648-2598
Deputy Chief
Ronald Doucette 648-2821
Chief
John Surette 648-0031
Deputy Chief
Warren Surette 648-3154
Page 201 of 448
Numbers
11
27
32
24
18
22
8
10
Wedgeport &
District Fire
Department
Amirault’s Hill /
Hubbards Point
Fire Department
5
Community Services
6
Emergency Measures
Organisations
7
Municipal Government
Emergency Social
Services
Red Cross
Local Radio
Coordinators
Controllers
EOC Group
Amateur Radio
Operators
Warden
CAO
Clerks
Water
Sewer
8
9
10
Pharmacists &
Dispensing Clerks
Ground Search &
Rescue
Food Dispensers
La Pharmacy
Ground Search &
Rescue
Wedgeport Quick
Mart
East Pubnico
Convenience Store
Co-op De La Tour
West Pubnico
Amirault’s Grocery
Pubnico Meats &
Produce
Pothier’s Grocery
Kemptville Corner
Store
Chief
Glen Muise 663-2665
Deputy Chief
Dwayne LeBlanc 663-2946
Chief
Melvin Landry 748-2863
Deputy Chief
Alvin Hubbard 648-2736
14
10
Aldric d’Entremont 762-2195 (h)
648-7066 (c)
Super: John Cook 742-2299 (h);
648-2623 (w)
Lorelei Doucette 648-2623
Randy Doucette 648-2623 (w);
648-2757 (h)
Amiro & Surette 762-2039 (w);
749-6126 (h)
T. d’Eon 762-2793 or 762-2095
3
14
Clinton Atkinson 643-2218
Walter Parnell 742-0914
Gary Hansen 663-2663
25
Joseph Boudreau 762-0559
7
Peter d’Entremont 762-2315
10
Lorna Amirault 762-2319
Wayne d’Eon 762-2708
Gary Hansen 663-4302
8
5
648-2468
Judy Roberts 761-2286
5
5
Page 202 of 448
6
11
Utilities
12
Funeral Directors &
Embalmers
Local Media
13
14
15
16
17
Municipal Skeleton
Staff & Finance
Employment Insurance
Providers
Banks & Financial
Institutions
Transportation
Electricity
Propane
Telephone
Garbage Collection
Snow Plow
Operators
Gas & Diesel
Stations
Home Heating
Fuels
Newspapers
TV stations
Internet providers
Municipal Staff
Royal Bank of
Canada
West Pubnico
Coastal Financial
Credit Union
Tusket
Coastal Financial
Credit Union
East Pubnico
Coastal Financial
Credit Union
West Pubnico
Coastal Financial
Credit Union
Argyle
Coastal Financial
Credit Union
Wedgeport
Buses
Island Ferries
Truckers
Neil LeBlanc 648-2311
Staff 648-2311
1
5
762-2205
10
Manager:
Tom Moulaison 648-2322
10
Manager:
Darryl LeBlanc 762-2617
9
Manager:
Kevin Cook 762-2372
10
Manager:
Toddie d’Entremont 643-2484
8
Manager:
Philip Atkinson 663-2525
10
Refridgerated Truck R&K
Murphy
Gary LeBlanc 663-4398
R d’Eon Transport
762-2894; 762-0309 garage
Air Traffic
Controllers
Page 203 of 448
Pilots
Other
18
19
20
21
Sheriffs & Justice
Workers
Veterinarians
SPCA & Animal
Control
Chicken & Pig Farmers
Page 204 of 448
Appendix C11 ESP Priority List for Municipality of Clare
Municipality of Clare
2
Service
Emergency
Health Services
Fire Department
3
Police
4
Fire Departments
1
Notes
Contact Information
Emergency Medical
Responders only
RCMP
See #4 Fire Departments
below
RCMP Meteghan Detachment
Sgt. Mike Doucet - 645-2326
Fire Chief
Daniel Gaudet - 837-7680
Deputy Chief
Jeffrey Doucet - 769-3168
paging system
837-5243
Fire Chief
André LeBlanc - 769-3469
Deputy Chief
Michel LeBlanc - 769-2480
paging system
769-0920
Fire Chief
Edward Comeau - 769-3828
Deputy Chief
Normand Comeau - 645-2096
paging system
645-3681
St. Bernard Fire
Department
Little Brook Fire
Department
Meteghan Fire
Department
Numbers
6
12
14
25
Salmon River Fire
Department
Fire Chief
Nicolas Power - 6453554
Deputy Chief
Wayne Smith - 649-2969
paging system 645-2977
15
Southville Fire
Department
Fire Chief
Doug Cromwell 837-5434
Deputy Chief
Robert Bright 837-4197
Fire Chief
Andrew Hill
- 837-4800
Deputy Chief
Blaire Rodgerson - 837-5713
10
Havelock Fire
Department
Page 205 of 448
10
Hectanooga Fire
Department
Richfield Fire
Department
5
6
Community
Services
Emergency
Measures
Organizations
7
Municipal
Government
8
Pharmacists &
dispensing clerks
Ground Search &
Rescue
10 Food Dispensers
Emergency Social
Services
Red Cross – field
reps,
volunteers
Radio Station - CIFA
Coordinators,
controllers, EOC
Amateur radio
operators
Mayor / Warden
Chief Administrative
Officer
Clerks
Saulnierville
Pharmacy
Saulnierville, N.S.
Pharmasave
Meteghan Centre,
N.S.
Fire Chief
Frederick Muise - 649-2739
Deputy Chief
James Theriault - 649-3121
paging system
649-2664
Fire Chief
Eldon White - 761-2140
Deputy Chief
Nick Maillet - 761-2476
paging system
761-2731
6
Darlene Comeau
769-2432 (w) 769-8248 (h)
Dave LeBlanc
769-2432 (w) 645-3014 (h)
Hubert Robicheau
645-2047
Delphis J. Comeau
769-2031 (w) 769-2979 (h)
5
4
15
Rick Theriault 769-0893
Elaine Saulnier 645-2153
12 ?
Marlene Boudreau 645-2219
Nathan Hanna 769-3530
12 ?
9
Clare Food Banks
Saulnierville, N.S.
Page 206 of 448
Annette Dugas
Church Point, N.S.
769-3819
Rose-Marie Saulnier
Saulnierville, N.S.
769-2273 (h)
8
11 Utilities
Clarence Shopping
Mart
Saulnierville, N.S.
Robichaud’s Save
Easy
Meteghan, N.S.
Comeauville Fresh
Mart
Comeauville, N.S.
Electrical power
Home propane
Telephone
Garbage collection
Snow plow operators
Department of
Highways
Gas and diesel
stations
Salmon River Service
Centre
Salmon River, N.S
Irving Gas Station
and Convenience
Store Meteghan,
N.S.
Saulnierville Gas
Saulnierville, N.S
Concession Service
Station
Concession
Delbert Thimot
Service Centre
Meteghan Centre,
N.S.
H. Comeau Service
Station
Meteghan, N.S.
Page 207 of 448
Aline Comeau 769-2538
Wade Bassett 769-3077
15
Rick Robichaud 645-2702
Donna Comeau 645-2920
14
Sylvia Thibodeau 645-2304
Rick Robichaud 645-2702
12
Delphis J. Comeau
769-2031 (w) 769-2979 (h)
Christine Comeau
769-2031 (w) 769-3247 (h)
Paul Dugas
769-2192 (w) 769-7679 (cell)
837-7349 (h)
Melvin Deveau
769-8998 (cell) 645-2728 (h)
14 ?
Russell LeBlanc 649-2804
5
Cynthia Dugas 645-3340
3
David Coggins 769-2077
3
Joel Doucet 769-2328
3
Daniel Thimot
645-2270 (w) 769-3630 (h)
769-7435 (cell)
3
Hubert Comeau
645-3280 (w) 645-3043 (h)
769-8540 (cell)
Stephen Comeau
645-1897 (h) 769-8764 (cell)
3
16
Clayt’s Irving Service
Station
Little Brook, N.S.
Clare Dodge Gas
Service
St. Bernard
Home heating fuel
Season dependent
12 Funeral Directors
& Embalmers
13 Communications
14 Municipal staff
15 Employment
insurance
16 Banks &
Financial
institutions
Clayton Saulnier
769-3522 (w) 769-3446 (h)
4
Roger and Louise Mullen
837-5171 (w) 837-5753 (h)
4
Hubert Comeau
Meteghan Centre, N.S.
645-3380 (w) 645-3043 (h)
Acadian Fuels
769-8540 (cell)
Meteghan, N.S.
Stephen Comeau
645-3880 (w) 645-1897 (h)
769-8764 (cell)
Roland Comeau
769-2744 (w) 769-2196 (h)
R. Comeau Fuels Ltd. 769-3226 (cell)
Saulnierville, N.S.
Aaron Dunn
769-2744 (w) 769-0842 (h)
Meteghan Funeral
Roland Deveau
Home
645-2272 (h) 769-3859 (cell)
645-2142
Emmanuel d’Entremont
769-3363 (h)
Local Newspapers
Denise Desaultels
Le Courier Church
769-3078 (w)
Point, N.S.
Delia Comeau
769-3591 (h)
Internet service
providers
Skeleton crew
Delphis J. Comeau
769-2031 (w) 769-2979 (h)
Christine Comeau
769-2031 (w) 769-3247 (h)
Finance support
4
Bank of Nova Scotia
Saulnierville, N.S.
Rolande Deveau
Lake Doucette, N.S.
769-5201 (w) 649-2809 (h)
Jacinthe Comeau
Meteghan Centre, N.S.
769-5200 (w) 645-3772 (h)
Page 208 of 448
4
3
10
14?
5
Royal Bank of
Canada
Meteghan and
Church Point
Branches
Caisse Populaire de
Clare
Meteghan, SainteMarie, Saint-Bernard
and Saulnierville
Branches
17 Transportation
André LeBlanc
Comeauville, N.S.
645-2214 (w) 769-5110 (w)
769-0217 (h)
Tanya Dugas Theriault
645-2022 (w) 769-0231 (h)
Paul-Émile LeBlanc
Meteghan, N.S.
645-2661 (w) 645-2351 (h)
769-7071 (cell)
Page 209 of 448
5
Nadine Saulnier
Meteghan River, N.S.
769-2453 (w) 769-8759 (cell)
Buses
Claredon Robichaud
Le Transport de Clare
769-2474 (h) - 769-7103 (cell)
Island Ferries
Truckers
Air traffic controllers
Pilots
18 Sheriffs & Justice
Workers
19 Veterinarians
20 SPCA Workers
Animal Control
Officers
21 Chicken & Pig
Farmers
5
3
Appendix C12 ESP Priority List for Municipality of Digby
Municipality of Digby
Service
2
Emergency Health
Services
Fire Department
3
Police
4
Fire Departments
1
Notes
Contact Name
Emergency
Medical
Responders Only
RCMP
Digby Dispatch
(Municipal
Airport)
Brighton /
Barton
Digby
See #4 below
Smith’s Cove
Westport
Plympton
Tiverton
Freeport
Bear River
Southville
5
Community
Services
6
Emergency
Measures
Organizations
Digby Neck
Weymouth
HRDC – Digby
Community
Services Digby
Red Cross
AVR
Joint EMO
Committee
Phone
Numbers
Vaccine
Numbers
S/Sgt Wylie Grimm 245-2579
Becky Doucet
245-5805
21
12
Chief Cliff Surette
245-5166
7
Chief Robert
Morgan
Chief Jim Martyn
Chief Clifton
Moore
Chief Michael
Amero
Chief Randy
Outhouse
Chief Roger
Thomas
Chief Darryl Jelfs
Chief Douglas
Cromwell
Chief Tom Ryan
Chief Roy Mullen
Carolyn Amon
245-4958
32
245-5557
839-2005
12
17
839-4552
7
839-2248
27
839-2566
30
467-3633
837-5895
28
21
834-2627
837-4066
9
32
24
Nicole Gidney
Bentley Rice
Bill Theriault
Controllers
EOC Group
Page 210 of 448
245-5811
245-2111
245-1805
245-8668
2
40
7
Municipal
Government
Town of Digby
Municipal
Government
District of Digby
Bear River Reserve
8
Pharmacists &
Dispensing Clerks
Ground Search &
Rescue
10 Food Dispensers
Amateur Radio
Operators
Mayor
CAO
Clerks
Water
Sewer Treatment
Plant
Public Works
Dept
Warden
CAO
Clerks
Water
Sewer: Digby
Salvage &
Disposal
Sewer: Clare
Landscaping
Band Chief
CAO
Clerks
Water
Sewer
Digby
Pharmasave
Shoppers Drug
Mart
Weymouth
Pharmasave
Sobeys
Drugstore
Superstore
Drugstore
9
Digby Foodbank
Atlantic
Superstore
Sobeys
Weymouth
Foodland
Value Foods
Weymouth
John Scott
834-2681
Frank Mackintosh
245-4633 (w)
9
1/7
Linda Fraser, Town 245-4769 (w)
Clerk
245-8173 (w)
David Speicht
245-4219 (h)
Kevin George
5
Supt. Bruce Murley
6
Jim Thurber
Brian Cullen
Richard Thomas
245-4887 (h)
245-4683 (c)
839-2643 (w)
245-4777 (w)
245-4297
Thomas Lombard
1
6
1/5
10
8
6
Edgar Head
245-4071
40
Christianne Land
245-4721
20
Suzanne & Rod
Lefort
837-5197
10
Danny Amero
837-7228
25
Helen Matheson
Butch Riezel
245-4108
245-4108
24
100
William Harvey
Larry Veinot
245-6183
837-7262
82
27
Morton Frankland
837-4953
15
Page 211 of 448
11 Utilities
Nova Scotia
Power
Superior Propane
Aliant Cottreau,
Supt.
Aliant
Garbage
Collection
Snow Plow
Operators
Gas & Diesel
Stations
1-800-428-6230
532-2306
7
1-877-8737467
5
Jeff VanTassell
245-
7
Dept of
Transportation
Dave Comeau /
Brian Foote
Irving
245-4090
28
245-2048 (h)
245-4266 (w)
245-5191 (h)
5
245-2126 (h)
5
Dominique Hannah
245-7224
28
Carla Druken /
Sharon Doucette
Cheryl Ross
Ken Gerhardt
837-7840
11
245-2233
245-1822
8
18
George Churchill
837-4089
2
Esso
Jane Justason
Shell
5
Home Heating
Fuels
12 Funeral Directors &
Embalmers
13 Local Media
Newspapers
TV stations
Internet
providers
14 Municipal Skeleton
Staff & Finance
15 Employment
Insurance Providers
16 Banks & Financial Royal Bank -Institutions
Digby
Royal Bank –
Weymouth
CIBC – Digby
Scotia Bank –
Digby
Weymouth
Credit Union
17 Transportation
Buses
Island Ferries
Truckers
Air Traffic
Controllers
Pilots
Other
18 Sheriffs & Justice
Page 212 of 448
Workers
19 Veterinarians
20 SPCA & Animal
Control
21 Chicken & Pig
Farmers
Page 213 of 448
Appendix C13 Shelburne County East Contact List
Pandemic Flu Planning
JSB EMO Shelburne County East
2004 11 12
Contact List for Flu Vaccine
Donald C. Bower
EMO Coordinator
Areas Covered:
The Joint Services Board Emergency Measures Organization (JSB EMO) for Shelburne County
East covers the municipal units of; the town of Lockeport, the town of Shelburne and the
Municipality of the District of Shelburne. This area has a population of about 8500. Donald C.
Bower is the EMO Coordinator for this area as appointed by the Joint Services Board
The list below also provides contacts for Shelburne County West, which includes the municipal
units of the town of Clark’s Harbour and the Municipality of the District of Barrington. This area
has a population of about 8000.
Flu Vaccine Contact List
Cautionary Note:: It is appreciated that any contact list is out of date as soon as it is published.
The list below is so structured as to be current for as long as possible. It is strongly
recommended that those responsible for the long term maintenance of this list acquire as soon as
possible the reference documents listed at the end of this document. Numbers provided are for
office numbers and presumably as such are valid for normal office hours only.
RCMP Shelburne
RCMP Barrington
875-2490
637-2325
Sheriffs Office
Lock Up Facility
875-3404
875-3432
Town of Shelburne
Town of Lockeport
Municipality of the District of Shelburne
Town of Clark’s Harbour
Municipality of the District of Barrington
875-2991
656-2216
875-3544
745-2390
637-2015
Shelburne County Fire Departments
Page 214 of 448
o none of the 15 fire departments in Shelburne County are staffed on a regular basis,
therefore no one is likely to answer the fire hall telephone number if it is called
o the fire chiefs are subject to change on an annual basis and some have unlisted numbers
o the contact number supplied for each fire department will be the number of the municipal
unit that they operate in. The municipal/town clerk will have the current contact
information.
Sable River VFD
Lockeport VFD
Little Harbour VFD
Jordan VFD
Shelburne VFD
Gunning Cove Carleton Village VFD
Middle and Upper Ohio VFD
Ingomar Roseway VFD
Northeast Harbour VFD
Port Clyde VFD
Port LaTour VFD
Barrington Head VFD
Island and Barrington Passage VFD
Shag Harbour VFD
Woods Harbour VFD
875-3544 (MOS)
656-2216 (TOL)
875-3544 (MOS)
875-3544 (MOS)
875-2991 (TOS)
875-3544 (MOS)
875-3544 (MOS)
875-3544 (MOS)
875-3544 (MOS)
637-2015 (MOB)
637-2015 (MOB)
637-2015 (MOB)
637-2015 (MOB)
637-2015 (MOB)
637-2015 (MOB)
Department of Transportation and Public Works
Shelburne Office
Dispatchers (Roseway Hospital)
School Bus Drivers (School Board)
School Bus garage - Shelburne
875-3017
875-3011
1-800-915-0113 (Southwest and Tri County
School Board)
875-4930
Truck Drivers
- contact Harold Newell
637-2243
Morticians
- contact Clifford Huskilson
875-2368
Telephone Services - contact Alaint
1-800-508-9464 (Head Office)
Cable TV / Internet- contact Eastlink
265-3588
Radio and TV stations
- CJLS (Yarmouth)
- CKBW (Bridgewater)
742-7175
543-2401
Page 215 of 448
Amateur Radio (Shelburne County)
- contact Dick d’Entremont
875-2222
Community & Social Services
- contact Karl White
637-2335
Nova Scotia Power Inc
DFO/Coast Guard
1-800-428-6230
1-800-782-3058
Service (gas) stations with s/b power
- Dexter’s Esso
875-2259
Banks
CIBC Shelburne
CIBC Barrington
Scotia Bank Shelburne
Royal Bank Lockeport
Royal Bank Barringtion
875-2388
637-2212
875-3115
656-2212
637-2040
Pharmacies
Heather Pharmacy - Lockeport
Lawtons Drugs - Shelburne
Shoppers Drug Mart - Barrington Pass
Sobey’s Pharmacy - Barrington Pass
Superstore Pharmacy - Barrington Pas
TLC Pharmacy - Shelburne
656-2211
875-3007
637-3211
637-3541
637-3529
875-4852
Food Stores
Atlantic Superstore - Barrington Pass
Foodtown - Clark’s Harbour
Lydgate Corner Store - Lockeport
Save Easy - Shelburne
Sobey’s Inc - Shelburne
Town Market - Lockeport
637-3512
745-2060
656-2258
875-2775
875-2458
656-2131
Food Bank
Bear Point
Lockeport
Pantry Shelf - Shelburne
Search and Rescue (Air/Marine)
723-2175
656-3216
875-3484
911 (federal function)
Search and Rescue - Ground
Barrington Ground Search and
Rescue - Mike Hopkins
723-2995
Page 216 of 448
Waste Disposal
- Burke Harris - Shelburne
- DM Snow - Barrington
875-3663
637-2410
EMO Staff - JSB - EMO
- Barrington/Clarks Harbour
875-3544
637-2015
Tri-County Housing Authority
875-3247
Nursing Homes
- Surf Lodge
- Roseway Manor
656-2015
875-4707
Other (needed to maintain infrastructure)
- Harlow Construction
- Swansburg Construction
- DM Snow Contracting
875-2758
875-4799
637-2410
Royal Bank Clark’s Harbour
745-2191
Reference Documents:
Aliant Telephone Directory for the South Shore (past and current issue)
The Shelburne County Community Guide (current and past issue) - Optipress Publishing,
Dartmouth
Shelburne County Community Health Board Service Directory - published 2000 by SCCHB
Shelburne County Resource Guide - published 2002 by South West Shore Development
Authority
Page 217 of 448
Appendix C14 Bear River First Nation ESP Priority List For Vaccine
Page 218 of 448
Appendix C15 Clinic Population Data
Clinic
1 Bridgewater
1 Caledonia
1 Chester
1 Chester 1
1 Liverpool
1 Lunenburg
1 New Germany
1 New Ross
1 Tancook
DHA 1
2 Barrington
2 Carleton
2 Digby
2 Freeport
2 Lockeport
2 Metaghen
2 Pubnico Head
2 Shelburne
2 Tusket
2 Weymouth
2 Yarmouth
DHA 2
3 Annapolis Royal
3 Berwick
3 Bridgetown
3 Canning
3 Kentville
3 Kingston
3 Middleton
3 New Minas
3 Windsor
3 Wolfville
DHA 3
TOTAL
Notes
Total
21608
2122
Includes Chester 1
8860
Hubbards
2665
9570
10788
5464
2088
205
63370
7509
1091
8124
935
2070
8002
4368
5583
3561
3218
18662
63123
6203
10342
3738
3305
15217
12776
7818
10913
CDHA?
688
7297
78297
204790
Page 219 of 448
0 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 64 65
5075
2210
3118
3648
3064
1097
469
218
274
303
331
123
1968
780
1240
1518
1367
496
620
240
400
465
445
135
2140
945
1340
1525
1450
534
2222
853
1342
1770
1644
652
1236
488
764
930
771
310
491
190
317
362
269
122
30
10
30
35
30
18
14251
5934
8825
10556
9371
3490
1890
1003
1187
1185
893
343
261
93
187
158
165
59
1857
790
1108
1224
1177
434
222
70
135
155
137
41
452
165
282
333
305
126
1588
815
1232
1305
1190
436
1102
520
670
670
555
183
1321
557
776
932
792
295
828
379
505
590
558
149
740
327
465
477
423
179
4810
2008
2693
2797
2427
843
15071
6727
9240
9826
8622
3088
1307
533
704
905
1040
392
2621
1001
1466
1656
1359
540
863
319
430
596
567
235
910
304
459
565
430
161
3992
1830
2289
2489
1895
690
3895
1162
2509
1998
1264
575
1907
695
1172
1178
1062
439
2775
1212
1618
1825
1463
503
167
57
93
116
108
43
1710
976
912
1134
947
356
20147
8089
11652
12462
10135
3934
49469
20750
29717
32844
28128 10512
Supplement to Appendix C15, South West Health Community Vaccine Clinic Data
The following is an explanation of the excel program contents that describes the number of clinic
days required to immunize the public during a pandemic of influenza. Read carefully before
attempting any changes.
There are 4 tabs along the bottom of the file. The file called clinic data is the working file; the
remaining 3 represent the work done with the population figures from the 2001 census for the 7
counties covered by South Shore Health, South West Health and Annapolis Valley Health.
Open the clinic data file. Each column will be explained below;
Column A = DHA # 1, 2 or 3
Column B = this is the name of the community recommended for the location of a public
vaccine clinic. Communities were chosen based upon probable travel patterns and traffic flow.
Column C = Notes. This is to document anything unusual that needs to be considered about the
community, e.g. population residing in Hubbards, Halifax County may choose to attend a clinic
in Chester, or people from Windsor may go to an AVH clinic. At the time of writing, there were
no plans to restrict the public from attending the clinic physically closest to them.
Column D = this is the total population from the immediate community as well as the
surrounding area most likely to travel to this community, again, considering probable travel
patterns.
Column E = the population aged 0 -19 associated with this community.
Column F > I = the population in 10 year age groupings up to age 59 associated with this
community.
Column J > K =the population aged 60-64 and the population aged 65-69 associated with this
community.
Column M > N = the population aged 70-79 and the population over 80 associated with this
community.
Column N = blank, left as a spacer to facilitate printing of file contents
Column O > Q = these are columns A, B, & C repeated for printing purposes
Column R = I Nurse. 1 Nurse can do one immunization every 3 minutes, 20 per hour for a total
of 120 immunizations during 6 hours of immunizing. These are agreed to be reasonable figures,
assuming all education has been done and only a health check is required per immunization. This
number is also reasonable regarding sustainability of staff over a lengthy immunization
campaign.
Page 220 of 448
Column S = Nurse Days. 1 Nurse can immunize 120 persons per day and it will take this many
days for 1 nurse to immunize the entire population on the same line in Column D. For example,
on column D, line 3, Bridgewater has a population of 21608; under column S, line 3, it would
take 1 nurse [working as described above under column R] 180 days to immunize that
population.
Column T = Number of doses available per month. The data has been calculated based upon the
information that ID Biomedical, Canada’s flu vaccine manufacturer, can release 6,000,000 doses
of vaccine each month. The figure shown in column T is the monthly share of that vaccine
allotted to that DHA based upon that DHA’s % of the population. If the amount of vaccine
available is more or less than the indicated amount, the new monthly amount is to be entered in
the column by someone very familiar with working an excel program and it will recalculate all
equations based upon this figure. The formula above the column is based upon the 3 DHAs
sharing 37,500 doses of vaccine per month.
Column U = Doses per community per month. The vaccine received in each DHA must be
equitably among all of the community clinics in the DHA. The number here is the total amount
of vaccine allotted to the community, for all ages.
Column V = blank
Column W = doses for those under the age of 20 in the specific community. This number is
from the total population in that community <20, divided by the total number of all population
<20 in the DHA.
Column X = blank
Column Y, Z & AA = doses for those of a specific age range in the specific community. Again
this number is from the total population of that specific age range in the community divided by
the total number of all population in that age range in the DHA.
Column AB & AC = blank
Column AF = the population of this specific community is this % of the population of the DHA.
Column AG = the number of clinic days it will take the 12 Vaccinator Certified Nurses in each
DHA to immunize the entire population of the community represented on that line. At the time
of this writing, there were 12 Vaccinator Certified Public Health Nurses in each DHA. It is
intended that all such nurses will be doing immunization, as required until each month’s vaccine
supply is exhausted.
Comments: As indicated in the explanation under column T, all calculations were done with
assumptions. For example, the population numbers were considered to be absolute for the
purposes of completing the calculations as they are based upon the 2001 census; however they
will change over time. Confirmation of population numbers can often be done via the various
Page 221 of 448
municipal offices as they keep of population more closely than Census Canada. Other absolutes
for the purpose of completing calculations were the number of Vaccinator Certified Public
Health Nurses in each DHA and the amount of vaccine we believe we will have. If any of these
absolutes are different when it comes time to use this, ensure that someone comfortable working
in the Excel program does the new calculations.
Page 222 of 448
Appendix C17 Clinic Registration Technical Option
Page 223 of 448
Appendix D
Health Services
Page 224 of 448
Appendix D01 Services temporarily suspended during Pandemic
For identified services temporarily suspended during a pandemic influenza and corresponding number of health care workers whom could
be relocated within the institution and/or to non-traditional sites, please see Table 1 below.
TABLE 1
Existing health care services / Health Care Services Temporarily Suspended
with Ptential Staffing Surplus/Skill Mix. Report staffing surplus and skill mix to Human Resource Coordinator.
Current Patient Services
Maternal/Child Care
Medical (3Med)
4 Surgery (4E,4S,4N)
Intensive Care Unit
Veteran’s Unit
Emergency outpatient service 24hour coverage
Inpatient Diagnostic Services
Services
Closed
During
Pandemic
Nursing Unit Beds
# Staff on
reserve(potential)
Due to suspension
of service
Comments/ie Skill Mix
10 beds
16 beds
44 beds
7 beds
15 beds
Spaces
Outpatient Diag. Services
Support Services
Visiting Clinics
Renal Dialysis- 6 days/12 hours
Chris Newell - Housekeeping, laundry, security (please see Securitas
Plan, Appendix ?) plant maintenance, plant operations, clinical
engineering, safety
Mike Pothier has - DI, Pharmacy, EKG, Respiratory, Lab, Rehab (Need
to look at i.e. If outpatient services curtailed do this free up DI staffing
to support other areas (minus the 35% of course).
What are the possibilities here re: support for other areas?
Currently dialyzing
35 clients (9 units)
Page 225 of 448
Realignment of clients re use of Sunday plus some clients could be
dialyzed twice per week instead of three times.
Current Patient Services
Services
Closed
During
Pandemic
Nursing Unit Beds
# Staff on reserve
Comments
Physiotherapy
Diabetes Education
Outpatient Nutrition Counseling
Outpatient
/Emergency
Visiting Specialist Clinics
Pharmacy
Mental Health
Speech Therapy
Addictions Services
Day Surgery
Operating Rooms
Medical Nursing Unit
Alternate Level Care Unit
Community Programs
Digby Hospital
Medical Nursing Unit
CCU (2nd Floor)
Please see mental health plan for district.
Emergency only
12 beds
7 beds
10 beds
2 beds
ER/OPD
Day Surgery
Ambulatory Care
Additional staff
Page 226 of 448
Additional support may be obtained from the following:
-utilization RN
-ICONS RN
-Unit managers
-collaborative professors (Dalhousie University)
Of note- Dalhousie BScN students will not be available for support.
-LPN instructors and students
Appendix D02 Discharge Planning Worksheet.
Table 2
UNIT
Room #
Diagnosis
Physician
Expected date
Of discharge
Page 227 of 448
Home Care
required
Home Oxygen Long Term
required
Care
Required
Home
Comments/Issues
Support
Appendix D03 Department Manager Current Bed Status
Table 3
Type of
Bed
Tot
al#
of
bed
s
Avail
able
in 72
hours
Avail
able
in 7
days
# of beds
without O2
supply (i.e.
Mental
Health,
Addictions)
# of
beds
able to
be
staffed
using
current
resourc
es
Number of ventilators
(Include BiPap, CPap,
time cycled ventilators,
transport ventilators
# of Negative/
Positive
pressure
rooms
Portable O2
tanks per
nursing
unit
211, 301, 324,
407, 212 (this
room has the
ability to
305, 425
Portable
O2 tanks
in storage
Current nurse
shortages
Comments
Medical
OBS/
PED/
NSY
4East
4South
ALCU
ICU
3 vents/1 non-invasive
vent/2 BiPAP/
1CPAP/1 transport ventcurrently in use/1 newborn
transport vent.
Mental
Health
No O2 at bedside
Addiction
No O2 at bedside
Physio
Day
Surgery
Long
Term Care
How many beds
available? Potential for
nursing care beds in
both physio and day
surg.
Page 228 of 448
Morgue
capacity
Equipmen
t shortage
Page 229 of 448
Appendix D04 Assessment Forms
1. Primary triage centre
a) Adults (18 years)
Identification
Health Care Number:
Name:
Surname/Family Name
Age
First Name
(yrs)
DOB
/
/
DD MM
DATE OF CONSULTATION
/
YYYY
/
DD MM YYYY
Risk Assessment For Complications Of Influenza
> Does this patient fall into a “high risk group” for complications of influenza? Y/N
High Risk Groups
Women in the second or third trimester of pregnancy
Chronic cardiac disease (hypertension is not enough)
Chronic pulmonary disease – asthma
Chronic pulmonary disease – COAD or emphysema
Chronic pulmonary disease – other than asthma, COAD or emphysema
Chronic renal disease
Non insulin dependent diabetes mellitus
Insulin requiring diabetes mellitus
Receiving immunosuppressive therapy, AIDS patients
Neoplastic disease
Hepatic disease
Resident of nursing home
Resident of other chronic care facility
65 year old
Details of vaccination
INFLUENZA vaccine within
the last 12 months?
PNUEMOCOCCAL vaccine
within the last 5 years
Yes
No
Page 230 of 448
N/A
Batch
number
Tick all relevant
Date given
DD/MM/YYYY
Tick if given
> 14 days ago
Details of antivirals:
Within last 3 months? Yes
No
N/A
AMANTADINE
RIMANTADINE
ZANAMAVIR
OSELTAMAVIR
Symptoms (adults > 18 years)
Date and time of onset of first symptoms:
Clinical features on history
In contact with someone with
influenza in the last 3 days?
Fever
Chills
Stiffness
Headache
Fatigue
Runny/stuffy nose
Cough
Sore throat, hoarseness
Purulent sputum
Thoracic pain when taking a
deep breath
Retrosternal soreness
(tracheitis)
Breathlessness
Anorexia
Vomiting
Diarrhea
Rash
YES
YES
Date
commenced
Date ceased
DD/MM/YYYY
DD/MM/YYYY
NO
NO
/
DD
/
MM YYYY
DETAILS: e.g. Date of onset,
symptoms that predominate
N/A
Time:
:
HH
Page 231 of 448
Dose
DETAILS: e.g. Date of onset
N/A
Examination Findings (adults ≥ 18 years)
Date
Tick if still
taking
MM
Vital signs
Description
Threshold for indication of secondary
assessment
< 35 C or 39 C
24/minute
100/minute
< 100 mmHg Systolic
New confusion
New inabililty to function independently
Cyanosis (bluish colour)
< 90 % on room air
Values for this
patient
Temperature
Respiratory Rate
Heart Rate
Blood pressure
Altered mental status
Function
Skin colour
Oxygen saturation*
* Some primary or secondary triage centres may be able to perform pulse oximetry (see Appendix 2.111)
Provisional Diagnosis
Please Tick all that apply
Yes
Influenza
Suspected
Recent contact (could be incubating)
Unlikely but at risk of complications and not immunized
Unlikely but at risk and immunized
Unlikely (recovered from documented influenza)
Other
Pregnant
Breastfeeding
Note: If secondary assessment is required, and patients are sent to another centre/ward for
complementary evaluation, each individual should be provided with a summary of the
symptoms and signs detected at the primary triage centre.
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No
b) Children < 18 years:
Identification
Health Care Number:
Name:
Surname/Family Name
Age
First Name
(yrs)
DOB
/
DD MM
/
/
YYYY
/
DD MM YYYY
Risk Assessment for Complications of Influenza
> Does this patient fall into a “high risk group” for complications of influenza? Y/N
Child with
High Risk Groups
Chronic cardiac disease
Chronic pulmonary disease – asthma
Chronic pulmonary disease – other than asthama
Chronic renal disease
Diabetes mellitus
Child with cyanotic congenital heart disease
Receiving immunosuppressive therapy, AIDS patients
Neoplastic disease
Hepatic disease
Resident of long-term care facility
< 2 years old
Page 233 of 448
Tick all relevant
Details of vaccination
the last 12 months?
the last 12 months?
Details of antivirals:
Within last 3 months?
AMANTADINE
RIMANTADINE
ZANAMAVIR
OSELTAMAVIR
Yes
Yes
No
N/A
Batch
number
Date given
DD/MM/YYYY
Tick if given
> 14 days ago
7-valent
23-valent
7-valent
23-valent
7-valent
23-valent
7-valent
23-valent
7-valent
23-valent
No
N/A
Date
commenced
Date ceased
DD/MM/YYYY
DD/MM/YYYY
Tick if still
taking
Dose
Symptoms (children < 18 years)
Date and time of onset of first symptoms
In contact with someone with
influenza in the last 3 days?
Fever
Chills
Stiffness
Headache
Fatigue
Runny/stuffy nose
Cough
Sore throat, hoarseness
Purulent sputum
YES
NO
Page 234 of 448
N/A
DETAILS: e.g. Date of onset
Thoracic pain when taking a
deep breath
Retrosternal soreness
(tracheitis)
Breathlessness
Anorexia
Vomiting
Diarrhea
Rash
Examination Findings (adults < 18 years)
/
Date
DD
/
MM YYYY
Time:
:
HH
MM
Vital signs
Primary Assessment
Temperaturea
Respiratory rate
Skin colour and
temperature (lips, hands)
Chest symptomsb (pain
may be difficult to detect
in young children)
Mental status
Function
Neurologic symptoms and
signs
Oxygen saturatione
Results Requiring
Secondary Assessment
35 C or 39°C
Cyanosis, sudden pallor, cold legs up to the knee
Values for this
patient
Chest indrawing, wheezing, grunting, inquire for
chest pain
Lethargic or unconscious, confusedc
Unable to breastfeed or drink, persistent vomiting
(> 2-3 times/24hr)d
Inability to function independentlyc
Seizures, full fontanelle, stiff neck
90% room air
a For indications about types of thermometers and how to take the temperature see Appendix 2.1. High fever (39 C)
in adolescents is a warning sign and needs further assessment.
b Signs of dehydration: sunken eyes, no saliva, doughty skin.
c Chest pain may be a sign of pneumonia, even in the absence of crackles or wheeze. It may also appear as
retrosternal pain (tracheal/bronchial pain) or as a pleuritic pain. When positive, it is an indication for secondary
evaluation.
d A deterioration of the consciousness and inability to function, lack of interest in playing and sleepiness should be
further investigated.
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e Vomiting (>2-3 times/24hr) particularly if the children are not breast-feeding or drinking well, is a warning sign
and requires a secondary assessment.
f Determination of blood gases by pulse oximetry as sign of respiratory failure (see Appendix 2.III)
Yes
No
Influenza
Suspected
2. Secondary clinical assessment:
a) Adults (18 years):
Identification
Health Care Number:
Name:
Surname/Family Name
Age
First Name
(yrs)
DOB
/
DD MM
/
/
YYYY
/
DD MM YYYY
Does this patient fall into a “high risk group” for complications of influenza? Y/N
Which symptoms and/or signs were found at the primary triage centre that required
secondary assessment?
Note: When the secondary assessment has to be completed in a different setting, a new clinical
evaluation of the patient, to confirm the diagnosis done at the primary triage centre, should
always precede the laboratory studies mentioned below. NOT ALL THE TESTS
MENTIONED UNDERNEATH WILL BE NEEDED FOR ALL PATIENTS, AND
CLINICAL JUDGMENT SHOULD ALWAYS PRECEDE ANY PROCEDURE,
PARTICULARLY IF RESOURCES ARE SCARCE.
The primary assessment forms, or part of these forms, may be repeated here.
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Yes
Influenza
Suspected
Pneumonia, confirmed (C)/suspected (S)/ unlikely (U)
Viral
Bacterial
Other
Pregnant
Breastfeeding
No
C/S/U
Bacterial pneumonia
Confirmed (by chest radiograph), suspected, unlikely.
Influenza viral pneumonitis
Confirmed (by chest radiograph and oxygen transfer), suspected (by oxygen transfer), unlikely.
Admission
Yes:
Suspected Flu ward
Confirmed Flu ward
General ward
Observation
ICU Admission
CCU Admission
If not admitted:
Sent to:
Home care with self-care
Health worker/Volunteer contacted
Not Traditional care centre: Hotel, School, Community Centre, etc.
Provide copy of:
Assessment sheet
Instruction sheet
Contact names/numbers (if get more breathless/deteriorate)
b) Children (18 years)
Page 237 of 448
Identification
Health Care Number:
Name:
Surname/Family Name
Age
First Name
(yrs)
DOB
/
DD MM
/
/
YYYY
/
DD MM YYYY
Does this patient fall into a “high risk group” for complications of influenza? Y/N
Which symptoms and/or signs were found at the primary triage centre that required
secondary assessment?
Note: When the secondary assessment has to be completed in a different setting, a new clinical
evaluation of the child, to confirm the diagnosis done at the primary triage centre, should always
precede the laboratory studies mentioned below. Not all tests mentioned underneath will be
needed for all patients, and clinical judgment should precede any procedure, particularly if
resources are scarce.
As with adults, part of the primary assessment forms may be added here.
Page 238 of 448
Yes
Influenza
Suspected
Pneumonia, confirmed (C)/suspected (S)/ unlikely (U)
Viral
Bacterial
Other
Pregnant
Breastfeeding
No
C/S/U
Bacterial pneumonia
Confirmed (by chest radiograph), suspected, unlikely.
Influenza viral pneumonitis
Confirmed (by chest radiograph and oxygen transfer), suspected (by oxygen transfer), unlikely.
Admission
Yes:
Suspected Flu ward
Confirmed Flu ward
General ward
Observation
ICU Admission
CCU Admission
If not admitted:
Sent to:
Home care with self-care
Health worker/Volunteer contacted
Not Traditional care centre: Hotel, School, Community Centre, etc.
Provide copy of:
Assessment sheet
Instruction sheet
Contact names/numbers (if get more breathless/deteriorate)
Page 239 of 448
Appendix D05 Definitions
Antigenic Drift
A gradual change of the hemagglutinin or neuraminidase proteins on the surface of a particular
strain of influenza virus occurring in response to host antibodies in humans who have been
exposed to it. It occurs on an ongoing basis in both type A and type B influenza strains and
necessitates ongoing changes in influenza vaccines.
Antigenic Shift
The movement of a type A influenza virus strain from other species into humans. The novel
strain emerges by reassortment with circulating human influenza strains or by infecting humans
directly. Because they flourish in the face of global susceptibility, viruses that have undergone
antigenic shift usually create pandemics.
Epidemic
An outbreak of infection that spreads rapidly and affects many individuals in a given area or
population at the same time.
H5N1
A strain of influenza type A virus that moved in 1997 from poultry to humans. While the
outbreak of this virus was rapidly contained, it produced significant morbidity and mortality in
persons who became infected, probably from direct contact with infected poultry.
Health Care Workers
(Pandemic)
Health Care Workers are professionals, including trainees and retirees, nonprofessionals and
volunteers, involved in direct patient care; and/or those working/volunteering in designated
health care facilities or services. For the purposes of this definition, Health Care Workers are
those whose functions are essential to the provision of patient care, and who may have the
potential for acquiring or transmitting infectious agents during the course of their work. This
group would also include public health professionals during the pandemic.
Influenza
A highly contagious, febrile, acute respiratory infection of the nose, throat, bronchial tubes and
lungs caused by the influenza virus. It is responsible for severe and potentially fatal clinical
illness of epidemic and pandemic proportions.
Morbidity
Departure from a state of well-being, either physiologic or psychologic illness.
Mortality
Death, as in expected mortality (the predicted occurrence of death in a defined population during
a specific time interval).
Pandemic
Referring to an epidemic disease of widespread prevalence around the globe.
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Primary Care
Primary care is the first level of care, and usually the first point of contact, that people have with
the health care system. Primary care involves the provision of integrated, accessible health care
services by clinicians who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with patients, and practicing in the context of family
and community. It includes advise on health promotion and disease prevention, assessments of
one’s health, diagnosis and treatment of episodic and chronic conditions, and supportive and
rehabilitative care.
Resistance
The development of strains of a pathogen that are able to withstand the effects of an
antimicrobial agent.
Triage
A system whereby a group of casualties or patients is sorted according to the seriousness of their
illness or injuries, so that treatment priorities can be allocated between them. In emergency
situations it is designed to maximize the number of survivors.
Vaccine
A substance that contained antigenic components from an infectious organism. By stimulating
an immune response (but not disease), it protects against subsequent infection by that organism.
Page 241 of 448
Appendix E
Occupational Health &
Infection Control
Page 242 of 448
Draft 3 – October 20, 2004
Appendix E01 PRINCIPLES OF INFLUENZA TRANSMISSION
Influenza is directly transmitted primarily by droplet contact of the oral, nasal or
conjunctional mucous membranes with respiratory secretions from an infected individual.
Influenza is indirectly transmitted from hands and objects freshly soiled with discharges
of the nose and throat of an acutely ill and coughing individual. (Page 123)
The incubation period for influenza is from 1-3 days. The period of communicability
continues for up to 7 days after the onset of illness. Individuals infected with influenza
tend to shed more viruses in their respiratory secretions in the early stages of the illness.
Patients are most infectious during the 24 hours before the onset of symptoms and during
the most symptomatic period. The period of communicability may vary with pandemic
influenza. (Page 125)
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Appendix E02 Routine Practices & Additional Precautions To Prevent The
Transmission of Influenza
Routine practices (as per Routine Practices and Transmission-based Precautions policy
IC-100) outline the importance of hand washing before and after caring for patients; the
need to use gloves, mask/eye protection, face shields, and gowns when splashes or sprays
of blood, body fluids, secretions or excretions are possible; the cleaning of patient care
equipment, the physical environment and soiled linen; the precautions to reduce the
possibility of HCW exposure to pathogenic organisms, and patient placement. Routine
practices are the infection prevention and control practices for use in the routine care of
all patients at all times in all health care settings. (Page 123)
Strict adherence to hand hygiene is the cornerstone of infection prevention. Proper hand
hygiene may be the only preventive measure available during a pandemic.
Health Canada guidelines recommend that in addition to routine practices, transmissionbased precautions (droplet and contact precautions) should be taken for pediatric and
adult patients with influenza during the pre-pandemic and inter-pandemic period. (Page
124). (See Routine Practices and Transmission-based Precautions policy IC-100).
Complete adherence to Droplet/Contact Precautions will not be achievable during a
pandemic phase; however every effort to employ transmission-based precautions should
be made. (Page 137)
DEFINITIONS
Influenza –like-Illness (ILI)
(for community surveillance, triage or staff surveillance)
Acute onset of respiratory illness with fever* (>38°c) and cough and with one or more of
the following:
- sore throat
- muscle or joint soreness
- extreme exhaustion
* Fever may not be present in elderly people. (Page 197)
Clinical Case Definition of Influenza
When influenza is circulating in the community, the presence of fever and cough of acute
onset are good predictors of influenza. The positive predictive value increases when
fever is higher than 38ºc and when the \time of onset of the clinical illness is acute (less
than 48 hours after the prodromes). Other symptoms, such as sore throat, rhinorrhea,
malaise, rigors or chills, myalgia and headache, although unspecific, may also be present.
(Page 115)
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Confirmed Case of Influenza
Confirmed cases of influenza are those with laboratory confirmation (i.e. virus isolation
from respiratory tract secretions, identification of viral antigens or nucleic acid in the
respiratory tract, or a significant rise in serum antibodies) or clinical cases with an
epidemiological link to a laboratory confirmed case. (Page 115)
IMMUNITY TO INFLUENZA
It is likely that most cases of influenza will be caused by the pandemic strain. Therefore,
HCW's who have recovered from an ILI during an earlier pandemic phase may be
assumed to be immune to the pandemic influenza strain. HCW’s who have been
immunized against the pandemic strain will also be considered immune, but will be
monitored for ILI using the ILI Assessment Tool. (Page 129)
Pandemic Influenza vaccine and antivirals may be in short supply during the early phases
of the pandemic. Healthcare workers and those trained to perform duties of HCW’s in
non-traditional sites are considered to be high priority. Priority groups within the health
care sector will be determined.
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Appendix E03 Occupational Health Management Of HCW’s (and Health Care Volunteers)
During an Influenza Pandemic
Adherence to the recommendations for vaccine and antivirals for patients / residents,
HCWs and volunteers, as outlined in the Canadian Pandemic Influenza Plan and the
vaccine priority list for South West Health Pandemic Influenza Plan, is necessary. (Page
136, 141, etc.)
Fit for Work – May work with all patients. May be selected to work in units where
patients, if infected with influenza, would be at high risk for complications.
4. They have recovered from ILI illness during earlier phase of the pandemic.
5. They have been immunized against the pandemic strain of influenza.* (See Annex
D Canadian Pandemic Influenza Plan)
6. They are on appropriate antivirals.* (See Annex E Canadian Pandemic Influenza
Plan).
*Subject to daily ILI assessment by/or under direction of Occupational Health before
work shift begins.
Whenever possible, well, unexposed HCW’s should work in non-influenza areas.
Asymptomatic HCW’s may work even if influenza vaccine and antivirals are unavailable.
(Page 129, 130)
Unfit for Work - Ideally, staff with ILI should be considered “unfit for work” and should
not work. Due to limited resources, these HCW’s may be required to work, if they are
well enough to do so. In such cases, they are determined to be “fit for work with
restrictions”. (Page 129,130)
Fit to Work with Restrictions – Symptomatic staff, who are considered “fit to work
with restrictions” should only work with patients with ILI. Symptomatic HCW’s who are
required to care for non-exposed patients (non-influenza areas) should wear a surgical
mask if they are coughing and pay meticulous attention to hand hygiene. (Page 130)
Symptomatic HCW’s who are well enough to work should not care for the following
types of patients: intensive care areas, nurseries or units with severely immuno
compromised patients, eg. transplant recipients, hematology/oncology patients, patients
with chronic heart or lung disease, or patients with HIV/AIDS and dialysis patients.
(Page 130)
ILI Assessment Tool to Monitor HCW’s/Volunteers – All HCW’s, who have
recovered from ILI during an earlier phase of the pandemic are considered immune and
are not subject to ILI assessment.
All other HCW’s, even those who have been immunized against the pandemic strain, will
be monitored daily before their shift, using the ILI Assessment Tool. HCW/volunteer ILI
Assessment will be under the direction of Occupational Health, but not necessarily
Page 246 of 448
conducted by OH. All cases of HCW/Volunteer ILI will be reported to OH for
determination of “fitness to work”. (Page 197)
See ILI Assessment Tool (Page 197) – to be revised /adapted
? develop Staff ILI Assessment Log Sheet
Consider 1-800 numbers for staff reporting ill in the District. Would need to be answered
24 hours. Conduct ILI Assessment, using screening tool. Provide report back to Manager
and OH.
Page 247 of 448
Appendix E04 INFECTION CONTROL PRACTICES for Pandemic
Influenza
A. Hand Hygiene – All HCWs, as well as patients, residents, clients, visitors and
household members should adhere to strict hand hygiene (as per Routine Practices
and Transmission-based Precautions policy IC-100). Hands should be washed or
hand antisepsis performed after direct contact with patients/residents with ALL
patients and after contact with their personal articles or their immediate environment.
Antibacterial soap is not required. (Page 137)
B. Hygiene Measures to Minimize Influenza Spread: Staff, patients, residents, and
visitors should all be encouraged to minimize influenza transmission.
1. Use disposable, one-use tissues for wiping noses or coughing.
2. Cover nose/mouth when sneezing/coughing.
3. Perform hand antisepsis after coughing, sneezing or using tissues and before and
after providing care or visiting patients/residents/clients.
4. Keep hands away from mucous membranes of the eye, nose and mouth.
B. Personal Protective Equipment:
It is recognized by Health Canada and Infection Prevention and Control that the
Pandemic Phase may be for a prolonged period of time and that supplies and
resources may become exhausted. It is recommended that you adhere to the most
stringent Infection Prevention and Control Practices available to you.
Masks (surgical type)
1. Masks to minimize the transmission of influenza should be worn when face-toface with coughing individuals (as per Routine Practices and Transmission–based
Precautions policy IC-100).
2. Masks should be worn to prevent the transmission of other organisms when
HCW’s are face-to-face with undiagnosed coughing patients/residents/clients.
(Page 137)
3. Masks and eye protection or face shields should be worn by triage personnel
when face to face with individuals for ILI assessment. (Page 169)
4. Patients with ILI who are coughing should only be out of their room for urgent
procedures and should wear a mask whenever they are out of their room. (Page
140)
5. Masks and eye protection, or face shields should be worn to prevent HCW
exposure to sprays of blood, body secretions or excretions. (Page 138)
6. Use the mask only once and change when it becomes wet or damaged.
7. The mask must cover both your nose and mouth.
8. Avoid touching the mask during use.
9. Discard used masks in the garbage.
10. Do not wear mask dangling around your neck. (Page 124)
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Gloves
1. Gloves are recommended for the routine care of patients/residents/clients
suspected or confirmed to have influenza (as per Routine Practices and
Transmission-based Precautions policy IC-100). If gloves are not readily
available, meticulous hand washing with soap and water or performing hand
antisepsis will inactivate the virus.
2. Gloves should be worn to provide an additional protective barrier between the
HCW’s hands and blood, body fluids, secretions, excretions, non-intact skin and
mucous membranes to reduce the potential transfer of microorganisms from
infected patients/residents/clients to HCW’s and from patient-to-patient via
HCW’s hands.
3. Gloves are necessary for HCW’s with open lesions on their hands when providing
direct patient care.
4. Gloves should be used as an additional measure, not as a substitute for hand
hygiene. Hand hygiene should be performed after glove removal.
5. Gloves should not be reused or washed. (Page 138)
Gowns
1. Gowns are recommended for the routine care of patients/residents/clients
suspected or confirmed to have influenza (as per Routine Practices and
Transmission-based Precautions policy IC-100).
2. Long sleeved gowns should only be used to protect uncovered skin and prevent
soiling of clothing during procedures and patient care activities likely to generate
splashes or sprays of blood, body fluids, secretions or excretions.
3. HCW’s should ensure any open skin areas/lesions on forearms or exposed skin is
covered with a dry dressing at all times. Intact skin that has been contaminated
with blood, body fluids, secretions or excretions should be washed as soon as
possible, thoroughly, but gently with soap and warm running water. (Page 138)
D. Cleaning, Disinfection and Sterilization of Patient Care Equipment:
1. Adhere to Health Canada Infection Control Guidelines, Hand washing, Cleaning
Disinfection and Sterilization in Health Care and Routine Practices and Additional
Precautions for Preventing the Transmission of Infection in Health Care. The
influenza virus is readily inactivated by hospital germicides, household cleaning
products, soap, hand wash or hand hygiene products. (Page 138)
E. Environmental Control (Housekeeping, Laundry, Waste):
1. Adhere to the recommendations for housekeeping, laundry and waste management as
outlined in the Health Canada Infection Control Guidelines Hand washing, Cleaning
Disinfection and Sterilization in Health Care and Routine Practices and Additional
Precautions for Preventing the Transmission of Infection in Health Care.
Page 249 of 448
2. Equipment and surfaces contaminated with secretions from patients/residents
suspected or confirmed to have influenza should be cleaned before use with another
patient/resident.
3. Special handling of linen or waste contaminated with secretions from
patients/residents suspected or confirmed to have influenza is not required. (Page
139)
Page 250 of 448
Appendix E05 IC MANAGEMENT OF PANDEMIC INFLUENZA IN
ACUTE CARE SETTINGS - See also Section 6.4.6 Infection Control Practices for
Pandemic Influenza
Accommodation
Single room is not required. Single rooms in acute care settings should be designated for
those suspected of having or confirmed to have airborne infections eg. TB, measles,
chickenpox or disseminated zoster, and for those who visibly soil the environment for
whom appropriate hygiene is difficult to maintain.
Minimize crowding. Maintain one meter spatial separation between patients and between
patients and visitors. (Page 139)
Patient Triage/Cohorting
When Pandemic Phase 2 is declared, open the following specified cohort areas/units in
the appropriate hospital: (Each site to designate 1, 2 and 3; 4 and 5 as required.)
1. ILI Assessment Area: Triage ILI patients promptly to a separate designated
influenza assessment area on site
2. Non ILI Assessment Area: These patients require acute care assessment for
conditions other than influenza. Triage to specific non ILI waiting and
examining areas physically separate from the ILI assessment area.
3. Suspected ILI/Confirmed Influenza Unit:
4. Not Exposed/Immune* to Influenza, Inpatient Units
5. Not Exposed to ILI but at very high risk of complications i.e. ICU patients,
nurseries or units with severely immunocompromised patients (transplant
recipients, hematology/oncology patients, patients with chronic heart or lung
disease or patients with HIV/AIDS and dialysis patients). (Page 139)
6.
*Immune are those recovered from the pandemic strain of influenza or those immunized
against the pandemic strain of influenza.
Cohort areas will be maintained until the pandemic wave has been declared over. (Page
140)
Patient Admission
When Pandemic Phase 2 is declared, elective medical and surgical acute care admissions
will be reviewed, prioritized and curtailed as deemed appropriate by the senior
management team. Surgery will be restricted to emergency cases only. (Page 140)
Patients who have recovered from influenza can be moved into the “non influenza”
cohort areas after the period of communicability of the pandemic strain has passed.
Patients should be discharged as soon as medically stable. (Page 140)
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Patient Activity Restrictions
Limit movement/activities of patients, including transfers within the hospital, unless the
patient has recovered from pandemic influenza. (Page 140)
Patients with ILI who are coughing should only leave their room for urgent/necessary
procedures. When it is necessary for these patients to leave their room, they should wear
a surgical mask. (Page 140)
Visitor Restrictions
There are no restrictions for asymptomatic visitors who have recovered from pandemic
influenza or who have been immunized against the pandemic strain, however visitor
restrictions (as per Visitor Restrictions During an Outbreak policy) may be in effect for
the district or for individual facilities during the pandemic phase. (Page 140)
Visitors with ILI must not visit while symptomatic. Close relatives of terminally ill
patients can be exempt, but they must wear a mask upon entry into the facility and
conduct hand hygiene before and after their visit. Their visit must be restricted to that
patient only. (Page 140)
Visitors should be informed when the acute care facility has influenza activity. Those
who have not yet had the pandemic strain of influenza or who have not been immunized
against the pandemic strain should be discouraged from visiting. Close relatives of the
terminally ill can be exempt, but they should restrict their visit to that individual only and
must wash their hands on exit from the patient’s room.
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Appendix E06 IC MANAGEMENT OF PANDEMIC INFLUENZA IN LONG
TERM CARE SETTINGS - See also: Infection Control Practices for Pandemic Influenza
Care of Residents with ILI/Influenza
When Pandemic Phase 2 is declared, open the area for the care of residents who have
Influenza or influenza like illness to minimize transfers to acute care hospitals. Residents
with influenza should not be transferred to acute care settings. (Page 141)
Admission/Re-Admission
Patients from acute care who have recovered from pandemic influenza or who are
immunized against the pandemic influenza strain may be admitted to the LTC facility
without restrictions. (Page 144)
Residents who were transferred to acute care and who have recovered from pandemic
influenza or who have been immunized against the pandemic influenza strain may be readmitted into the LTC facility without restrictions. (Page 144)
LTC facilities that have already had pandemic influenza through their facility may admit
individuals from the community or acute care without restrictions. (Page 144)
LTC facilities that have remained “influenza free” may admit patients from acute care or
the community who have been potentially exposed to influenza. However, such residents
must be managed using influenza precautions (maintain one meter of spatial separation,
mask if within one meter of the resident and emphasize hand hygiene) for 3 days until
past the incubation period if no influenza symptoms occur and until 7 days after the onset
of symptoms, if influenza develops (Page 144)
Note: This one will spark some discussion. I assume that LTC would not admit patients
from acute care or the community if they have any symptoms of ILI.
Resident Activity Restriction
When influenza has been identified in one area of the LTC facility (via residents, staff or
visitors) efforts will be made to cohort and isolate, as supplies and resources allow.
A) Cancel or postpone inside and outside facility procedures, appointments and
activities until influenza activity has stopped.
(Page 145)
B) Encourage coughing residents to remain in their own rooms. These residents
should not attend the dining room, but have meals served in their own room.
Visitor Restrictions
There are no restrictions for asymptomatic visitors who have recovered from pandemic
influenza or who have been immunized against the pandemic strain, however visitor
Page 253 of 448
restrictions (as per Visitor Restrictions During an Outbreak policy) may be in effect for
the district or for individual facilities during the pandemic phase. (page 140)
Visitors with ILI must not visit while symptomatic. Close relatives of terminally ill
residents can be exempt, but they must wear a mask upon entry into the facility and
conduct hand hygiene before and after their visit. Their visit must be restricted to that
resident only. (Page 140)
Visitors should be informed when the LTC facility has influenza activity. Those who
have not yet had the pandemic strain of influenza or who have not been immunized
against the pandemic strain should be discouraged from visiting. Close relatives of the
terminally ill can be exempt, but they should restrict their visit to that individual only and
must wash their hands on exit from the resident’s room.
Page 254 of 448
Appendix E07 IC MANAGEMENT OF PANDEMIC INFLUENZA IN
AMBULATORY CARE SETTINGS – See also: Inflection Control Practices for
Pandemic Influenza.
Access to Services
When Pandemic Influenza Phase 2 is declared, review and prioritize all ambulatory care
services and consider canceling non-urgent and routine ambulatory care visits. (Page
146)
Identify Ambulatory Care Services where ILI Assessment should be done on all patients
prior to their visit to the department i.e. dialysis, rehabilitation services, etc. Each site
should consider if this is required and how it will be accomplished.
Accommodation
Separate well patients from those with ILI:
a) Minimize time spent in waiting rooms.
b) If possible provide separate waiting area for those with ILI.
c) Place patients with ILI directly into a single room.
d) Separate patients as quickly as possible by placing ILI patients in an area of the
waiting room separated from non- ILI patients by at least 1 meter. (Page 147)
Other Infection Control Considerations:
a) Provide tissues, surgical masks, and alcohol hand sanitizer, with appropriate
instructions in strategic areas of the lobby and waiting room as supplies permit.
b) Remove magazines and toys from all waiting rooms. (Page 147)
c) Clean equipment and environmental surfaces potentially contaminated by coughing
patients as frequently as possible, preferably after each patient. (Page 147) (Increase
availability of Environmental Services Staff to these areas; increase routine cleaning
schedules in waiting room areas).
Patient Activity/Transport
Patients with ILI should not leave the ambulatory care area, except for essential
procedures. Patients who are coughing should wear a surgical mask when transported to
other areas. (Page 149)
Page 255 of 448
Appendix E08 IC Management Of Pandemic Influenza In Home Care
Settings – See also: Infection Control Practices for Pandemic Influenza
Access to Services
When Pandemic Phase 2 is declared, evaluate case load and cancel home care visits that
are not absolutely necessary. (Page 149)
ILI Assessment
Perform an ILI Assessment of the client and their household contacts by phone (if
possible) prior to the appointment or before going into the home. Assess the risk of
influenza in the client or household contacts. (Page 152)
Provide clients/family members with information regarding symptoms of ILI, Self Care
Guidelines and the purpose of Triage Settings (Non-Traditional Sites). (Page 152)
Counsel clients/household contacts to avoid public gatherings to minimize exposure.
Visitors
Recommend that only well (asymptomatic/unexposed) visitors should visit severely
immunocompromised patients in the home.
Visitors for the terminally ill can be exempt from restrictions. (Page 152)
Page 256 of 448
Appendix F Lab
Page 257 of 448
Appendix F01 Viral Swab Action Sheet
DISASTER PLAN LAB ACTION SHEET FOR PANDEMIC INFLUENZA
INFLUENZA VIRAL SWABS ARE TO BE SENT IN THE EVENT OF A PANDEMIC TO
THE QE11 AS STAT SPECIMENS. EARLY DIAGNOSIS IS CRITICAL FOR THE
IMMUNIZATION PROGARM TO COMMENCE.
HOW TO TRANSPORT EXPOSED SAMPLES:
In the event that a pandemic influenza strain is expected then the initial identification is crucial.
After we have identified the presence of the strain of influenza in the area, then we will no longer
be sending to Halifax as a stat.
As we cannot count on purolator delivering our specimens same day we will rush the viral swabs
to Halifax by the courier identified for each area. Please try to send as many as possible per day
together.
The designated courier for each area as of Sept. 29, 2004 is as follows:
YARMOUTH REGIONAL HOSPITAL AJ’S TAXI
742-5554
DIGBY GENERAL HOSPITAL
245-6162
245-3541)
245-4408
ROSWAY HOSPITAL
DIGBY CAB
(AFTER 10 PM
BASIN TAXI
BILL’S TAXI
ALTERNATE NUMBER
875-2872
875-7588
PROCEDURE FOR SHIPPING VIRAL SWAB:
AFTER THE SWAB ARRIVES IN THE LAB:
1. PHONE COURIER AND REQUEST THE TRANSPORT.
2. PHONE QEII TO INFORM THEM OF THE SPECMEN OR SPECIMENS BEING
SENT.
NOTIFY:
DR. TODD HATCHETTE
473-6885
OR
BRIAN MACLELLAN
473-5528
OR
VIROLOGY
473-6881
NOTE TO THE RECEIVER:
A. HOW MANY SAMPLES ARE BEING SENT
B. THE HOSPITAL
C. THE EXPECTED TIME OF ARRIVAL
Page 258 of 448
3. FILL OUT COURIER SHIPPING FORM (SEE SAMPLE PROVIDED)
4. PACKAGE SPECIMEN FOR TRANSPORT. INCLUDE THE REQUISIONS FORM.
5. ENSURE THAT THE TAXI DRIVER UNDERSTANDS THE NATURE OF THE
SAMPLES AND THE LOCATION OF THE DELIVERY.
Page 259 of 448
Appendix F02 Personnel Resources
SOUTH WEST NOVA DISTRICT HEALTH LABORATORY RESOURCES
FOR PANDEMIVC INFLUENZA
CATERGORY
SITE
PATHOLOGISTS
YRH
LABORATORY
MANAGER
YRH
STAFFING #
2 PART TIME
PHONE____________
742-3542 EXT 237
1
742-3542 EXT 147
YRH
RH
DGH
TECHNOLOGISTS YRH
(FT, PT, CASUAL) RH
DGH
LABORATORY
YRH
ASSISTANTS
RH
(FT, PT, CASUAL) DGH
4
1
1
30
5
6
5
1
0
742-3542 EXT 115 0R 239
875-3011
245-2501
742-3542 EXT 146 0R 114
875-3011
245-2501
742-3542 EXT 146 0R 114
875-3011
245-2501
RETIRED
LABORATORY
PERSONNEL
2
0
0
CLERICAL
YRH
RH
DGH
In the event of Pandemic Influenza outbreak the Pathologists and the Laboratory Manager would
make the decision on the level of regular service that would occur on consultation with Senior
Management of South West Nova District Health, Department of Health and any other external
agencies involved in the situation. The plan would evolve on a day-to-day basis or maybe hourby-hour depending on severity of the situation and the Laboratory’s ability to cope with any
internal staff illness as well as that of their families.
Actions that may be considered:
1.Doctor’s offices requested to limit ordering non-urgent Lab tests
2. All outside clinics will be cancelled
3. Laboratory services limited to Inpatient only
4. Staff may be transferred from site to site if illness starts to take toll
5. Blood collection may be done off site to prevent the spread of the virus in-house. This
will depend on the amount of staff not affected by the illness.
6. Only one Lab in District operating
Page 260 of 448
Appendix F03 Disaster Plan Fanout - YRH
YARMOUTH REGIONAL HOSPITAL
Disaster Plan Fanout
LABORATORY
Holly Cottreau, Lab Manager
742-3542 Ext. 147
742-3542 Ext. 147
Dave Pothier
742-3542 Ext 146
Susan Bain
742-3542 Ext 112
Andrew d’Eon
742-3542 Ext. 146
Yvonne Doucet
742-3542 Ext. 114
Wendy Sollows
742-3542 Ext 146
Henry Thibodeau
742-3542 Ext 148
Cathy LeBlanc
742-3542 Ext 152
Page 261 of 448
Appendix F04 Disaster Plan Fanout - RH
ROSEWAY HOSPITAL
DISASTER PLAN FANOUT
LABORATORY
TECHNOLOGIST ON CALL
ELAINE WILLIAMS
IRVIN D’EON
HOME: 762-3375
MICHELLE BRANNEN
MARK COSMAN
JOANNE D’ENTREMONT
Page 262 of 448
Appendix F05 Disaster Plan Fanout - DGH
Disaster Plan Fanout
LABORATORY
TECHNOLOGIST ON-CALL
PAGER #1-902-558-1523
DONNA THIBAULT
GERRY O’NEIL
GERRY O’NEIL
CAROLYN ADAM
JUDY COMEAU
SUSAN YOUNG
BRENDA WONG
Page 263 of 448
Appendix G Pharmacy
Page 264 of 448
Appendix G01 SWH PHARMACEUTICAL SERVICES OFFERED
A.
PREPANDEMIC
1.
Hours of operation:
Monday thru Friday 08h00 – 16h00
Closed evenings, weekends, holidays
Staff complement includes the following:
1 FTE pharmacist
Services in order of priority:
a. Inpatient dispensing to all wards (wardstock and individual prescriptions)
b. Chemotherapy
c. Narcotic and Controlled Drug dispensing and distribution
d. Night cupboard management
e. Wardstock distribution to various clinics and support services
f. Wardstock distribution to nurse practitioner
g. Home Care and Public Health prescriptions
h. Active drug monitoring and intervention (therapeutics, pharmacokinetics)
i. Inventory control
j. Active participant in hospital committees
2.
ROSEWAY HOSPITAL
Hours of operation:
Monday thru Friday 08h00 – 13h00
Closed evenings, weekends, holidays
0.5 FTE pharmacist (0.32 FTE on-site)
0.7 FTE pharmacy technician
b. Chemotherapy
c. Narcotic and Controlled Drug dispensing and distribution
d. Night cupboard management
e. Wardstock distribution to various clinics and support services
f. Home Care and Public Health prescriptions
g. Active drug monitoring and intervention (therapeutics, pharmacokinectics)
h. Inventory management
i. Active participation in hospital committees
Page 265 of 448
3.
Hours of operation:
Monday thru Friday 0830h – 1630h
Weekends, holidays 10h15 – 14h00
Closed evenings, December 25.
1 FTE pharmacy coordinator (pharmacist)
1 FTE pharmacist
0.5 FTE certified drug clerk
1.5 FTE pharmacist vacancies
4 FTE pharmacy technicians
b. Chemotherapy
c. Active drug monitoring and intervention (therapeutics, pharmacokinetics)
d. Narcotic and Control Drug dispensing and delivery
e. TPN services
f. Wardstock distribution to various clinics and support services
g. Inventory control
h. Night cupboard management
i. Blister packaging
j. Wardstock checks
k. Home Care and Public Health prescriptions
l. Outpatient dispensing to psychiatry – clozapine program
m. Miscellaneous sterile services
n. Active participation in many hospital committees
Page 266 of 448
B.
PANDEMIC
Looking at the worst case scenario of a 35% to 50% infection rate it is prudent to assume that
the pharmacy department will take a significant hit.
It is also reasonable to assume that there will shortages of medications and/or delays from
suppliers.
If available, some services will be provided remotely (computer access from another site)
The option chosen will depend on the staffing situation.
Option 1.
Assume staff complement:
Digby General Hospital:
0
Roseway Hospital:
0 to 0.5 FTE pharmacy technician
Yarmouth Regional Hospital: 1 FTE pharmacist
2 FTE pharmacy technicians
Consolidate pharmacy services to Yarmouth Regional Hospital and utilize Materiels
Management van service to deliver medications.
This will result in significant delay of services to Digby General Hospital and Roseway
Hospital.
Yarmouth Regional Hospital pharmacy closed one weekend day.
Reduced services in order of priority:
a.
Inpatient dispensing to all wards (wardstock and individual prescriptions)
b.
Chemotherapy
c.
Narcotic control and distribution
d.
Inventory control
e.
Night cupboard management
f.
Outpatient dispensing to psychiatry – clozapine program
Services to be dropped (highest priority at bottom)
a.
Active participation in many hospital committees
b.
Miscellaneous sterile services
c.
TPN services
d.
Blister packaging
e.
Home Care and Public Health prescriptions
f.
Active drug monitoring and intervention (therapeutics, pharmacokinetics)
g.
Wardstock checks
h.
Wardstock distribution to various clinics and support services
Page 267 of 448
Option 2.
Assume staff complement:
0
Roseway Hospital:
0 to 0.5 FTE pharmacy technician
2 FTE pharmacy technician
Reduced hours of operation:
2 x 3.75hours per week
Roseway Hospital:
2 x 3.75hours per week
Yarmouth Regional Hospital: 5 x 3.75hours per week plus 1 x 7.5hours
To equal 26.25 hours per week
Closed one day per week
Pharmacy staff from Yarmouth Regional Hospital will travel to provide service at Digby
General Hospital and Roseway Hospital (4 x 3.75hr per week) then return to Yarmouth
Regional Hospital to provide service.
Travel time will decrease actual time at all sites.
Closed one weekend day per week to give staff a day off.
a.
Inpatient dispensing to all wards (wardstock and individual prescriptions)
b.
Chemotherapy – will require careful planning of patient appointments
c.
Narcotic dispensing
d.
Inventory control
e.
Night cupboard management
f.
Outpatient dispensing to clozapine program
Services to be dropped (highest priority at bottom)
a.
b.
c.
TPN services
d.
Blister packaging
e.
f.
g.
Wardstock checks
h.
Narcotic distribution
Page 268 of 448
Option 3.
Assume staff compliment:
1 pharmacist
Roseway Hospital:
0.5 FTE pharmacist
1 FTE pharmacy technician
Reduced hours of operation:
Normal hours
Roseway Hospital:
Normal hours
Yarmouth Regional Hospital: Normal hours except only one weekend day
Pharmacist from Digby General Hospital will help Yarmouth Regional Hospital using remote
access and will provide medications via Materiels Management van.
b. Chemotherapy
c. Narcotic dispensing
d. Inventory control
e. Night cupboard management
f. Outpatient dispensing to psychiatry – clozapine program
Services dropped in order of priority (highest priority at bottom)
a.
b.
c.
d.
e.
f.
g.
h.
i.
TPN services
Blister packaging
Wardstock checks
Narcotic delivery
Wardstock distribution to various clinics and support services
Page 269 of 448
Appendix G02 Disbursement of Vaccines to Clinic Sites
PHARMACY DEPARTMENT – PANDEMIC INFLUENZAE
DISPERSEMENT OF VACCINES TO CLINIC SITES
POLICY: A quadruplicate form (Appendix G 02) will be used when transferring
vaccine. At all steps of the transfer a count must be done to ensure that
the quantity noted on the transfer form is exact.
PROCEDURE:
1. Once the vaccine is received the Nurse Manager will transfer vaccine to
the nurse(s) administering the vaccine. For tracking purposes the Nurse Manager
will sign off using the Vaccine count form (Appendix G 03) to the nurse(s)
administering the vaccine.
2. At the end of the day the number of doses administered by the nurse will be
compared to their count sheets. These two numbers must be the same.
3. If possible a printed report of the number of patients seen by the clinic and the
Vaccine count forms (Appendix G 03) will be attached to the Vaccine/Antiviral
Transfer Form (Appendix G 02) when returning the unused vaccine back to the
hospital of origin.
7 OC 04
Page 270 of 448
Appendix G 03 Vaccine/Antiviral Transfer Form
TRI DISTRICT
VACCINE/ANTIVIRAL TRANSFER FORM
Item Transferred: (Vaccine) (Oseltamivir)
I.
(Zanamivir) (Amantadine)
PLEASE CIRCLE
Transfer From
(Other ___________________)
Receiving
Site Name: _______________
Pharmacist:
Security:
_______________________
signature
__________________
print
Witness:
II.
__________________
print
Materials Management:
_______________________
signature
Date: __________
_______________________
signature
__________________
print
Time: __________
Count: ________
Transfer From
_______________________
signature
Date: __________
__________________
print
Time: __________
Count: ________
Receiving
Site Name: _______________
Security:
Nurse Manager:
_______________________
signature
__________________
print
_______________________
signature
Date: __________
III.
__________________
print
Count: ________
_______________________
signature
Date: __________
Transfer From
Receiving
Nurse Manager:
Security:
__________________
print
Witness:
__________________
print
Time: __________
_______________________
signature
Count: ________
__________________
print
_______________________
signature
Date: __________
__________________
print
Witness:
Time: __________
_______________________
signature
IV.
_______________________
signature
__________________
print
Time: __________
Count: ________
Transfer From
_______________________
signature
Date: __________
Time: __________
Receiving
Site Name: _______________
Page 271 of 448
__________________
print
Count: ________
Security:
Pharmacist:
_______________________
signature
__________________
print
_______________________
signature
Date: __________
_______________________
signature
__________________
print
Witness:
__________________
print
Time: __________
Count: ________
8 OC 04
Page 272 of 448
_______________________
signature
Date: __________
__________________
print
Time: __________
Count: ________
Appendix G 04 Vaccine Tracking Form
TRI DISTRICT CLINIC SITE
VACCINE TRACKING FORM
SITE NAME: ____________________
I.
Transfer From
Receiving
Nurse Manager:
Nurse Administering:
________________________
signature
________________________
signature
________________________
Print
________________________
Print
Date: _____ Time: _____
Date: _____ Time: _____
Witness
________________________
Signature
________________________
Print
II.
COUNT: _____
COUNT: _____
Transfer From
Receiving
Nurse Administering:
Nurse Manager:
________________________
signature
________________________
signature
________________________
Print
Print
________________________
Witness
Date: _____ Time: _____
________________________
signature
Page 273 of 448
________________________
print
Date: _____ Time: _____
COUNT: _____
PATIENT COUNT: _____
NOTES:
Page 274 of 448
COUNT: _____
Appendix G 05 Adverse Drug and Vaccine Reactions Reporting
PHARMACY DEPARTMENT – PANDEMIC INFLUENZA
ADVERSE DRUG AND VACCINE REACTIONS REPORTING
POLICY: All significant adverse drug reactions and adverse vaccine reactions will
be reported in a timely manner using the standardized Health Canada forms
(Canadian Adverse Drug Reaction Monitoring form and the Report of a VaccineAssociated Adverse Event form).
PROCEDURE:
1. With the first shipment of vaccine to a clinic site a supply of Vaccine
Associated Adverse Event forms will be supplied.
2. With the first shipment of auxiliary drugs to a clinic or triage site a supply of
Adverse Drug Reaction Monitoring forms will be supplied.
2. With the first shipment of antiviral drugs to a triage site a supply of Adverse
Drug Reaction Monitoring forms will be supplied.
8 OC 04
Page 275 of 448
Appendix G06 Vaccine Adverse Reaction Form
Page 276 of 448
Page 277 of 448
Appendix G 07 Adverse Drug Reaction Monitoring Form
Page 278 of 448
Page 279 of 448
Appendix G 08 Auxiliary Drugs
1.
AUXILIARY DRUGS
A.
ANTIVIRAL/VACCINE CLINIC SITES
POLICY: The pharmacy department will supply all auxiliary drugs to the
Antiviral/Vaccine clinic sites. Auxiliary drugs will be unit dose packaged.
PROCEDURE:
1. A set list of drugs (appendix G 08a) will automatically be supplied to all sites.
2. Additional supply of drugs found on the list will be requisitioned by nurse the
manager when needed.
3. Materials management or bonded courier will deliver all auxiliary drugs.
4. Delivery times will be based upon the availability of transportation.
5. Drug requisition will be based upon the pharmacy departments operating
hours.
VRH – Monday through Friday 0800 to 1700 hrs, weekends
and holidays 0900 to 1630 hrs.
YRH – Monday through Friday 0830 to 1630 hrs, weekends
SSRH –
B.
PALLIATIVE CARE SITES (TRIAGE SITES)
POLICY: The pharmacy department will supply all auxiliary drugs to the Palliative
Care sites. Auxiliary drugs will be bulk packaged.
PROCEDURE:
1. A set list of drugs (Appendix G 08) will automatically be supplied to all sites.
2. Additional supply of drugs found on the list will be requisitioned by the nurse
manager when needed.
3. Additional supplies of Narcotic, Control and Benzodiazepine drugs will also
need a prescription from a physician.
4. Materials management or bonded courier will deliver all auxiliary drugs.
5. The receiving nurse or physician will enter all Narcotic, Control and
Benzodiazepine drugs into a control drug registry (Sample - Appendix C1 &
C2).
Page 280 of 448
6. Standard protocols regarding the dispensing and storage of Narcotic and
Control drugs (this will also apply to Benzodiazepines) will be followed.
7. Delivery times will be based upon the availability of transportation.
8. Drugs requisition will be based upon the pharmacy departments operating
hours.
VRH – Monday through Friday 0800 to 1700 hrs, weekends
YRH - Monday through Friday 0830 to 1630 hrs, weekends
SSRH –
25 SE 04, Revised 7 OC 04
Page 281 of 448
Appendix G08a Auxiliary Drugs for Antiviral/Vaccine Clinic Sites
AUXILIARY DRUGS FOR ANTIVIRAL/VACCINE CLINIC SITES
DRUG
QUANTITY
UNIT SIZE
ACETAMINOPHEN 325 mg tablet
500
1
ACETAMINOPHEN 80 mg chewable tablet
100
1
ACETAMINOPHEN 160 mg/5 mL solution
500 mL
100 mL
150 mL
15 mL
DIPHENHYDRAMINE HCl 25 mg capsule
100
1
100
1
DIPHENHYDRAMINE HCl 2.5 mg/mL
500 mL
500 mL
DIPHENHYDRAMINE HCl 50 mg/2 mL vial
50
1
EPINEPHRINE 1 mg ampoule
20
1
IBUPROFEN 200 mg tablet
100
1
IBUPROFEN 20 mg/mL suspension
480 mL
120 mL
METHYLPREDNISOLONE 125 mg/2 mL vial
20
1
SALBUTAMOL 100 mcg/inhalation inhaler
10
1
Page 282 of 448
Appendix G 08b Auxiliary Drugs for Palliative Care Sites
AUXILIARY DRUGS FOR PALLIATIVE CARE SITES
DRUG
QUANTITY
UNIT SIZE
ACETAMINOPHEN 325 mg tablet
500
100
ACETAMINOPHEN 80 mg chewable tablet
48
24
200 mL
100 mL
45 mL
15 mL
ACETAMINOPHEN 325 mg
WITH CODEINE 15 mg tablet
100
20
ACETAMINOPHEN 325 mg
WITH CODEINE 30 mg tablet
100
20
BETAMETHASONE 0.1% cream
60 G
15 G
CELECOXIB 100 mg capsule
50
25
CELECOXIB 200 mg capsule
50
25
DIMENHYDRINATE 50 tablet
50
25
DIMENHYDRINATE 50 mg/mL 5 mL vial
10
1
50
25
DIPHENHYDRAMINE HCl 50 mg/2 mL vial
20
1
GLYCOPYRROLATE 0.4 mg/2 mL vial
50
1
HALOPERIDOL 2 mg tablet
50
25
HALOPERIDOL 5 mg tablet
50
25
HALOPERIDOL 5 mg/mL ampoule
20
1
IBUPROFEN 200 mg tablet
100
50
Page 283 of 448
INSULIN NPH 100 u/mL vial
20 mL
10 mL
INSULIN REGULAR 100 u/mL vial
20 mL
10 mL
LOPERAMIDE 2 mg tablet
50
25
LORAZEPAM 1 mg tablet
50
25
LORAZEPAM 1 mg sublingual tablet
100
25
MEPERIDINE HCl 50 mg ampoule
20
1
MEPERIDINE HCl 75 mg ampoule
20
1
MEPERIDINE HCl 100mg ampoule
20
1
MORPHINE HCl 10 mg ampoule
30
1
NALOXONE 0.4 mg ampoule
10
1
OXAZEPAM 15 mg tablet
100
25
PROCHLORPERAZINE 10 mg/2 mL ampoule
20
1
PROCHLORPERAZINE 5 mg tablet
50
25
SALBUTAMOL 100 mcg/inhalation inhaler
10
1
SILICONE 20% cream
450 G
450 G
ZINC OXIDE 15% cream
250 G
50 G
Page 284 of 448
Appendix G10 Antiviral Policy and Procedure
PHARMACY DEPARTMENT - PANDEMIC INFLUENZAE
1.
HOSPITAL ANTIVIRAL - POLICY AND PROCEDURE
RECEIVING AND STORAGE OF ANTIVIRALS
POLICY:
All antivirals used in the prophylaxis or treatment of influenzae will be
received by pharmacy personnel and stored in the pharmacy department.
PROCEDURE:
1. The company shipping antiviral medication will report directly to the pharmacy
department.
2. The pharmacy department will receive antiviral medication as per the Narcotic and
Control Drug Policy.
3. All antiviral medication received will be stored under lock and key in the pharmacy
department.
DISPENSING OF ANTIVIRALS
POLICY:
All oral or inhaled antivirals used in the prophylaxis or treatment of
Influenza will be treated as per the Narcotic and Control Drug Policy.
PROCEDURE:
1. Antivirals will be dispensed in their original foil packaging, or in a drug scanner to all
wards requiring said drugs.
2. The immediate supply and the number of patients requiring the drug will determine
the quantity dispensed to a given ward.
3. The quantity of drug given to a given ward will be noted in the pharmacy antiviral
drug registry and the pharmacy antiviral delivery record.
4. Pharmacy personnel will deliver the antiviral drug to the requesting ward.
5. The antiviral drug will be stored in the narcotic and control drug drawer on each cart,
or cupboard on wards not having drug carts.
6. Pharmacy personnel delivering the antiviral drug will note in the nursing antiviral
drug registry the quantity delivered to the ward and the total count.
7. The pharmacy personnel delivering the drug and the nurse receiving the drug will
sign the nursing antiviral drug registry.
8. The nurse receiving the drug will sign the pharmacy antiviral delivery record.
Page 285 of 448
ADMINISTRATION OF ANTIVIRALS
POLICY:
All oral or inhaled antivirals administered for prophylaxis or treatment of
influenza will be noted in the nursing antiviral drug registry.
PROCEDURE:
1. Nursing personnel administering antiviral drug medication will note in the antiviral
drug registry the patient name, dose, date and time administered.
2. The nurse administering the antiviral will sign out each dose administered.
3. All administered doses of antiviral medication will be countered signed by another
health professional.
4. Wasted doses will be countered signed by another health professional.
5. The Pharmacy Department will be notified of any wasted antiviral dose in a time
efficient manner.
11 SE 04
Page 286 of 448
Appendix G 11 Antiviral Estimates
Antiviral Estimates for Tamiflu
DHA1
15%
DHA2
Tx 25%
Tx
35%
7
110
76
70
1100
760
1930
8106
9
154
107
Age 0-19
1287 12870 2145
Age 20-64
2747 27470 4578
Age >65
812
8120 1354
Total doses
48460
Cost of Tx in $
203532
21450
45780
13540
80770
339234
3002
6409
1895
Tx
DHA3
15%
Tx
25%
Tx
35%
50
690
460
1200
5040
8
114
76
80 11
1140 160
760 106
1980
8316
30020 1436
64090 2863
18950 810
113060
474852
14360 2393
28630 4772
8100 1350
51090
214578
115760
486192
52290
219618
Tx 15%
Tx
25%
Tx
35%
Tx
60
880
540
1480
6216
11
147
90
110
1470
900
2480
10416
15
205
126
150
2050
1260
3460
14532
23930 3350
47720 6681
13500 1890
85150
357630
33500 1996 19960
66810 3674 36740
18900 956 9560
119210
66260
500682
278292
3327
6124
1594
33270
61240
15940
49222
206732.4
4657 46570
8573 85730
2231 22310
154610
649362
87130
365946
121980
512316
51702
217148.4
158070
663894
Hospital
Age 0-19
Age 20-64
Age >65
Total doses
Cost of Tx in $
4
66
46
40
660
460
1160
4872
90
1540
1070
2700
11340
5
69
46
110
1600
1060
2770
11634
6
88
54
OP
Total treatment numbers = Hospital Tx and OP Tx
Total treatment
49620
82700
Cost of Tx in $
208404
347340
Prophylaxis of HCW with Tamiflu
Total doses = number of HCW x one capsule per day x number of treatment days
Cost = total doses x $4.20 per capsule
Page 287 of 448
67740
284508
Appendix G12 Disbursement of Antivirals to Triage Sites
PHARMACY DEPARTMENT – PANDEMIC INFLUENZA
DISPERSEMENT OF ANTIVIRALS TO TRIAGE SITES
POLICY:
A quadruplicate form (Appendix G 12) will be used when transferring
antivirals. At all steps of the transfer a count must be done to ensure that
the quantity noted on the transfer form is exact.
PROCEDURE:
1. Once the antivirals are received the Nurse Manager will transfer the antivirals to the
nurse/pharmacist dispensing. For tracking purposes the Nurse Manager will sign off
using the Antiviral Count form (Appendix G 13) to the nurse/pharmacist dispensing.
2. The antivirals will be stored in a secure location.
3. The antivirals will be dispensed in their original foil packaging.
4. The nurse/pharmacist dispensing the antiviral will note in the Antiviral Count form
(Appendix G 13) the patient name, amount given and the date dispensed.
5. Any wasted doses will be counter signed by another health professional.
6. At the end of the day/shift a drug count will be done with the signature of the
nurse/pharmacist and another health professional.
7 OC 04
Page 288 of 448
Appendix G13 Antiviral Count Form
TRI DISTRICT
ANTIVIRAL COUNT FORM
DATE AND TIME
PATIENT NAME
ISSUEING
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RECEIVING
QUANTITY
DISPENSED
COUNT
Appendix G14 Amantadine
AMANTADINE
Protection Against Influenza A
USES:
Amantadine is licensed in Canada for the treatment of Parkinson’s disease as well as for
prevention and treatment of infections due to susceptible strains of Influenza A. Amantadine has
been shown to reduce the severity and shorten the duration of illness (Influenzae A) by
approximately one day when taken early on in the course of illness.
DOSAGE AND ADMINISTRATION:
In adults the recommended dose for treatment of Influenza A is 200 mg once daily or 100 mg
twice daily for 5 to 7 days. In the elderly, 65 years of age or older, the dosage is 100 mg once
daily. In children 9 years and older the dose is 100 mg twice daily or 200 mg daily. In children
1 to 9 years old the dose is 4.5 to 9.0 mg/kg/day (maximum dose not to exceed 150 mg) given in
two or three divided doses.
The dosage used for prevention, for all age groups, is the same as the dose used for treatment.
The drug is usually given for 7 to 10 days or as long as the outbreak of Influenza A continues.
Individuals with kidney impairment may have their dosage reduced depending on the severity of
such impairment.
SIDE EFFECTS:
Amantadine has been shown to be 70 to 90% effective at preventing Influenza A infection, but is
associated with significant side effects. The most common side effects (5 to 10% of patients)
include the following: nausea, dizziness and difficulty sleeping. Other side effects (1 to 5% of
patients) include: behavioral changes, hallucinations, seizures, delirium and agitation.
NOTE: The more severe side effects are more likely to occur in the elderly and in those with
kidney function impairment. Any of these symptoms should be discussed with your doctor. The
dosage of Amantadine may be altered to reduce side effects or discontinued by your doctor.
PRECAUTIONS:
Individuals should not take this medication until they speak to their doctor if they have a known
sensitivity or allergy to Amantadine, are pregnant or breastfeeding, or have a seizure disorder.
11 SE 04
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Appendix G15 OSELTAMAVIR (Tamiflu®)
OSELTAMAVIR (Tamiflu®)
Protection Against Influenzae A and B
USES:
Oseltamavir is licensed in Canada for the prevention and treatment of infections due to
susceptible strains of Influenzae A and B. Oseltamavir has been shown to reduce the severity
and shorten the duration of illness by approximately one day when taken early in the course of
the illness.
In adults and children 13 years of age and older the recommended dose for treatment of
Influenzae is 75 mg twice daily for 5 days. In children, between the ages of 1 to 13 years old,
the recommended dose is based upon body weight, with a maximum dosage of 75 mg twice daily
for 5 days.
The dosage for prevention in adults and children 13 years of age and older is 75 mg once daily
for at least 7 days, or as long as the outbreak of influenza continues. There is no recommended
prevention dose for children under 13 years of age.
Individuals with kidney impairment may have their dosage reduced depending on the severity of
such impairment.
Individuals with liver impairment should speak to their physician.
SIDE EFFECTS:
The most common side effects (5 to 10%) include the following: nausea and vomiting.
PRECAUTIONS:
Individuals should not take this medication until they speak to their doctor if they have a known
sensitivity or allergy to Oseltamavir, are pregnant or breastfeeding, or have a liver disorder.
11 SE 04
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Appendix G16 ZANAMIVIR (Relenza®)
ZANAMIVIR (Relenza®)
Protection Against Influenzae A and B
USES:
Zanamivir is licensed in Canada for the treatment of infections due to susceptible stains of
Influenzae A and B. Zanamivir has been shown to reduce the severity and shorten the duration
of illness by approximately one day when taken early in the course of the illness.
In adults, and children older than 7 years, the recommended dose for treatment of Influenzae is
10 mg (2 x 5 mg inhalations) twice daily for 5 days.
SIDE EFFECTS:
The most common side effects include nausea, headache, sinusitis and nasal symptoms.
Zanamivir can cause bronchospasm following inhalation and it is therefore not recommended for
use in patients who have asthma or chronic obstructive airway disease.
PRECAUTIONS:
Generally not recommended in patients with underlying airways disease such as asthma or
chronic obstructive airway disease; serious adverse events have occurred in these patients.
Discontinue treatment if you develop bronchospasm or a decline in respiratory function.
The inhalation powder does contain lactose.
Individuals should not take this medication until they speak to their doctor if they have a
known sensitivity or allergy to Zanamivir, are pregnant or breastfeeding, or have a kidney
disorder.
13 SE 04
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Appendix G20 Antiviral Drugs – Patient Education
ANTIVIRAL DRUGS - PATIENT EDUCATION
POLICY:
All triage sites involved with the dispensing of antivirals will be supplied
with patient education leaflets.
PROCEDURE:
1. With the first shipment of antiviral drugs to a triage site a supply of Antiviral
Patient Education leaflets (Amantadine, Oseltamavir, Relenza) will be sent.
8 OC 04
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Appendix H
Mental Health Services
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Appendix H01 Mental Health Services During a Pandemic Influenza
Flow Chart for Providing Mental Health Services
In case of a Pandemic Influenza Crisis
Management
Director, orSenior
designate,
will contact the
Clinical Manager, or designate, with
instructions to implement the strategic
plan.
The Director of Mental Health Services, or
designate, will be contacted by Senior
Management or EMO Coordinator indicating
mental health services are required.
Clinical Manager, or designate, will
contact Team Leaders at all sites
and ask them to contact staff.
The Team Leaders will contact
staff and direct them as follows
Go directly to the
designated site and
wait for directions
Be on standby in the
event assistance is
required
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Pandemic Infleunza Crisis Plan
Mental Health Centres – District 2
All Mental Health Centres will follow the set Disaster plan for external disaster
using the callback lists that have all recently been updated.
Services will be provided where the need is, in the community or in Hospital.
Services will be provided to the population in need, patients with influenza,
families, care providers, or members of the community.
A minimum of two (2) staff members will provide services in each site at any one
time; a rotation will be in place to ensure coverage on a 24-hour basis, if needed.
Care providers are to be assessed by Nurse Manager/Shift Coordinator/
Occupational Health Nurse for signs of stress/distress at the end of each shift. A
Mental Health Clinician is to be available for support and to assist the care
provider with stress management.
MENTAL HEALTH SERVICES
CALLBACK LIST FOR PANDEMIC INFLUENZA CRISIS
After hearing that the Strategic Pandemic Influenza Plan is in effect and it is determined
that staff are needed, the Shift Coordinator/Nursing Supervisor or Clinical Manager will
contact the Team Leaders or designate with specifications of the services needed, i.e.
how many staff, where….
Team Leader or designate will contact Centre staff and ask that they:
A)
Be on standby in the event assistance is needed;
OR
B)
Go to the designated site/location and await further instructions.
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Duties for Psychiatry Inpatient Unit
In the event of a Pandemic Influenza Crisis
In the event of a Pandemic Influenza crisis, you would be notified by the Shift
Coordinator or Clinical Manager.
The Shift Coordinator may ask you to clear as many beds as possible. Should
this occur, the Charge Nurse or Team Leader would review all the patients and
recommend which are most appropriate for discharge.
These patients could be made ready, i.e. with charts and Medication Kardex, to
await Psychiatrist/Physician to discharge. They may need to wait in the Patient
Lounge until Psychiatrist/Physician arrives.
Patients who are appropriate for discharge may be discharged from the Inpatient
Unit directly to home.
The observation rooms will be designated as “emergency psychiatric beds”.
If we are receiving a large number of admissions, you may need to call the
appropriate departments, i.e. Materials Management, Pharmacy, etc. for extra
supplies and extra staff would be called back as well.
The Shift Coordinator may ask the Charge Nurse or Team Leader to call back
staff.
Charge Nurse or Team Leader would then follow the Disaster Call Back
Procedure.
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Emergency Community Supports
For Social and Psychological Services
Mental Health Service
-
Yarmouth Centre 742-4222
Digby Centre
245-4709
Shelburne Centre 875-4200
DHA 2 CISM Team via Occupational Health Nurse
Yarmouth Hospital 742-3541
Roseway Hospital 875-3011
Digby Hospital
245-2501
EHS support – Paul Dawson -
742-8167 (Cell 769-7089)
Fire Marshall’s Office
-
1-800-559-3473
Clergy – Rev. Bill Newell
-
742-2237
RCMP
-
742-8777
FGI (EAP) - Donna Scotten
-
426-1711 Ext. 224
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Mental Health Services, District 2
Pandemic Influenza Plan
Plan for Mental Health Centres.
•
•
•
•
•
•
•
In the event of a pandemic influenza outbreak services will no longer be provided
in Mental Health Centres, services will be moved to the flu treatment clinics in the
designated communities to decrease consumer traffic and possible infection at
the general hospitals.
Two staff members will provide services at one time; a rotation will be in place to
ensure coverage on a 24-hour basis if needed.
Current and appropriate health information provided by Health Canada regarding
pandemic influenza will be made available to those requesting it.
All clinicians will provide an Early Response Service, assessing and triaging
consumers.
Services will be provided to those in need: known mental health consumers,
care providers, family members, general public.
Psychiatry will be on call to do triage, assessments, ordering of medications and
for the management of patients in the community.
Consumers accessing services for Depot injections will be seen at the flu
treatment clinics, injections will be given by the community mental health nurses
or registered nurses from the in-patient unit with reassignment to the flu
treatment site. A Depot “kit” has been prepared for transport and a list posted in
the Depot clinic including what else is to be taken to the identified site to
effectively provide this service. Documentation of services will be indicated as
Population Focused Service Events.
Plan for the in-patient unit.
•
•
•
•
•
•
One registered nurse and one licensed practical nurse per shift will staff the inpatient unit.
Coverage will continue 24 hours per day, every day.
Capacity will be reduced from 10 to 5 beds.
Patients admitted to the in-patient unit will be those in need of acute care, those
under observation and those with a formal status.
The psychiatrist and management team, or designate, will ensure that
admissions to the in-patient unit meet admission criteria.
When necessary, patients discharged from the in-patient unit will be seen on an
outreach basis. This service will be provided by; community mental health
nurses, adult community support services, in-patient social worker, occupational
therapist and other clinicians reassigned to the community.
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MENTAL HEALTH SERVICES
Upon notification that the Emergency Plan is in effect, the Director or designate
will contact the Clinical Manager and Administrative Secretary with instructions to
implement the Mental Health Plan.
Administration:
The Clinical Manager or designate will contact team leader(s) with instructions to
activate the Callback List and to give direction to staff as to how to proceed.
Team Leaders:
Digby Mental Health Centre (645-4709) – Janice Belliveau
Yarmouth Mental Health Centre (742-4222) – Barry Wiser
Shelburne Mental Health Centre (875-4200) – Linda McNicol
The Inpatient Unit Charge Nurse or Team Leader will be contacted by the Clinical
Manager or Shift Coordinator and given direction.
The Team Leaders will contact two (2) staff in order of the list and direct them to:
1.
a) Be on standby in the event assistance is required.
OR
b) Go directly to the designated site and wait for further direction.
2.
The Clinical Manager will advise if more/specific human resources are
required. In this event, the following process/call list will be used.
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YARMOUTH MENTAL HEALTH
CALL BACK LIST FOR EMERGENCY
THE TEAM LEADER OR DESIGNATE IS TO CONTACT THE FIRST PERSON ON THE
LIST AND ASK THAT PERSON TO CALL THE NEXT PERSON ON THE LIST. IF
UNABLE TO CONTACT A PERSON, SKIP TO THE NEXT ONE ON THE LIST. THESE
PEOPLE ARE LISTED IN ORDER OF THEIR PROXIMITY TO THE HOSPITAL.
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SHELBURNE MENTAL HEALTH
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DIGBY MENTAL HEALTH
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PSYCHIATRY INPATIENT UNIT
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Appendix H02 Dealing with Stress and Fear about Pandemic Flu (Public)
DEALING WITH THE STRESS AND FEAR YOU MIGHT FEEL BECAUSE OF
PANDEMIC INFLUENZA
Pandemic influenza is concerning many of us. There is a lot of media attention and the number
of cases of the disease is increasing. It is normal to be feeling anxious and worried about a
spreading disease. Anxiety is related to fear of the unknown.
Under condition such as these, it is extremely important to take the advice of the experts. We
have some information about how the disease spreads and what to do. The experts can tell you
how to protect yourself and those you love. Health Canada, provincial government and public
health office have set up hot-lines where you can call to get the most up to date information.
You can also call your family doctor.
You may also want to follow developments in the media. However, it is really important not to
spend a lot of time listening to programs or reading about the flu if it upsets you. Limit the
amount of exposure you have to these events.
The best thing you can do is to take the advice of the public health official and go about your
normal daily routines as much as possible.
Talk about your thoughts ad feeling with family and friends. This can help everyone feel less
stressed.
Am I too Upset?
You will know you are becoming too upset if you change your daily routine where there is no
need to. This might involve things like:
• Watching too much television about the illness
• Thinking too much about it
• Sleeping poorly
• Not wanting to get out of bed
• Avoiding others
• Not wanting to leave the house
• Feeling anxious and depressed
• Feeling panic and having panic attacks
• Crying
• Drinking more alcohol
• Taking more prescription drugs
• Having little patience, etc
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What Do I Do?
The first thing to do is to talk to someone you love and trust. This can be a family member,
friend, clergy teacher, etc. Be honest. Getting it off your chest helps. You can support each
other. You may need to talk more than once. Don’t be shy. Bring it up as often as you need to.
If you notice a love one, friend, colleague or co-worker’s behaviour has changed, ask them how
they are doing. Make time to talk. If right now is not appropriate, set aside a dedicated time to
talk. After you have talked, follow up to see how they are doing. Check in. It shows you care
and it can be a relief to both of you. In fact, check in even if their behaviour has not changed.
They may be upset and hiding it well.
If, however, you or someone that you know is experiencing these symptoms over a period of
time, such as a week or two, you should consider seeing a health professional. This is true if you
just can’t cope. The professional will explain your reactions and help you find ways to better
deal with the situation.
Caring for your Kids
Outbreaks of illness can be upsetting to children and teenagers as well. It is important to discuss
these issues with them. Don’t be afraid to bring up the subject. You may need to discuss it more
than once.
It is important to tell them the truth, to reassure them and to let them know that they can count on
you and the adults around them. Often giving them a hug will help reassure them along with the
words.
If you notice the behaviour of your children or teenagers changes significantly at home or at
school, discuss the situation with them. Don’t be afraid to bring it up. If the above suggestions
do not work over a period of a week or two, you may want to consider consulting a health
professional. Some of the behaviour changes might include:
• Sleeping too much or too little
• Being tired all the time
• Staying in their room
• Avoiding others
• Talking less
• Feeling cranky and irritable
• More arguments and fights with others
• Behaviour problems at home, at school or in the community
• Eating lots more or less
• Sad and anxious
• Poor grades
If you have had other sad or traumatic events in your life recently, the flu outbreak may seem
even more upsetting. Such events may include a car accident, the loss of a loved one, the loss of
Page 306 of 448
a job, a serious health problem. It is normal to feel more stressed under these conditions. It is
important to watch your behaviour and if it changes as described above, you may want to discuss
the situation with a friend or loved one. If that doesn’t work, and the symptoms persist over a
week or two you may need to contact a health professional.
Pandemic Influenza and the Health System
The actions taken by authorities to help keep us safe from disease may cause disruptions that are
difficult. Health appointments and procedure, some that have been planned for a long time may
be delayed. You may not be ale to see you loved ones or friends in the hospital. This can be
very frustrating. Health care officials will do everything they can to resume normal operations as
soon as possible.
Who Can Help?
•
•
•
•
•
Get the correct information from the experts such as the public health hotlines and
the government.
Follow the expert’s advice
Talk to people you care about and trust. Don’t be shy.
See a health profession if symptoms persist or they are too strong for you to handle.
These may include your family physician, nurses, psychologist and social workers.
If you do not have access to one of the people above, call 1-800--------
Page 307 of 448
Appendix H03 Pandemic Flu and Health Care Workers
PANDEMIC FLU AND HEALTH CARE WORKERS
DEALING WITH STRESS
The sudden emergence of Pandemic Influenza can be a particularly upsetting situation for health
care worker. The spread of the disease, the extent of the illness and the precautions being taken
to protect the public, patients, and professionals can be very disrupting and often scary.
It is important for workers and patients to keep the extent of the danger in context. Following prudent,
good hygienic practices are always recommended to reduce your risk of catching an infection. If you are
working in a health care facility, there will be special infection control precautions in place. Please follow
the recommendations of the Infection Control Team.
Anxiety
To be feeling anxious under these conditions is normal. People naturally become concerned when their
health is threatened. This can be as true of health workers as anyone else. Because you are a professional
does not mean you are immune. Anxiety is a normal reaction. Often people become afraid of feeling
anxious and this makes matters worse.
You may feel upset because of the significant disruptions in the workplace. Following isolation
precautions will mean it will take more time to do the necessary work. These security measures can
increase frustration levels and reduce efficiency at a time when maximum efficiency is required. The
extra work required is added to an already overstretched system. You may be concerned about the
canceling of services and the impact this has on patients and the work schedule. Canceling services will
back up an already overloaded system. The longer that influenza is a problem, the bigger the problem for
the health care system.
As services are shut down, the usual familiar and stabilizing routine of your workday will be missing. The
people you have coffee with or chat to are preoccupied or unavailable. This is both an opportunity for
finding new people and ways to look after yourself and a risk of feeling too isolated and alone during
stressful times.
What to Watch For
You will probably know you are becoming too upset if you feel that you are, but sometimes we have to
figure this out by being a little more observant of how stress affects us. As health care professionals,
sometimes we tune out our own reaction too successfully. For instance, if you change your daily or
professional routine more than you need to, it may indicate you need to stop and check whether or not
you are coping adequately or not. Other things to be aware of are:
•
•
•
•
•
•
Over vigilance regarding the media and coverage of the pandemic
Daily preoccupation about the flu
Sleep disruption
Fatigue Disturbance of daily eating (over or under eating)
Avoidance of others or certain patients
Feeling anxious and depressed
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•
•
•
•
Feeling panic or having panic attacks
Easily startled
Crying
Drinking more alcohol
Taking more prescription drugs
• Having little patience
What to Do
The first thing to do is to talk to someone you trust. This can be a colleague, family member, friend,
clergy, etc. Be honest. Getting it off your chest helps. You can support each other. Remember you can get
comfort from talking more than once. This is not like a periodic check up where one time is sufficient.
Don't be shy. Talk about your thoughts and feelings as often as you need to.
If you notice a colleague or co-worker’s behaviour has changed, ask them how they are doing. Make time
to talk. If right now is not appropriate, make a time certain. After you have talked, follow up to see how
they are doing. Check in. It shows you care and it can be a relief to both of you.
Remember that we need to practice good psychological first aid on ourselves as well as our patients! Eat
well, rest and relax with the activities that give you pleasure and distraction. Uncertainty and rumor
increase our anxiety and fear, so keep up-to-date with the latest information available. Enjoy the friends,
colleagues and family that you care about, and truly, laughter can be the best medicine for stress!
If, however, yon or someone that you know is really struggling with symptoms over a period of time such
as a week or two, you should consider seeing a health professional. This is also true if you just can't cope.
Unfortunately, professionals all too often avoid consulting other professionals for a variety of reasons.
This is not wise.
People who have recently experienced a sad or traumatic event may find the influenza outbreak even
more upsetting. These may include a car accident, the loss of a loved one, the loss of a job, a serious
health problem etc. It is normal to feel more stressed under these conditions. You may find yourself
revisiting feelings and thoughts about the event. It is important to watch your behaviour and if it changes
as described above, you may want to discuss the situation with a colleague, friend or a loved one. If the
symptoms persist over a week or two, you may want to contact a health professional.
Pandemic Influenza and Kids
Pandemic illness can be upsetting to children and teenagers as well. It is important to discuss these issues
with them. Don't be afraid to bring up the subject. Listen to what their concerns are. The way children
hear things and the worries this raises for them is often very different from adults. Make no assumptions;
listen for how they have picked up on rumours and adult anxiety. Likely you'll need to enquire and clarify
and come back to the subjects more than once.
It is important to tell them the troth, to reassure them and to let them know that they can count on you and
the adults around them. Often giving them a hug will help reassure them along with the words. It can be
good therapy for you, also.
If you notice the behaviour of your children or teenagers changes significantly at home or at school,
discuss the situation with them. Don't be afraid to bring it up. If it’s related to being afraid of the illness or
other such situations try to help them as suggested above. If this does not work over a period of a week or
two, you may want to consider consulting a professional.
Page 309 of 448
Some of the behaviour changes might include:
• Sleep too much or too little
• Being tired all the time
• Staying in their room
• Avoiding others
• Talking less
• Feeling cranky and irritable
• More arguments and fights with others
• Behaviour problems at home, at school or in the community
• Eating lots more or less
• Sad and anxious
• Poor grades
The above advice is effective for your spouse and significant other as well. Talking as often as needed can
help you both. Don't be shy. Bring it up and check in from time to time.
Who Can Help
1. Get the correct information from the experts such as Infection Control and Public Health and the
government.
2. Follow the expert's advice.
3. Talk to people you care about and trust. Don't be shy.
4. See a regulated help professional if symptoms persist and they are too strong for you to handle.
These professionals include your family physician, nurse, psychologists and social workers.
COMMENT RÉAGIR AU STRESS ET AUX CRAINTES QUE VOUS RESSENTEZ EN
RAISON DE LA PANDÉMIE DE GRIPPE
La pandémie de grippe nous préoccupe tous. Les médias en parlent beaucoup et le nombre de cas
de personnes atteintes ne fait qu'augmenter. Il est normal de se sentir inquiet et préoccupé au
sujet d'une maladie qui se propage. L'inquiétude est reliée à la crainte de l'inconnu.
Dans de telles circonstances, il est très important de suivre les conseils des experts. Nous avons
de l'information sur la façon dont la maladie se propage et sur les mesures à prendre. Les experts
peuvent vous dire comment vous protéger et comment protéger vos proches. Santé Canada, le
gouvernement provincial et la santé publique ont tous établi des lignes d'information où vous
pouvez obtenir les renseignements les plus récents. Vous pouvez également communiquer avec
votre médecin de famille.
Vous pouvez aussi suivre les développements dans les médias, mais il est vraiment important de
ne pas passer trop de temps à écouter des émissions ou à lire des articles traitant de la grippe si
vous êtes bouleversé. Limitez le temps pendant lequel vous êtes exposé à de tels événements.
La meilleure chose à faire est de suivre les conseils des agents de la santé publique et de procéder
à votre routine quotidienne habituelle, dans la mesure du possible.
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Partagez vos sentiments et vos idées avec votre famille et vos amis. Cela peut aider à réduire le
stress chez toutes les personnes concernées.
Est-ce que je suis trop bouleversé?
Vous savez que vous devenez trop bouleversé si vous modifiez votre routine quotidienne sans
raison valable, par exemple :
• vous regardez trop d'émissions de télévision au sujet de la maladie;
• vous y pensez trop;
• vous ne dormez pas bien;
• vous n'avez pas envie de vous lever;
• vous évitez les autres personnes;
• vous ne voulez pas quitter la maison;
• vous vous sentez inquiet et déprimé;
• vous ressentez de l'anxiété et vous souffrez de crises d'anxiété;
• vous pleurez;
• vous consommez plus d'alcool;
• vous prenez plus de médicaments sur ordonnance;
• vous êtes irritable, etc.
Qu'est-ce que je peux faire?
La première chose à faire et de parler à quelqu'un que vous aimer et en qui vous avez confiance.
Il peut s'agir d'un membre de la famille, d'un ami, d'un membre du clergé, d'un professeur, etc.
Ça fait du bien de dire ce qu'on a sur le cœur. Vous pouvez vous offrir du soutien mutuellement.
Vous aurez peut-être besoin de parler à plusieurs reprises. Ne vous gênez pas. Parlez-en autant
de fois que vous en aurez besoin.
Si vous remarquez que le comportement d'un proche, d'un ami, d'un collègue ou d'un compagnon
de travail a changé, demandez-lui comment il va. Prenez le temps de parler. Si le moment n'est
pas approprié, prévoyez du temps pour discuter. Après votre discussion, faites un suivi pour vous
assurer que la personne se porte bien. Renseignez-vous sur la personne. C'est un signe que vous
vous préoccupez d'elle et c'est un soulagement pour les deux parties. En fait, communiquez avec
la personne même si son comportement n'a pas changé. Elle peut être bouleversée et bien le
cacher.
Toutefois, si ces symptômes durent pendant une certaine période de temps, par exemple pendant
une ou deux semaines, il faut considérer obtenir les conseils d'un professionnel de la santé.
Consultez également un professionnel si vous ne pouvez tout simplement pas faire face à la
situation. Le professionnel expliquera vos réactions et vous aidera à trouver de meilleures façons
de remédier à la situation.
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Prendre soins de vos enfants
Une épidémie de maladie peut bouleverser les enfants et les adolescents aussi. Il est important de
discuter de ces questions avec eux. N'hésitez pas à en parler. Il vous sera peut-être nécessaire
d'en parler à plusieurs reprises.
Il est important de leur dire la vérité, de les rassurer et de leur dire qu'ils peuvent compter sur
vous et sur les adultes qui font partie de leur vie. Souvent, une étreinte accompagnée de propos
rassurants peut les aider à se sentir mieux.
Si vous remarquez que le comportement de vos enfants ou de vos adolescents change de façon
considérable à la maison ou à l'école, discutez de la situation avec eux. N'hésitez pas à en parler.
Si les suggestions ci-dessus ne sont pas efficaces après une ou deux semaines, considérez obtenir
les conseils d'un professionnel de la santé. Les changements de comportement peuvent être que
les enfants ou les adolescents :
• dorment trop ou pas assez;
• sont toujours fatigués;
• restent toujours dans leur chambre;
• évitent les autres;
• parlent moins;
• sont grincheux et irritables;
• se disputent plus souvent avec les autres;
• ont des problèmes de comportement à la maison, à l'école ou dans la communauté;
• mangent beaucoup plus ou moins que d'habitude;
• sont tristes et inquiets;
• obtiennent de mauvaises notes à l'école.
Si vous avez vécu un événement triste ou traumatique récemment, la pandémie de grippe peut
sembler encore plus bouleversante. De tels événements peuvent inclure notamment un accident
d'automobile, la perte d'un être cher, la perte d'un emploi ou un problème de santé grave. Il est
normal de ressentir un plus grand stress dans de telles circonstances. Il est important de surveiller
votre comportement, et si vous constatez un changement comme il est décrit ci-dessus, vous
devriez discuter de la situation avec un ami ou un proche. Si le problème n'est toujours pas réglé
et si les symptômes persistent pendant une ou deux semaines, vous devriez consulter un
professionnel de la santé.
La grippe pandémique et le système de soins de santé
Les mesures prises par les autorités pour nous protéger des maladies peuvent causer des
perturbations qui sont difficiles. Des interventions médicales ou des rendez-vous qui sont prévus
depuis longtemps peuvent être reportés. Vous ne serez peut-être pas en mesure de visiter un
proche ou un ami à l'hôpital. Une telle situation peut entraîner bien des frustrations. Les
représentants des soins de santé feront tout leur possible pour reprendre les opérations normales
dès que possible.
Page 312 of 448
Où puis-je obtenir de l'aide?
•
•
•
•
•
Obtenez l'information exacte des experts, par exemple grâce à la ligne d'information
de la santé publique et au gouvernement.
Suivez les conseils des experts.
Parlez à des personnes que vous aimez et en qui vous avez confiance. Ne soyez pas
gêné.
Consultez un professionnel de la santé si les symptômes persistent ou si vous ne pouvez
pas faire face à la situation. Les professionnels de la santé peuvent inclure votre médecin
de famille, les infirmières, les psychologues et les travailleurs sociaux.
Si vous n'êtes pas en mesure de consulter l'une des personnes ci-dessus, composez le 1800--------.
Page 313 of 448
Appendix I
Influenza Treatment Clinics
Page 314 of 448
Appendix I01 SAIC recommended criteria for Nova Scotia
The role of flu treatment clinics is to provide the following services:
•Influenza diagnosis and triage
•Providing medicine and a course of treatment and instructions for home recovery
•Short term clinical care including possible use as a step-down unit (hospitalization)
•Holding area for patients requiring transfer to a facility offering a higher level of care
•Palliative care
Requirements:
♦
♦
♦
♦
♦
♦
♦
♦
Easily accessible from the highway system
Accessible for persons with disabilities
Equipped with emergency lighting
Exits equipped with “panic hardware”
Two or more entrances/exits
In compliance with all building codes (e.g., fire alarms, sprinklers, etc)
Numerous electrical outlets
Minimum of five lines for telephone, fax and data lines (cellular phones may be included
in this number)
♦ Adequate storage for general stores such as linen (approximately 3m2)
♦ Public phones available
Vehicle Parking Area
♦ Staff and patient parking
Reception area
♦ Processing area for patients - four reception desks (or as req.)
♦ Area for providing information and consultation on home care treatment
♦ Waiting area with seating for 50 people
Staff Rest and Feeding
Essential
♦ Small eating area (minimum capacity for 10 persons)
♦ Food preparation area (meals may be catered)
Enhancements
♦ Small staff lounge (minimum capacity for 10 persons)
♦ Kitchen
Page 315 of 448
Washrooms
♦ Staff washroom(s)
♦ Separate public washroom(s)
♦ Shower / bath facilities
Medical Services
♦ Area large enough to accommodate examination rooms (may be existing rooms or
created using room dividers / privacy screens) Approximate size of each examination
room should be 2 m x 3 m
♦ Secure / guarded area for pharmacy and medical supplies
♦ Small office / area for medical records management
Treatment Ward
♦Area large enough to accommodate 5- 10 hospital beds (minimum 3.5 m2 per bed with a
7m separation between beds for medical gases and oxygen)
♦Adequate ventilation / air exchange
Bio-waste
♦ Secure area for bio-waste storage (approximately 3m2)
Page 316 of 448
Appendix I02 From the Canadian Pandemic Influenza Plan re. NTS
Assess Locations for Potential NT Sites
It is recommended that a multidisciplinary team approach be used to assess potential NT sites in
a jurisdiction, to ensure suitability of a potential site. Ideally the assessment team should include:
♦ emergency personnel/police/fire,
♦ health care personnel, and,
♦ engineering/maintenance/public works staff.
This team should conduct a community-wide space and site inventory to determine the location
and availability of potential sites for NT hospitals and vacant land for possible mobile hospital
installations. This assessment should be repeated at regular intervals during the interpandemic
period to ensure that identified sites remain suitable. Potential locations for NT sites include, but
are not limited to:
♦ schools
♦ hotels
♦ community halls
♦ banquet facilities
♦ arenas
♦ churches
♦ closed hospitals or hospital wards
♦ day care centres
For each location the feasibility of its use as a NT site should be determined based on the
information below and the intended use of the facility.
Since a site at which inpatient care will be provided will have the most stringent and demanding
requirements, it might be reasonable to assess each location for this type of service provision.
Locations that are not found to be suitable for provision of inpatient care may be considered for
another purpose such as triage or provision of education/counselling.
Characteristics and Services Required for an Inpatient Care Setting
Each building under consideration should meet the National Building Code standards for its
currently designated building type. Once the building code standards have been assessed, the
following issues need to be considered:
Adequacy of external facilities:
♦ public accessibility (including public transport, parking, directions) off-loading, traffic
control, assistants for elderly, etc.
Adequacy of internal space:
♦ washrooms and sinks: number m/f; amenities, function
♦ kitchen: refrigeration, dishes, dishwashing capability, food preparation areas etc.
Page 317 of 448
♦ secure space for administration/patient records
♦ space for reception, waiting, patient care, patient/family education, counselling/support,
and any other services defined by the planning process
♦ secure storage capacity for pharmacy and other supplies
♦ mortuary space
Adequacy of critical support systems required for the site to provide patient care:
♦ ventilation system (adequate air flow, air conditioning)
♦ physical plant/ building engineering
♦ electricity - power for lighting, sterilizers, refrigeration, food services.
♦ natural gas supply – e.g., for heating or electricity or cooking
♦ water supply
♦ sanitation (including number of toilets, showers or washing facilities)
Arrangements to provide essential support services required for the provision of in-patient
care:
♦ security
♦ communications capability
♦ maintenance
♦ laundry
♦ environmental/cleaning services
♦ sterilization services – Sterilization of equipment should be provided by trained and
experienced personnel using certified equipment. Appropriate arrangements for
sterilization services, e.g., with a hospital, may be required
♦ pharmaceutical services
♦ medical waste disposal/storage
♦ mortuary/funeral services
♦ food services
♦ facilities for staff lodging and feeding
Page 318 of 448
Appendix I03 Non-traditional Sites Planning to December 2004
South West Health
Flu Treatment Clinic Planning to December 2004
Also see Main Plan Sections 6.4.3.4 & 6.6.0.0 to 6.6.7.6
A NTS Working Group is being established to inspect the sites for suitability, determine most
appropriate site and consider the logistics of delivering services there.
The NTS Working Group will include:
-
A Team Leader for each NTS
o Shelburne – Kim Ott (875-3011);
o Argyle – Dianna Surrette (742-3541)
o Yarmouth – Peggy Green
o Clare –
o Digby – Wendy Locke (245-2501)
-
DHA Maintennance/Engineering
Health Records
Lab
Nursing
Pharmacy
Housekeeping
Materiel Management
IS
Infection Control
Laundry/Safety
Food Services
School Board Representatives are: Phil Landry, TCSB & Yvonne Banks, CSAP
NTS options are:
-
Shelburne - #1 Hillcrest Academy; #2 New High School;
Argyle/Barrington - #1 Pubnico West, #2 Forrest Ridge;
Yarmouth - #1 Plymouth School, #2 Meadowfields;
Clare - #1 Jean Marie Gaie, #2 Joseph Dugas;
Digby - #1 Digby Elementary, #2 Digby High School.
Page 319 of 448
Appendix I04 Influenza Treatment Clinic – Hillcrest Academy
Non-Traditional Sites Clinical Services Checklist
Program: 24/7 Facility
{SWN District
- Proposed (staff dependent)- (2)12/7 hour facility = treatment and discharge; (3)24/7 hour facilities = Treatment/discharge/Overnight stay
patients (pts.). Yar, Digby, Shelb – (1) 24/7 facility each; (1)12/7 Facilty in Barrington/Pubnico area and (1) 12/7 in Clare Area}
Non-Traditional Site: Hillcrest Academy
Inspection Date: June 28, 2005
Completed by: Kim Ott, Debbie Sutherland, Ellen Suttle, Linda MacLachlan
{Please see equipment list for each space-next page}.
Item/Criteria
What’s available at NTS
SPACE: (When assessing designated areas
below, keep in mind traffic flow in and out of
school (including EHS access and assessment of
EHS arrivals.
Registration Area:
Triage/Waiting area (2)
(Triage can be done in waiting area –behind
screens; sink; bathroom in near vicinity)
Exam Area (To be seen by Physician and
discharged or possible transfer to treatment area);
sink
Gaps, Challenges and Comments
Adequate entrance/exit, wheelchair accessible. Site
centered geographically. Adequate space in front
foyer for waiting.
Adjacent male and female bathrooms
Adequate parking north end of building and in bus
park.
Office space, phone lines and computer drops
adequate
Waiting area not as spacious as High School
Will need chairs (stored under stage in gym)
Quick triage (chief complaint & visual) Room 126
available if needed.
Adequate space in front foyer for waiting – keep a
clear path to the kitchen
Sinks available in adjacent male/female washrooms
(Hand sanitizer, Kleenex and individual garbage
bags)
Room 105 (music room) To be divided into space
for detailed triage and exam cubicles.
Sink available
Will need dividers/barriers
Computer hook-up available, ? phone line
Page 320 of 448
Will need to construct a see-through barrier for
registration desk
Education/Follow-up care: (if possible
separate area close to exam area-for discharge
planning if needed, as well as poss. Home Care
referral ie. nutrition/hydration.
Treatment/Holding Area: For 24
hour facility. (? 2 classrooms-remember 1
metre rule-; close to utility rooms; sink; place for ?
Geri chairs, physio mats etc. see equip list. (There
may be need to accommodate palliative pts. as
well)
Respiratory Care: (corner of treatment
Room 101 – for Education, treatment, and
discharge planning
Close to back exit
Sink available
Room 161, 2 bathrooms and 1 shower room,
additional sink in classroom
Adequate space for 5 beds
Computer hook-up available
Need phone lines
Will need barriers between beds or 3 ft between
beds
1 Hospital bed available (Room 101)
Corner on Room 161
Adequate space – will need a cart
area to store equip. (see equip list below).
Mental Health Area: (needs a room).
Corner of Room 101
Additional areas required:
Office: (Phone, computer) Signage and access
Room 149 in Administration area
Phone line and computer hookup available
2 bathrooms close by
Clean/Soiled Utility:
Supplies – Room 102
Soiled utility – Room 143 (near male washroom)
Floor sink available
Cleaning supplies in Room 106 (janitor’s room)
Showers:
2 showers/washrooms available off gymnasium,
access available from Rm 105
(Extra shower available in office)
Large storage area available, close to exam and
treatment areas or carts in hallway
Near back exit for deliveries
May need to push supplies to back of Rm 102 and
erect a barrier.
Will need walk-way barrier (sides and ceiling) to
block off gym area
to facility control.
Page 321 of 448
Staff Area:
Morgue:
Pharmacy (Double lock cupboard or box; small
Room 157 (existing staff room) Fridge and sink
available, 2 adjacent washrooms
(additional fridge in Rm 106 across the hall)
Room 163
Sink available
Close to treatment area
Phone available
Locked cabinet available in Room 161
Will need second lock
Room 150 – office in administration area
Phone line and computer hookup available
Near back exit
fridge)
Lab
(sink, small fridge, blood collection equip.
computer)
Page 322 of 448
Equipment for each space:
Registration Area: Desk, 3 chairs, computer, phone.
Triage/Waiting area (2): ?# chairs in waiting rooms, garbage cans, sink/hand sanitizers, BP cuff, glucose monitor and kit, stethoscope, thermometers and
covers, O2 sat machine, emesis basins,, Kleenex, disinfecting wipes, masks, gloves, gowns, wheelchair.
Exam Area: Sink/hand sanitizers, Exam table/geri chair/physio (1) bed, chair (2), stool, stethoscope, Virox wipes, PPE, Otoscope, opthalmoscope, disposable
supplies, tongue depressors, throat swabs (refrig), emesis basins, Kleenex, garbage bin, laundry hamper, ?EKG, small desk top, spec. containers, approp. paper
work..
Education/Follow –up area: Desk , chairs, table, phone, phone lists resources, education information
Treatment/Holding Area: ? Stretchers, geri chairs, physio mats?{ (3)24 hour facilities-Places for up to 10 pts-Yar; 5 pts- Digby; 5 pts- Shelb.} O2 tanks and
equipment, cart for linen supplies (sheets, blankets, pillowcases, towels, PPE,, incontent pads, briefs-all sizes-, disposable wipes, bedpans, urinals, commode
chair, IV caths/Tubing/solutions, pedialyte, mouthwash, disp. Toothbrushes, laundry bins, peri pads, TENA products, garbage bins IV poles (IV pumps-if
available-, suction equip, sharps containers
Respiratory Care: store portable O2, resp. equip ie. masks, tubing; medications and resp. box; crash cart; portable suction.
Clean/Soiled Utility rooms: See Support Services checklist.
Staff Area:
Additional Comments:
Pro’s: Centrally located, staff room near treatment areas, easy access – adequate entrances/exits and parking.
Adequate bathrooms available and sinks in each classroom. This facility meets the needs of support and clinical services, and meets
infection control standards, safety will not be compromised for infection control.
There is easy access to Ambulance entrance/exit. The School Board indicated their preference of an Elementary school choice.
Con’s: Classrooms smaller than High School, no security cameras in place, less phone lines than High School, delivery entrance
difficult to access and supplies must come in the front doors.
Renovations: Barrier to be constructed in registration area, barrier needed for a pathway to the showers from the Music room.
Conclusion: This site is recommended as the first choice for a Shelburne 24/7 Non Traditional Site.
Page 323 of 448
24 Hour Pandemic Flu Clinic
Hillcrest Academy
Room List
1. Room 101
2. Room 102
3. Room 105
4. Room 106
5. Room 114,115
6. Room 123
7. Room 126
8. Room 141,142
9. Room 143
10. Foyer
11. Room 148
12. Room 151
13. Room 150
14. Room 149
15. Room 157
16. Room 161
17. Room 163
Education, Mental Health, D/C Planning
Supplies
Triage/Exam
Environmental Services
Staff showers
Kitchen
Extra space if needed
Public Washrooms
Soiled Utility
Waiting Area
Registration
Staff overnight room (cot available)
Lab
Office
Staff Lounge and adjacent washrooms
24 Hour treatment area
Morgue
See Hillcrest Academy floor plan
Page 324 of 448
Client Pathway
Flu Treatment Clinic
Non Urgent
Registration
Waiting Area
Quick Triage (Chief complaint and visual)
Urgent
Detailed Triage and
Exam
Transfer
Treatment
24 Hour
To Hospital
Education
Discharge Home
Page 325 of 448
and
Appendix I05 - Influenza Treatment Clinic – Shelburne High
Non-Traditional Sites Clinical Services Checklist
Program: 12/7 Facility or 24/7 Facility (circle)
{SWN District
Non-Traditional Site: __Shelburne High ___
Inspection Date:_June 6/05
Completed by:________________________________________________
Item/Criteria
EHS arrivals.
Adequate parking, adequate phone
lines, computer drops
Registration Area:
Administration area - spacious
Quick Triage – corner of cafetorium
Waiting area – cafetorium (close the
dividing wall)
Plenty of seats available
sink
Rooms 100 & 102, with anteroom in
between for Lab, computer and
Nursing
Seminar room (next to library)
Page 326 of 448
Barrier needs to be constructed,
harder to construct barrier due to
shape of desk
Cloth wall panels need to be
covered,
Balconey upstairs needs to be
blocked off
No sink in either room
Library to be sealed off
Conference table and chairs
available
Adequate space in Room 105
Learning Support
Sink, W/C bathroom and shower
(washer and drier)
Locked cupboards
Corner of Room 105
Adequate space
Room 103
Two exits?
Office available in Administration
Security cameras in place
Staff Area:
Soiled – recycle room near kitchen
Supply room
Plenty of showers available near
gymnasium
Office available in Admin.
Morgue:
Room 101`
May need to keep supplies on carts
in the hallway
Block off hallway in area of Room
124 and 129 (east wing)
Adequate space, also could utilize
staff lounge
Near back entrance
well)
Space may be restricted depending
on type of beds
Showers:
Pharmacy (Double lock cupboard or box; small Locked cupboards in Rm 105
Lots of locked cupboards
fridge)
Lab
computer)
Anteroom between Rm 100 & 102
Page 327 of 448
Computer hook-up available
work..
Staff Area:
Pros
-
Structurally new (opened 2005)
Rooms large, spacious
Security surveillance in place already, ↑ safety for staff and patients
Cons
-
Staff area more removed from treatment areas
Not enough sinks available
Page 328 of 448
Appendix I06 Influenza Treatment Clinic – Argyle
Purpose: This report will provide information for clinical and support services who need to plan
and fit their service in West Pubnico school, in the event of a pandemic. The report is modeled
around the flow of the patient through the clinic.
Patient Flow
Entry
There is ample parking at the site at the front entrance but only one suitable entrance for patients
(see figure 1) this is entrance # 9 on the school map. The entrance is wheel chair accessible and
turns directly into a ramp (figure 2). The width of the ramp has 2 side rails and only measures 30
inches. Figure 3 shows the size of the entryway, the ramp and the stairwell. The ramp ends at a
separate right angle hallway that if you turn to your right bring you directly to the registration
area.
Figure 1
Figure 2
Figure 3
Photos deleted to reduce file size of document.
Needs: Signage: 1) for outside the building and selected entrance (this is not the main door); 2)
arrows to direct clients to registration. Ramp: removal of one of the rails on the ramp
Registration
The Registration area is room 30 (the library) on the school map. The entry door area is well
glassed (figure 4) and the room is approx. 25 feet long; sufficient space for 3 desk area for
registration and the administrator area (figure 5). Figure 5 shows some boxed books etc. this
area’s normal use will only have some carts with books that are easily stored on the 2nd level.
The 2 level (figure 6) is like a stage and can be sealed off. There is computer and phone drops in
the corner behind the door.
Figure 4
Figure 5
Figure 6
Needs: Registry access; 1) 1 window needs to be cut or replaced to provide access. Window
panes are screwed in and easily removed. 2) available desk or tables (may be able to negotiate
with the school for some tables. Telecommunication: IS services will assess the need for phone
lines and computer access, there should be a minimum of 2 to 3 computers and 2 phone lines.
Infection Control: the 2nd level of the library must be sealed off by plastic or another disposable
or cleanable product. The 2nd level will be storage for all the library books and supplies.
Waiting Area
The waiting areas for clients awaiting triage and physician can be in the corridor seen in figure 3,
figure 4 and along corridor in front of cafeteria towards gym (figure 6). The original intent to
use a classroom needs to be changed because of the change in Triage and Physician assessment
rooms.
Figure 6
Figure 6 (a)
Page 329 of 448
Need: Sufficient washable/cleanable chairs. Plastic chairs available in cafeteria Figure 6(a).
Public Washroom (s)
In the corridor where registration will occurs there is a handicapped access washroom. This is
easily accessible and visible for public use (figure7). Figure 7 also shows the entry to room 41
(staff room). The other public washroom (figure 8) is the (boys or girls) washroom situated next
to room 16 and next to the janitor’s closet. This room can be used by the clients fro the
treatment room. Consideration should also be given to using the end bathroom stalls as a hopper/
soiled utility space.
Figure 7
Figure 8
Need: Signage.
Triage-Primary Assessment
The triage room entrance can be seen in figure 3. Figure 9 demonstrates the space for
assessment and 9 (a) the bathroom; although small it meets the requirements of a sink and
privacy.
Figure 9
Figure 9(a)
Need: The clinical group will need to assess equipment and supplies required. Stethoscopes,
blood pressure, scale, etc…
Physician Assessment
Room 41, the staff room on the school map, has ample space and the much required sink (figure
10) for physician to see, evaluate and plan client care. If required, 2 assessment areas can be setup to see clients, thus improving client flow (figure 11&12). Consideration to privacy is an
issue; however this is not different than the current situation found in most ER observation
rooms across the province.
Figure 10
Figure11
Figure 12
Page 330 of 448
Laboratory Services
The administration office (figure 13) will meet the space requirements to hold lab supplies while
offering space for the collection of blood. There is no sink in this area so hand washing should
be done in the 1st washroom (figure 14) after the office to be labeled- Staff washroom. This area
also provides for storage of supplies (figure 15).
Figure 13
Figure 14
Figure 15
Need: To be determined by the support staff
First Aid/Treatment Area
Room 12, based on the school map, will be assigned for client care (figure 16). There is
sufficient space to establish 5 care areas. The bathroom access is across the hall see figure 8.
The room has a connecting door to Room13 on the school map.
Figure 16
Needs: both the clinical and the support group need to establish the supply needs for this area.
Teaching/ Education and Discharge
The principles office can be used for the education area;
There is sufficient space, a desk, computer hook-up and phone lines to allow for teaching and
contacting families if required (figure 17). Access can be made via the canteen door (figure 18)
that connects directly into the office.
Figure 17
Figure 18
Need: Clinical group to determine
Storage and Supplies
Room 16 (figure 19) has been designated as the soiled utility room; there is a door that has direct
access to the exit as seen in figure 21. Room 15 used for art has been designated as the clean
supply room (figure 20) this has sufficient shelving and tables. Figure 21 shows the back
entrance; # 3 on the school map. The entrance allows for large trucks/ vans or even an
ambulance to back up to the space.
Figure 19
Figure 20
Figure 21
Page 331 of 448
Staff Lounge
Figure 22
Room 13 on the school map is currently being used as a second staff lounge. This room has a
connecting door to the treatment area, a fridge, tables etc and would meet the need for staff to eat
their meals and rest breaks. The chairs are cloth and cannot be used; however there are plastic
chairs available from the cafeteria.
Room 14 Found on School Map
This room will not be used. It is currently used by the community for a pre-school. The preschool would have to be closed and the room with their supplies closed off.
Page 332 of 448
Appendix I07 – Influenza Treatment Clinic – Forrest Ridge
{SWN District
Non-Traditional Site: Forest Ridge Inspection Date: June 6, 2005
Completed by:________________________________________________
Item/Criteria
Adequate parking and wheelchair accessible
entrance
Waiting area in front foyer
Parking removed from front entrance
Adequate space
Registration Area:
Administrative area
Will need to erect a barrier
Adequate phone lines and computer drops
Adequate space, will need chairs
Quick triage (chief complaint and visual) Room
101
Waiting area in front foyer
Near bathrooms
Room 102
Sink available?
Adequate to meet the needs of a 12 hour clinic
Room 104
Bathroom near
EHS arrivals.
sink
Page 333 of 448
n/a
well)
?Corner of room 104
?
In administration area
Clean supplies – Room 159
Soiled – Room 164
Showers:
Administration Area or cafeteria
Staff Area:
Morgue:
fridge)
Lab (sink, small fridge, blood collection equip.
computer)
Page 334 of 448
Adequate space
work..
Staff Area:
Pro’s:
Adequate Parking but removed from entrance
Sinks & bathrooms available
Storage space available
Con’s:
Out of the way, would need signage
Page 335 of 448
Appendix I07 Influenza Treatment Clinic – Digby Elementary
South West Health
Pandemic Planning
Non-Traditional Site Clinical Working Group
Digby Site Selection- Digby Elementary School
July 2005
Patient Flow:
Entrance- rink parking lot for patient parking; ambulance and patient drop
off at bus entrance; staff parking and entrance by the gym; food delivery
at the kitchen exit; delivery of supplies and linen removal at playground back
exit; morgue exit at end of hallway. They will need to construct a slight
incline ramp due to a lip at each entrance.
Registration- this will be at the front office as you enter the building; they
can replace 1 of the windows with plexy glass to use for registering patient
which will also provide safety for staff. BR available for this staff close by.
This area also has 3 other spaces: a staff room and 2 office spaces ( 1 could
be used for site administrator office)
Waiting Rm- designated for Rm 75; this is a large space with an available
sink and its own bathroom. As well, 2 public washrooms are close by for
patients.
Triage Rm- designated for Rm 73; connecting door between waiting room
and triage room; also is a large space with an available sink and its own
bathroom.
Examination Rm, Treatment/Holding Rm- designated for Rm 64; this is a huge
space with enough room for a doctor’s examination plus 5 holding beds for
treatment and overnight patients. This space has a separate sink for staff, and
a BR and shower for patients which are w/c assessable. There are also 2 small
office spaces that could be used for lab and a nsg office/station, and/or
storing clean linen, as well as an area for locked space for pharmacy.
Page 336 of 448
Education/Follow up Care Rm- designated for Rm 65; connecting door
between exam room and education room; large space with a sink for staff
hand washing available.
Mental Health Rm- designated for Rm 50; appropriate space for this
service.
Morgue Rm- designated for Rm 68; away from patient traffic; there is a
separate exit beside room for transporting.
Cafeteria- kitchen appropriate for providing small meals to holding patients
and staff; could seal off half of the seating area in cafeteria which would
leave enough space for the flu clinics’ needs.
Staff- showers available by gym (still enables gym to be sealed off); staff
room and bathrooms at the administration area; food provided at the
cafeteria
Space available at back playground exit under stairwell for storing dirty
linen or garbage prior to pick up.
Utility/janitor room with water supply available for housekeeping (beside
public washrooms).
Multiple closets/small rooms can be used for storing supplies and clean linen.
(Space beside Rm 50, and space besides Rm 64).
Would like to have a volunteer information desk at the intersection to guide
patients to registration or waiting room etc.
Sealed off areas- gym, library, Rms 66,67 & 71, Art room, Computer room,
and 2nd floor.
Page 337 of 448
South West Health
Pandemic Planning
Non-Traditional Site Clinical Working Group
Digby Site Selection- Digby Elementary School
July 2005
School Office
Cafeteria
Rm # 75
Rm # 73
Rm # 64
Rm # 65
Rm # 50
Rm # 68
Registration Area & Staff Room
Cafeteria
Waiting Room
Triage Room
Examination & Treatment/Holding Room
Education/ Follow up Room
Mental Health Room
Morgue
Page 338 of 448
Appendix I08 Influenza Treatment Clinics – Maple Grove
{SWN District
Non-Traditional Site: Maple Grove Education Center Inspection Date: 04 Aug 2005
Completed by:________________________________________________
Item/Criteria
EHS arrivals.
Registration Area:
-Good parking close to entrance
-Entrance for patients & staff as well as
EHS well located and w/c accessable
-Good space for all identified areas
-Initial plan will be not to use gym,
however should need arise, this space
could be adapted
-Good office & registration space
-Window area for patient access also
allows for visual of waiting area
-Phone lines and computer access present
-Waiting area will be the main foyer at the
entrance
-Male & female washrooms close by
-After discussion with YRH nursing it has
been decided to do triage in hallway
adjacent to registration and very close to
the exam area
-
Page 339 of 448
-Chairs will be required for wait area
(these are available at the school)
-Screen could be used for triage
-Rm 109 to be used for Exam
sink
-Has washroom inside room with sink
-Enough space to have two exam areas
-Will require dividers/curtains to allow two
treatment areas
-needs telephone & computer connections
Education/Follow-up care: (if possible -Rm 107 has plenty of space for both
education and NSHC
-Close to waiting area & entrance/exit
-Although this is the library area there
would be actually very little to have to
move to make it serviceable
-Rm 118 has space for 10 beds/cots
-Two sinks in room
-Good counter and cupboard space
-Male & female washrooms next door
-Showers available across hall
-Has computer access
-Good storage in Rm 118
well)
-Rm 106
-Close to waiting area & entrance/exit
-Located in general office/registration area
Showers:
-Clean storage Rm 121
-Dirty utility could be in janitor space
between Rm 118 & Rm 121
-Available across hall from Rm 118
Page 340 of 448
-Located away from exam area
-Should have telephone hook up
-Rm 122
-Furniture from library could be relocated
here
-Close to kitchen facilities
-Rm 123
-Exit available beside this room
Staff Area:
Morgue:
Pharmacy (Double lock cupboard or box; small -Locked cupboard available Rm 118
fridge)
Lab
computer)
-Rm 121
Page 341 of 448
-Requires phone hookup
-Requires fridge
work..
Staff Area:
Additional Comments: This site has met all the space requirements and has room to grow if necessary. All clinical reviewers were
very pleased with the number of sinks available for staff and bathrooms available for patients remaining on site for care.It is noted that
this is a P3 school and therefore not under the control of the School Board. The chief custodian was on site and stated that his boss had
indicated his desire to cooperate with the DHA. Obviously this would have to be investigated if this site is chosen.
Conclusion: The clinical team indicated that this would be their first choice for a NTS. It is recognized that this is a P3 school
and we are hoping that the Committee Chairs will be able to discuss with the owners a satisfactory resolution for school to be
turned over if the DHA feels it is necessary to prepare the site for pandemic care.
Page 342 of 448
Influenza Clinic – Maple Grove Education Center
24 Hour Site – Exam, Treatment, Education & 10 Bed Unit
October 2005
Patient Flow
Entrance: Main school entrance to be used; ample parking outside school; EHS would
also use main entrance to bring patients to clinic; entrance available at back of school for
supply delivery, garbage removal and morgue exit.
Registration: This will be set up just off the main foyer, it is a glassed area that is easily
visable. Office for administrator is also available here as well as a staff washroom. Good
setup for communication – telephone, fax and IS.
Waiting Rm: Located in main lobby. Public washrooms are available close to waiting
area. There is plenty of space for chairs; close to education, follow up care and mental
health areas.
Triage Area: Following discussions with ER nurses from YRH, it has been decided to
do triage in hallway just down from registration. A small screen could be used for
privacy. A washroom is located close by for staff to do regular hand washing.
Examination/Treatment Rm: Rm 109 – Space enough for two exam areas; will need
curtains to divide room. Washroom located in room for staff/doctor hand washing.
Observation/Overnight Rm: Rm 118 – Ample space for 10 beds and necessary
equipment. There are two sinks in the room, washrooms next door and showers across
hall. Good cupboard/counter space for supplies; ability to lock cupboard for pharmacy.
This room is a distance from the treatment area and will require telephone set up to assist
with communication.
Dirty Utility: Rm 119 – Located between washrooms next to obs/overnight room. This is
presently a janitor room with large floor sinl and water supply.
Clean Storage/ Lab: Rm 121 – Directly down the hall from observation/overnight area.
Ample room for storage and lab setup. Has IS hook up but may need telephone line.
Education/ Follow-up Care: Rm 107 – Located by waiting area. Large room that may be
divided to have several functions but there is also a small office that could be used
instead of dividing the room.
Mental Health Rm: Rm 106 – Located by waiting area. Separate office to allow for
privacy. Has telephone hook up; washrooms across the hall.
Page 343 of 448
Morgue: Rm 123 – This room is located close to an entrance that could be used which
would allow for privacy away from the patient areas. This room could also be used for
garbage storage, if health codes allow.
Cafeteria: Rm 124 – The present kitchen is very adequate. The “caferorium” could be
used for staff meals if staffing and time allowed.
Staff: Rm 122 – This room could be used for the staff to take breaks, eat, etc. Showers
are available across the hall in the gym changing rooms (gym can remain sealed). This
room is located close to the kitchen as well as a separate entrance that staff could use.
Sealed Areas: The upstairs of the school will not be used. The initial plan does not use
the gym and this should be sealed. The hall beyond room 103 and the washrooms will be
sealed. Rooms 115 and 113 would also be sealed.
Alternate Entrances: The school has many additional entrances. The two entrances at
the back of the school on either end of the corridor beginning with room 113 and ending
with room 124 can be used for delivery and removal of supplies/waste.
Page 344 of 448
Appendix I09 – Influenza Treatment Clinics – Meadowfields
{SWN District
Non-Traditional Site: __Meadowfields Community ___
Inspection Date:_June 7/05
Completed by:__Debbie Sutherland RN____________________
Item/Criteria
EHS arrivals.
EHS able to access entrance near room 124.
Security cameras available for increased staff
safety.
Registration Area:
Site manager can utilize office administration
space. Administration area at entrance with
area to be utilized for registration and patient
waiting area in foyer
Triage can be done in multimedia room (109);
*large* open area of part on map called cluster
area for waiting
sink
Use Room #116 for exam area. Large room
classroom. 2 sinks and toilets in each of rooms
#116, 120, 131 and 127.
Page 345 of 448
Noted a distance from registration to patient
area; Challenge for larger # children to be
relocated.
Boys and Girls washrooms across the hallway to be
utilized for public washrooms.
Room #120 education area.
well)
*Positive – 8 electrical outlets here*
Space 131-127 on map. These are two
classrooms with access between the two. Put
five cots in each room = 10 total
Adequate space for equipment in corner of a
room treatment area.
Room 122 for Mental Health.
Kitchen can utilize a corner of cafeteria for
storage for #155 on map.
Alternate entrance near cluster area not
optimal but can be utilized.
Office:
(Phone, computer) Signage and access
Area #132 for duty utility space. Room in 121
for clean storage.
Showers:
Shower in infirmary room for staff to use.
Staff Area:
Use the “infirmary” for staff. Room #154.
Morgue:
Room 124 (last room) at end of wing closer.
Next to back exit.
Page 346 of 448
This school has 8 sinks in treatment areas
versus 2 at Plymouth site.
Has a shower, cot, sink and toilet in this room.
Cupboard space available to lock.
fridge)
Lab (sink, small fridge, blood collection equip.
computer)
•
•
Available space for lab.
This facility overall is a first choice for 24/7 site after review of it compared to Plymouth. Pros outweigh the cons by far.
Jodi/Nancy need to check with administration of this school t see if it would be accessible for a 24hour day.
Positive – geographically this school is town area, resources close. i.e. personnel, hospital.
Page 347 of 448
work..
Staff Area:
Pros
-
Geographically close.
Staff safety can be achieved much easier due to 4 sinks for staff in treatment areas.
Visibility ++ of patients by staff due to set up of rooms 131-127.
Staff area (infirmary) much closer than area chosen at Plymouth site. Quite a distance at Plymouth.
Easier access for public.
Good access to exits.
Lots of extra space.
↑ Safety with use of surveillance cameras.
Page 348 of 448
Cons
-
Distance from chosen registration area to actual patient area – bit long -.
Alternate entrance not optimal.
Larger number of school students to move if this site utilized.
Not the first choice of the schools themselves for us to utilize. * They prefer we utilize Plymouth.
Page 349 of 448
Appendix I10 – Influenza Treatment Clinic – Jean Marie Gaie
Notes from school inspections for Pandemic non traditional sites;
(Clare area, 12 hour clinic)
Ecole Jean Marie Gay;
The following were identified as positive characteristics;
• Parking is adequate.
• Location is on the “main street”, in the centre on the municipality.
• There are enough classrooms which could be used for storage, offices, staff area, clean and soiled utilities, lab, pharmacy etc…
The following were identified as negative characteristics;
• The one wheelchair entry leads to a ramp which would be difficult to use, it is too steep. Could not be safely used by the frail
or elderly.
• There are steps in the male and female bathrooms (to access the stalls).
• The patient care area would be a long distance from the other areas.
• There is only 1 plug in each classroom.
• There are not enough sinks for staff or patient use (only 2 in total, in the bathroom).
• There are no showers in the facility.
Team’s Conclusion; this facility does not meet the basic requirements to provide a safe environment for staff and patients in a 12 hour
clinic.
Page 350 of 448
Appendix I11 – Influenza Treatment Clinic – Joseph Dugas
Ecole Joseph Dugas – recommended as second choice.
Positive characteristics;
•
•
•
•
•
•
•
•
•
Plenty of parking.
Can easily be made wheelchair accessible.
Good registration area with good patient flow to triage, treatment, education areas
etc…
Sufficient number of sinks for staff and patients.
Shower area.
Good staff area – private.
Sufficient number of rooms for all departments.
Washrooms are adequate and easily accessible.
Is easy to find via number 1 highway.
Recommendation of the group; that this location be used for the Clare 12 hour non
traditional site.
Page 351 of 448
Appendix J Materials
Management
MATERIEL MANAGEMENT SERVICES
District Health Authorities
Western Nova Scotia
Pandemic Flu Plan
•
Provide appropriate Materiel Management Services including procurement,
supplies, equipment, sterilization, and distribution at
District Facilities – SSRH; FMH; QGH
- RSW; YRH; DGH
- ACHC; SMH; WKM; VRH; EKM
All Non-Traditional Sites
All Vaccine Clinics
•
Forty percent (40%) of Materiel Management Services staff may be ill.
•
Emergency situation may last 6-8 weeks
•
Pandemic Flu will spread rapidly but there will be some notice
•
District plans allow for reduction in Ambulatory Care Clinics and Surgery, but
bed numbers are expected to be maintained or increased and fully occupied.
•
Pandemic will likely result in shortage of medical supplies due to stockpiling
•
Medical Supplies will not be stocked beyond normal levels prior to a Pandemic
flu
Page 352 of 448
Western Nova Scotia
Pandemic Flu Plan
District Facilities, Non Traditional Sites, Vaccine Clinics
(Yarmouth Regional Hospital; Digby General Hospital; Roseway Hospital)
1. (i)
Procurement Services
-
Procurement service will be available 8 hrs per day ( Mon – Fri)
On call coverage will be provided for weekends/holidays.
Procurement will utilize their 24hr vendor emergency contact listing when
required for after hours or weekend/holiday urgent supply requests.
EMO/ Government initiatives for supply/demand of pandemic flu supplies
(yet to be determined) will be utilized by Procurement staff if applicable.
Procurement will work closely with other provincial procurement departments
during the pandemic flu.
-
(ii)
Staffing
-
-
(iii)
Minimal staff requirements – 5.0 FTE’s
( will provide procurement for routine and emergency supply requests. Other
procurement functions such as contract management, tendering, capital
equipment process, renovation/special projects, product standardization may
not be sustainable by the procurement department during a pandemic flu.)
Staffing levels will be assessed on a day to day basis and reorganized in order
to continue procurement services.
Supplies
•
•
•
•
•
Medical supplies will not be stocked beyond normal levels prior to a Pandemic flu
Vendors will be notified as soon as there is any indication of an impending
pandemic flu ( Appendix A )
Supplies will be stocked ASAP
Additional supplies required ( appendix B)
Provincial Directors of MM are currently working on MOA for assistance and
support of each other DHA during pandemic flu. ( Appendix C )
Page 353 of 448
Western Nova Scotia
Pandemic Flu Plan
2. (i) WAREHOUSE/DISTRIBUTION
•
•
•
•
•
•
Warehouse/Distribution service will be available 8 hours per day/7 days per
week
Supply distribution will continue, at approximately the same time
Additional coverage will be provided for weekends and holidays
Inventory levels will be monitored and increase demands will be
communicated to Procurement Coordinator
Additional distribution vehicles will be secured from outside contractor
( Enterprise Rental)
Outside contracted courier service (at present DHA 2 does not have the
services of an external courier service).
(ii) Staffing
•
Minimal staffing requirements – assuming supplies being distributed at all
three (3) sites and NTC are set up on quota carts and maintained once daily
by MM staff.
3 Stores Clerks ( 8:00am – 4:00pm )
2 Van Drivers ( 7:30am – 3:30pm )
1 District Manager
•
•
•
•
•
•
On call services will be implemented
Volunteers will be required for STAT delivery of supplies
Staffing levels will be re-assessed on day to day basis and will depend on
availability of volunteers
Staff will be re-deployed to NTC as needed
SPD staff will be re-deployed to warehouse as needed and depending on
sterilization requirements/workload
Outside courier service will need to be available for distribution to facilities,
NTC, and vaccine clinics as required
Page 354 of 448
Western Nova Scotia
Pandemic Flu Plan
(iii) Supplies
•
•
•
•
•
•
•
•
•
•
Inventory levels will not be increased beyond normal levels prior to a
pandemic flu
If there is any indication of an impending pandemic flu, inventory levels of
supplies required will be increased
Quota carts in effected departments will be adjusted accordingly to meet
demand
Additional totes to include NTC and vaccine clinics will be utilized for
transporting of supplies
Existing van schedule to all facilities within DHA will be maintained
Additional van schedule will be implemented to include NTC and vaccine
clinics
Weekend and holiday distribution schedule will be implemented to include
DHA facilities, NTC, and vaccine clinics
Requisitioning process will remain the same. Educational guidelines will be
provided to NTC and vaccine clinics.
Request for supplies from NTC and vaccine clinics will be faxed to (902742-1947)
Quota carts will be set up and maintained on a scheduled basis by MM staff
Page 355 of 448
Western Nova Scotia
Pandemic Flu Plan
3.(i) STERILE PROCESSING
•
Sterile Processing services will be available 9 hours per day/ 5 days per week and 7.5
hours on weekends and holidays.
Currently DHA 2 has chosen to continue with reusable Linen Packs and Gowns. Linen
packs and gowns will still be prepared as needed.
Disposable Trays (see appendix D) are available and will be utilized where applicable.
Sterile supplies to all departments will continue as usual. Quota levels will be
adjusted accordingly.
Sterile Processing services will be provided at Yarmouth Regional Hospital and
distributed through MM van to off site facilities, NTC, and vaccine clinics.
•
•
•
•
(ii) Staffing
•
•
•
Minimal staffing requirements – assuming reduction in services and utilization of
disposable packs, gowns, and trays
2 SPD Aides (7:30am – 3:30pm )
1 SPD Aide (8:30am – 4:30pm )
1 SPD Aide (9:00am – 5:00pm)
On call services will be implemented.
Staff will be re-deployed to warehouse and LPN staff to Nursing as needed.
(iii) Supplies
•
•
•
•
•
Quota levels will be adjusted accordingly
Sterilization Integrity will not be affected when processing/preparing of
instruments/trays
Sterile supply items will be transported in appropriate totes to off site facilities,
NTC, and vaccine clinics
NTC and vaccine clinics will be provided with written instructions and appropriate
soaking containers for dirty instruments
Disposable trays will be utilized accordingly
Page 356 of 448
Western Nova Scotia
Pandemic Flu Plan
4. (i) PATIENT PORTERING
•
•
•
•
Patient Portering will be available 10 hours per day/ 5 days per week and 7.5 hours
per day on weekends and holidays
Porter services will focus mainly on patient and visitor portering needs
Daily scheduled runs will be provided at 8:00am, 10:00am, and 2:00pm
Mail distribution will be provided when possible
(iii) Staffing
•
Minimal staffing requirements – assuming Portering service will not be offered at
NTC and vaccine clinics
1Porter ( 8:00am – 4:00pm )
1 Porter ( 9:00pm – 5:00pm )
1 Porter (10:00am – 6:00pm)
•
•
Volunteers will be required for additional assistance depending on day to day activity
Staffing levels will be re-assessed on day to day basis and will dependent on
availability of volunteers
Page 357 of 448
Western Nova Scotia
Pandemic Flu Plan
Supplier Contacts
Supplier
Telephone Number
Page 358 of 448
Contact Info
SUPPLY LIST FOR OFF-SITE CLINICS
Triage
Desk or table
3 chairs (patient, staff, escort) - chairs should be easy to wipe down
• Hand sanitizer
• B/P cuff
• Stethoscope
• thermometers (adult/pediatrics)
• probe covers for thermometer
• O2 sat machine
• Emesis basins (preferably pink disposable)
• Kleenex
• Disinfecting wipes
• Masks
• Gloves
• Gowns (disposable yellow)
• Garbage bin
• Wheelchair
• Portable O2 tank
• O2 masks (pediatric and adult)
• O2 nasal prongs (pediatric and adult)
• Nebulization equipment
Accucheck machine and supplies (strips and needles)
EKG machine (paper and electrodes)
Crash cart (endotracheal tubes of various sizes – ask respiratory)
Drug tray (pharmacy)
Scales (upright and baby)
**Would need enough supplies for at least 10 overnight stay patients and 5 day treatment
patients. After first few days of clinic, we would be able to determine what needs to be
increased
Page 359 of 448
Treatment and Overnight Stay Area
All bulleted items from triage list plus:
Linens for beds, chairs (sheets, blankets, pillowcases, towels, facecloths, gowns, soakers)
Incontinent pads
Briefs (all sizes)
Pediatric diapers (all sizes)
Disposable wipes
Bedpans
Urinals
Commode chairs (2)
Iv tray
IV equipment: solutions: NS, R/L, D5W, 0.3/3.3, D5 .45%S, (500 & 1000 mls)
50 &100 ml saline med bags
IV catheters (24, 22, 20, 18 gauge)
Butterflies (23, 25 gauge)
IV tubing (primary and secondary)
Needleless equipment (twinpak, prn adapter)
Tape, kling , burn net
Gauze (2x2)
Tourniquet
IV poles (10-15)
IV pumps (minimum 5)
Suction equipment (portable and disposable, suction catheters and tubing)
Pedialyte fluid replacement
Toothettes
Mouthwash
Disposable toothbrushes
Combs
Laundry bins
Sanitary Napkins
Tena
Stretchers (10 – 15)
Recliner chairs (5 chairs from day care surgery)
Page 360 of 448
Physicians Assessment Area
Desk
Chairs (2 or 1 chair/1 stool)
Stretcher (from OR)
Linens
B/P cuff
Stethoscope
Otoscope
Ophthalmoscope
Tongue depressors
Kleenex
Swabs (pink)
Urine/ stool/ sputum collection containers
Garbage bin
Emesis basins
Hamper
Hand Sanitizer
Waiting room
Hand sanitizer
Kleenex
Chairs (from ambulatory care FMH)
Bathroom supplies
Garbage bin
TV
Palliative Care
Lamp
Bed
Cot or recliner chair for family member
Chairs
Lamp
Garbage bin
Small table
Linens
Extra stretchers will be needed (10 – 15)
The bulleted items will be needed in most areas
Page 361 of 448
Annapolis Valley Health Authority
South Shore Health
Southwest Nova District Health Authority
215 Dominion Street, Suite 109
Bridgewater, N. S. B4V 2K7
543-0850 (Phone)
543-8024 (Fax)
Dennis Oxner
South Shore Regional Hospital
90 Glen Allen Drive
Bridgewater, Nova Scotia
B4V 3S6
Dear Dennis:
Re - Supplies for Pandemic Flu Clinics
Syringes –
3 ml., for adult’s 100/box
1 ml., for children 100/box
Needles -
1 in., 25 gage for adults 100/box
7/8 in., 25 gage for children 100/box
Alcohol Swabs 200/box (2 per person)
Gauze 2 x 2” or 5 x 5 cm. 200/pkg.
Band-Aids 100/box
Gloves – small and medium, non sterile
Paper bags
Garbage Bags – small
Sharps Containers
Towels – (small, 16.5 x 16.9, 100/box) (large, 15/pkg.)
Aprons
Paper Tissue
I hope this list is helpful, if you need any further assistance please don’t hesitate to contact me.
Regards,
Lynn Boudreau
Commicable Disease Prevention & Control Nurse
J/Lynn Boudreau/Letter to Dennis Oxner
Page 362 of 448
Western Nova Scotia
Pandemic Flu Plan
MOA – Provincial MM Directors
Page 363 of 448
Mass Vaccination Clinic Supplies
One box of general supplies for each clinic site shall contain:
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
12 Portable partitions [corrugated school display boards are acceptable]
6 individual orange or apple juice boxes
12 pens
12 pencils
1 steno note pad
1 stapler
1 package 2” x 4” post-it notes
1 box large elastic bands [size # 32 ok]
1 box paper clips [size #3 ok]
1 roll of “Scotch” Tape
1 dozen large garbage plastic bags
2 dozen small plastic bags
1 box of small towels [16.5x16.9 with 100 per box]
1 box of large towels [with 15 per box]
1 box of 1 inch needles
4 Sharps container [7.6 litre size]
1 package of Virox wipes [160 sheets per container]
1 box small gloves
1 box of medium gloves
1 box of large gloves
Clinic box for 100 persons shall contain:
*This box will be primarily for adults; if children are expected at the clinic, contact Materials
Management for contents adjustment.
♦
♦
♦
♦
♦
♦
1 box of 25 gauge- 1 inch needles
1 package of 2x2 inch non-sterile wipes (100 per pkg)
1 box of alcohol swabs with 200 swabs per box
1 box of Band-aids with 100 per box
1 Sharps containers 7.6 litre size
Page 364 of 448
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
1 box of tissue paper [Kleenex]
2 Pens
2 pencils
1 roll of masking tape
1 apron
1 container of hand sanitizer
2 small plastic garbage bags
2 large towels [in Ziploc bag]
4 small towels [in Ziploc bag]
6 pair of each size of gloves [in Ziploc bag]
1 dozen disposable face cloths [in Ziploc bag]
2 emesis bags per box [in case of nausea and vomiting]
Public Health shall pack supplies for each mass clinic and it shall contain:
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
Signs for clinic time
Laminated signs; “Please remain in clinic area for 15 minutes”
12 anaphylaxis kits [1 per vaccinator]
2 coolers
14-16 Ice packs
14-16 pieces of bubble wrap
Tear-off sheets [if available]
Reciprocal forms [if using]
1 cell phone or phone available at site
Canadian Immunization Guide [optional]
Pandemic flu vaccine specific information for immunizers
Tickets/coupons to manage traffic flow of clients [for internal traffic controller]
Method of documentation for clients [long forms, recips and/or laptops as per IT
plan]
♦ Awareness and informed consent video/DVD [TV & VCR/DVD player]
Page 365 of 448
Western Nova Scotia
Pandemic Flu Plan
Disposable Trays
Catalogue
Number
DT00001
DT00003
DT00004
DT00005
DT00006
DT00007
DT00008
DT00009
DT00010
DT00011
DT00012
DT00014
DT00015
DT00016
DT00019
DT00020
Description
Tray Lumbarpuncture Adult
Tray Urethral Catheter
Tray Irrigation with Bulb Syringe
Tray Dressing Disp. Sterile
Tray Continuous Epidural Sterile
Set Enema Administration
Kit Suture Removal Sterile
Tray Paracervical Pudental Block
Tray Shave Prep
Tray Dressing Customized
Tray Irrigation with Piston Syringe
Tray Foley Catheter Disposable
Tray Thoracentesis sterile
Tray Catheter Universal
Tray Disposable Bone Marrow
Tray Spinal
Page 366 of 448
U/I
SSH
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
ea/1
Inventory
SWN
AVH
Appendix K
Human Resources
Page 367 of 448
Appendix KO1 Human Resource Staff Coordination
•
•
•
•
Human Resource/Staff Coordination area will be managed by Human Resources and
Departmental Managers in each location.
Influenza Treatment Clinics are an extension of SWN and will be managed by designated
site administrators, who will direct the other managers and employees.
On arrival to the Human Resource/Staff Coordination area, staff will sign in, be assessed
for skill mix and assigned to an area of need, including Non-Traditional Clinics.
All managers should be encouraged to keep current records of staff which include their
skill set, areas of experience and expertise for reference in the event of a disaster.
Identification of existing health care services (see
). Services which will be
suspended during a pandemic and number of health care workers who could be relocated
within the institution and/or to flu treatment clinics due to temporary suspension of some
services – Please see Appendix F05A. (Marilyn Pothier and managers currently updating).
It is recommended a resource management sub-group be created at time pandemic is
declared to coordinate human health resources for each facility, off site clinics, as well as
an equipment and supplies officer. This sub-group will have available, all human health
care resources, registered health care worker volunteers (Appendix F06) including skills
mix and availability (being worked on by Marilyn Muise), and current awareness of
equipment and supplies (materials management-check their plan for worksheet??). This
group will consist of a combination of health care support.
Page 368 of 448
Appendix K02 Human Resource Management Issues that Require
Clarification
•
•
•
•
•
•
Relocating health care workers to different settings within an acute care facility (or
expansion to Flu treatment clinics) needs ?policy.
Retired health care workers (are they volunteers/or paid, and they will need assurance
that working during a pandemic would not affect their pension plans. As well, College of
Registered Nurses of Nova Scotia (CRNNS) make note that retired nurses will not be
licensed unless they can meet the regular requirements for licensing as required for all
RNs. That means no retirees can provide care that falls under the scope of practice for all
RNs unless they can prove their competency to practice. They can act as highly trained
volunteers and the district would need to develop a policy as to what we are prepared to
allow them to do for liability purposed i.e…vital signs, bed baths, etc.
Who will coordinate health care facility volunteers?; will also coordinate skill for same).
Liability/insurance issues in relation to health care professionals, other non-professional
health care workers, retired health care professionals, volunteers providing patient care
(families), and other non-medical tasks. It is our understanding that these issues will be
addressed by provincial planners to determine the legislative, administrative, licensing
and other options within the province.
Changes to Scopes of practice issues and delegation of tasks to non-professional. Staff
and volunteers. Theses need to be reviewed with respect to licensing practices, labor
agreements and Emergency Legislation.
Provision of clothing (Protective clothing) to Red Cross Volunteers in the community as
well as health care workers and volunteers within flu treatment clinics.
Retired Health Care Workers
(Please see Appendix F04 (one part of the larger data base) for retired physicians and nurses. It
is important to establish a method for assessing qualifications and competence during a
pandemic when people are being hastily recruited.
Community Volunteers
The following are needs that must be addressed by SWH, Community Services, Red Cross and
Volunteer Agencies Working together.
There should be one person responsible for volunteers with two back-ups for assistance and
support. The volunteers can be recruited from government staff, district staff, community
organizations such as Kiwanas, Lion’s Club, etc., and church groups ( there is one contact person
at each church who is responsible for organizing the volunteers for that
church ).Community services can assist with this assignment as they use community resources.
The volunteers should be screened by individuals who have experience at interviewing.
Questions should be drawn up to demonstrate that the individual has good communication skills
and a high level of maturity and it must be made clear that it is not a job where there will be
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monetary compensation. It may be worthwhile having an agreement drawn up to indicate that it
is volunteer work rather than employment for compensation.
The volunteers can be used to :
• Register clients and complete forms
• Direct clients within the clinics.
• Provide basic answers to common questions.
• Direct traffic
• Organize refreshments for clients and staff
• Provide support in the rest area
• Provide assistance as runners for supplies
• Track and replenish supplies within the injection stations
Training of volunteers:
A training session for volunteers should cover very basic information on pandemic influenza,
how the clinics are structured, who receives vaccine and why and a list of commonly asked
questions and answers provided.
At the start of each shift an update should be provided to each group of volunteers with an
opportunity to ask questions and delegation of duties for that shift.
Refreshments should be provided for volunteers as well as the other staff.
It should be noted that the volunteers may need to have more flexible hours. They may need to
work shorter shifts in some cases.
Provide verbal and written acknowledgement for their volunteerism.
For additional information on possible volunteer roles, please see Appendix F08
Red Cross
1. Red Cross will provide Volunteer Coordinator (Role-identify community volunteer
agencies, positions or individuals and to take responsibility for directing the process of
accepting, screening, training (in collaboration with health services) and placing
volunteers).
2. Red Cross will coordinator volunteer location site (Community Volunteers).
3. Red Cross has contact names and numbers for District Volunteer Agencies and will liaise
with organization within district to determine number of volunteers that may be available
along with specific skill sets (see Appendix F 08 for possible volunteer roles).
4. Red Cross will partner with Dept. of Community Services to help provide services for
emergency foster care for children whose parents died from influenza
Volunteer Training resources:
A pool of trained individuals can be maintained, during the interpandemic period that would be
available to implement training programs as quickly as possible at the onset of a pandemic. To
facilitate the process it would be essential to identify training resources to ensure adequate, easy
to use procedures/instruction manuals for tasks such as admissions, patient tracking, etc
Volunteer agencies have in place recruitment, screening, some training programs and
management programs in place.
Additional Training Resources and Programs for volunteer agencies:
Curricula for the above listed skills are available through existing agencies.
Training programs include, but are not limited to:
on-line courses, including an Infection Prevention on-line course for infection
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control issues at www.igc.org/avsc/ip/index.html
Association for Practitioners in Infection Control and Epidemiology training
manual “Influenza Prevention: A Community and Healthcare Worker Education
Program” < http://www.apic.org/resc/>
St. John Ambulance Brigade. Brigade Training System. 1997
St. John Ambulance Brigade. Handbook on the Administration of Oxygen. 1993.
ISBN 0-919434-77-0
The Canadian Red Cross Society. Yes You Can prevent disease transmission.
1998
Nursing colleges training programs (i.e. the basic care programs for health care
aides)
CHICA, APIC and the Infection Control Association in the UK have a “tool kit” with
detailed forms and templates that could be used at the NT site, 2002. [reference:
“Infection Control Toolkit” - Strategies for Pandemics and Disasters, can be
ordered through the Community and Hospital Infection Control Association
(CHICA-Canada), Phone: 204-897-5990 or toll free 866-999-7111; Email :
chicacda@mb.sympatico.ca]
Safety and protection of workers is of primary concern. For list of Volunteer Fire Departments
please see Appendix K.
Queries:
**Work with Community Services/Red Cross and other organizations to develop plan to
include recruitment, screening, training, scheduling and coordination
**Communication and education for service clubs/organizations to seek willingness to
volunteer.
**Develop ‘just in time’ training programs.
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Appendix K03 Retiree Lists
August 2004
Yarmouth
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Digby
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Roseway
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Appendix K04 Memo re Volunteers
MEMO
TO:
Dr. Gould
FROM:
Nan Holden
RE:
Volunteers
DATE:
September 23, 2004
I have pulled together the references for the use of volunteers in a Pandemic Influenza.
We need to develop a plan which addresses:
•
•
•
•
•
Where volunteers will be needed and their roles;
Who will be responsible for volunteers in specific settings eg. facilities, NTS, home care,
etc.;
Who does recruitment and screening;
What are the training needs and who takes responsibility for that and how;
How the volunteer “program” would be coordinated.
I believe the best way to accomplish this to ensure good communication and planning is to bring
the appropriate parties together e.g. Human Resources, Community Services, Red Cross and the
District people responsible for the Health Services piece.
__________________
Nan Holden
cc: John Dow
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PANDEMIC INFLUENZA PLANNING
VOLUNTEERS
September 24, 2004
These are references to preparedness planning for volunteers in the following:
NS Pandemic Influenza Preparedness Plan
Page 28 – Emergency Preparedness & Response Checklist
•
•
Provincial – Identify voluntary organizations which would assist during the pandemic.
District – Identify voluntary organizations which would assist during the pandemic.
Page 35 – Provincial Health Services Pre-Pandemic Checklist
•
•
Provincial – Determine sources where health care workers and volunteers could be
acquired during the pandemic.
DHA’s – Determine source from which health care workers and volunteers could be
acquired assuming that hospitals are using much if not all of the available staff for their
own needs.
Page 40 – Roles & Responsibilities
•
Police/RCMP – Establish a registry of former & retired personnel and suitable volunteers
who could be called upon to assist during times of staff shortage.
Page 41 – Community Services
•
Establish a registry of former & retired personnel and suitable volunteers.
Page 42 – EHS
•
Page 43 – Fire Departments
•
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Canadian Pandemic Influenza Plan
Section 3.2.4 Health Services Emergency Planning (Page 40)
(iv)-Non Traditional Workers: Health Care Workers and Volunteers
Communities and health care organizations needs to have strategies in place that will address
what will be done when health care facilities are overwhelmed and medical care must be
provided in non-traditional settings. Temporary hospitals and outpatient clinics may need to be
set up to provide care. Guidelines for the provision of care in non-traditional settings have been
developed to assist with this task (Annex J). The issues addressed include: administrative
options for non-traditional hospitals, potential resources and sites, critical characteristics and
support services needed, type of work done within the sites, and liability protection.
Guidelines have also been developed addressing the potential sources of additional labour during
a pandemic, volunteer recruitment and screening, liability and personal insurance workers,
temporary licensing of workers, roles and responsibilities, and training programs (Annex J).
Annex J – Guidelines for Non-Traditional Sites & Workers; Section 2.2.6 Human Resource
Issues; Page 410-414 – Identify.
Section 2.2.6 Interpandemic Tasks in Volunteer Management (Page 410)
There are several tasks/activities that should take place during the interpandemic period to
optimize the use of volunteers in the pandemic response. These include:
a. Communicate with the public and with volunteer organizations;
b. Develop and maintain databases of volunteer organizations;
c. Develop job descriptions and skill lists for volunteer positions in conjunction with
volunteer agencies. (See Checklist of Functions and Personnel);
d. Develop recruitment, screening procedures;
e. Develop training procedures;
f. Monitor and track qualifications;
g. Prepare to manage volunteers.
The time between the WHO declaration of an influenza pandemic, the first wave and analysis of
the severity of the pandemic will be very short. There will be a need to recruit, screen, train and
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deploy volunteers as quickly as possible. Therefore procedures need to be in place in order to
best place volunteers in as short a time as possible.
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Identify and Recruit Volunteers
Definition of Pandemic Volunteer
The following is a definition of a volunteer for the purposes of pandemic planning and
response. A volunteer may be a health care or other professional, or any other person who offers
their services freely. Notwithstanding that while a volunteer may not expect financial gain, or
remuneration for their time, the agency or government may provide supports such as:
insurance protection, family support and job security to facilitate the recruitment of needed
volunteers.
Interpandemic Tasks in Volunteer Management
There are several tasks/activities that should take place during the interpandemic period to
optimise the use of volunteers in the pandemic response. These include:
a. Communicate with the public and with volunteer organizations.
b. Develop and maintain databases of volunteer organizations.
c. Develop Job descriptions and skill lists for volunteer positions in conjunction with
volunteer agencies. (See Checklist of Functions and Personnel)
d. Develop recruitment, screening procedures.
e. Develop training procedures.
f. Monitor and track qualifications.
g. Prepare to manage volunteers.
The time between the WHO declaration of an influenza pandemic, the first wave and analysis
of the severity of the pandemic will be very short. There will be a need to recruit, screen, train
and deploy volunteers as quickly as possible. Therefore procedures need to be in place in
order to best place volunteers in as short a time as possible.
A volunteer is a person registered with a government agency orgovernment designated agency, who
carries out unpaid activities,occasionally or regularly, to help support Canada to prepare for and
respond to an influenza pandemic. A volunteer is one who offershis/her service of his/her own free
will, without promise of financialgain, and without economic or political pressure or coercion.
a. Communicate with volunteer agencies
Existing volunteer agencies will be the primary source of trained, screened volunteers in
most jurisdictions. Developing ongoing communications and planning procedures with
these agencies will be essential to the planning effort.
Potential sources of volunteers include, but are not limited to:
Red Cross
St. John Ambulance
Salvation Army
Volunteer Fire Departments
Mennonite Disaster Services
Adventist Disaster Relief Association (ADRA)
Scouts, Sea/Army/Air Cadets, Guides
Big Brothers
Big Sisters
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Community Service Agencies
Christian Reformed World Relief Committee - Disaster Response Services
Each jurisdiction needs to liaise with non-governmental organizations within their district
to determine the approximate number of volunteers who would be available during a
pandemic.
During the interpandemic period, recruitment of volunteers, both those with health care
skills and those without should take place primarily through existing agencies. These
agencies already have recruitment, screening, training programs and management
programs in place. It is important that health authorities and emergency planners
establish communication with existing agencies to communicate community needs
during a pandemic, in order that agencies may recruit and maintain a core group of
volunteers with appropriate training. They may wish to add certain types of training to
standard training programs in order to address issues regarding pandemic influenza.
Specifically, volunteers should be aware that unlike other emergencies such as
earthquakes or floods, the duration of the “emergency” will be longer for an influenza
pandemic and more than one pandemic wave will likely occur. Since people view the risk
of disease differently than the risk of injury, and will be concerned about bringing this
disease home to their families, it is important that these issues are addressed during
training sessions.
b. Develop and maintain databases of volunteers
Because maintaining up-to-date databases of volunteers is time consuming, difficult and
expensive, health authorities will likely have to depend on existing volunteer agencies.
Such agencies should be encouraged, where possible, to track trained and screened
(those that had interviews, reference checks and criminal records checks) volunteers and
track records of certificates or diplomas and maintain methods of communication.
Health authorities may wish to encourage these agencies to keep their databases
current, and to expand the information on their volunteers’ skill sets or experiences, to
include skill sets that would be required in a pandemic.
c. Develop job descriptions and skill lists for volunteers
Develop a list of jobs, job descriptions and skills based on the needs of the region or
community and working in conjunction with volunteer agencies. (See Checklist of
Functions and Personnel). This list can be used to determine which training programs
are necessary and how best to recruit, train and assign volunteers in the interpandemic
and pandemic periods.
d. Develop volunteer recruitment, and screening procedures.
Develop procedures that can be implemented quickly once a pandemic is declared. (See
Pandemic Period – Recruitment, Screening and Deployment.)
e. Monitor and track qualifications and certification
Plan for methods to ensure health care workers, including volunteers are trained and
certified for the tasks they are undertaking.
Review the logistical and legal issues around developing databases of HCW’s who
have the training and skills to be deployed during a pandemic.
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Arrange with appropriate agencies to maintain databases of members for use
during a crisis. There may be legal requirements that individuals agree to keep their
names on a list of those available for work in a crisis.
Plan for a “Quick Check” method of confirming certification or qualification.
If a volunteer is trained at an NT site during a pandemic, plan for ways to test and
record the level of skills.
f. Prepare to manage volunteers
During a major crisis many people come forward who wish to volunteer. In some cases
managing the numbers of people who come forward to volunteer is a major logistical
effort in itself.
During the interpandemic period:
Review emergency plans for managing an influx of volunteers.
Plan for a volunteer co-ordinator or team – identify agencies, positions or
individuals – to take responsibility for directing the process of accepting, screening,
training and placing volunteers.
Ensure resource information is available to the volunteer co-coordinator/team.
Plan for a location for volunteer recruitment/management that is separate from
existing hospitals or clinics to reduce congestion and security issues.
Provide Training
Both health care professionals and other workers will need training for dealing with pandemic
influenza. Professionals may need training or refresher courses in tasks they don’t normally
perform, including supervision and management. Due to the limited number of health care
professionals that will be available in the community, volunteers and other non-medically
trained staff will likely be needed to perform direct patient care.
i) Train the Trainer
Health authorities and existing volunteer agencies, may establish programs to “train the
trainers,” to maintain resources to call on during a pandemic. Plan for where and how
training programs will be delivered, ideally during the interpandemic period, but also
during the pandemic.
ii) Train for Self-Care
All health care workers should be trained in self-care as it pertains to pandemic influenza
treatment and symptom control and the ability to communicate the principles of
self-care to others. As professionals will likely be required for the provision of medical
services, teaching self-care skills may become part of the volunteers’ role.
A number of jurisdictions are currently developing “Self-Care” modules designed to
improve the quality of home care. (See the Clinical Care annex for more information).
Jurisdictions are encouraged to share such resources and to develop other health
information services for the public, e.g. 24-hour telephone health information services.
Ensure that all those training in self-care are using consistent, accurate and up-to-date
information.
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Plan for methods to educate health care workers and the public in Self-Care. While some
education will be done in advance, much of the education of patients and their families
will take place in clinics, NT Sites, vaccination clinics during a pandemic.
iii) Train Health Care Professionals
A number of training programs exist which can be adapted for pandemic influenza.
Health care professionals may need training for reassignment and training for
supervision.
The time for training once a pandemic is underway will be extremely short; therefore
training should be incorporated into existing programs now. By incorporating the skills
needed during a pandemic into existing training, we reduce costs, improve efficiency and
enhance readiness.
Training may include medical training essential to working in a pandemic situation
including:
Infection control procedures
Use of respirators and care of patients on respirators
Worker and volunteer supervision
Working with grieving families
Develop a plan for training/retraining health care workers who have not been working in
health care (retirees, etc.) at the time of a pandemic. (See Resource Management
Guidelines in Acute Care Settings (Annex H) for lists of Health Care Professionals.)
iv) Train Volunteers
During the interpandemic period, volunteer training may be left as much as possible to
existing agencies. In areas without well-developed volunteer systems and agencies,
planners may wish to review the need for developing, maintaining and funding core
groups of volunteers trained for medical emergencies such as pandemic, and trained
trainers.
All volunteers should be trained for
Self-care and
Infection prevention and control (routine or universal precautions).
Based on the Checklist of Functions for your jurisdiction, volunteers working in direct
patient care may also be trained in:
Basic personal care (Bed baths, bed pans)
Observation of condition (temp, pulse, resp, etc.)
Case definition, identify the illness
Giving medications (pills, eye and ear drops, liquids)
Oxygen administration
Pressure ulcer prevention – skin care
Ambulation, mobilization
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Volunteers will also be needed who are trained in the following:
Cleaning in health care facilities
Records management
Food preparation (Food Safety Courses)
Workplace Hazardous Materials Information Systems (WHMIS) protocols
Security staff trained in working with grief stricken people.
Review the Checklist of Functions for the training required in your jurisdiction. As far as
possible, existing agencies should be encouraged to maintain skills in these tasks during
the inter-pandemic period.
v) Training Resources and Programs
ISBN 0-919434-77-0
1998
aides)
Page 383 of 448
Appendix K05 Letter to John Webb
Page 384 of 448
Page 385 of 448
Appendix K06 Memo to Community Services
Memo
From: Holly Campbell, Health Services Working Group
To: Jeannine Doucette, Community Services
The following note attempts to address some of the ‘volunteer’ issues around pandemic planning.
Nan has gathered all the references to ‘Volunteers in a pandemic’ from the provincial and federal
plans and notes that we need to develop a plan which addresses/answers the following questions.
• Where volunteers will be needed and their roles
• Who will be responsible for volunteers in specific settings eg. Facilities, NTS, home care
• Who does recruitment and screening
• What are the training needs and who takes responsibility for that and how
• How the volunteer “program” would be coordinated
Response:
From a health services perspective, these are our thoughts: (we have used the federal guidelines
as our main resource)
Where volunteers will be needed and their roles: These roles will be non-medical in nature.
WHERE:
a) 1 Non-Traditional Site (NTS) in Yarmouth (ability to hold up to 10 patients plus
triage)
b) 1 NTS Shelburne County (ability to hold up to 5 patients plus triage)
c) 1 NTS Digby County (ability to hold up to 5 patients plus triage
d) 2-3 other sites for triage only
e) Vaccination clinics
f) Home Care
g) LTC
h) Telephone information Services (24 hour health line)
i) Acute Care
ROLES:
Non-traditional sites/Triage sites need all or part the following personnel support: Following
each position will be a list of required qualifications and/or skills required as well as suggested
training/and suggestions as to how training may be provided.
FUNCTIONS
Health Records Management
IT resource
Medical Equipment and
housekeeping
SKILL SETS/PERSONNEL
Clerical skills (including computer skills), confidentiality
agreement
Knowledge of IT systems and problem solving skills
Basic Infection control knowledge
Transport of equipment for sterilization (Infection control
knowledge)
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Food Services
Care for children/family members of
workers
Emergency social services
Transportation of corpses
Transportation of patients/Staff
Transportation of Dangerous goods
(eg. Oxygen/medical waste)
Transportation of
supplies/Laundry/Lab Tests
Maintence
Pharmacy Services
Dietician at hospitals. Delivery of meals on wheels
(home care and workers’ meals) Basic food safety
training.
Training or experience in child care (criminal records
check/child abuse registry)
Community services/Red Cross
Drivers License
Class 4 license
Appropriate licenses and liability Insurance
Drivers license/Criminal records check
Knowledge of plumbing/Electrical, etc Snow Removal
Pharmacist at Hospital. **Volunteers required to
transport medication . Drivers license
Additional Information: Please verify (**) sections
(**) Red Cross will provide Volunteer Coordinator (identify agencies, positions or individuals
to take responsibility for directing the process of accepting, screening, training (in collaboration
with health services) and placing volunteers).
(**) Red Cross will coordinator volunteer location site; (What will this actually look like?)
(**) Red Cross has contact names and numbers for District Volunteer Agencies and will liaise
with organization within district to determine number of volunteers that may be available along
with specific skill sets (see above).
(**) Volunteer agencies already have recruitment, screening, training programs and
management programs in place
Safety and protection of workers is of primary concern. District Health Services will provide
Red Cross with protective clothing and equipment.
Volunteer agencies may wish to add certain types of training to standard training programs in
order to address issues regarding pandemic influenza. Such Agencies will be encouraged, where
possible, to track trained and screened (those that had interviews, reference checks and criminal
records checks) volunteers and maintain methods of communication
Valuable on-line resources:
v) Training Resources and Programs
Page 387 of 448
ISBN 0-919434-77-0
1998
aides)
Issues not yet addressed:
6. Liability/insurance issues in relation to health care professionals, other non-professional
health care workers, retired health care professionals, volunteers providing patient care
(families), and other non-medical tasks. It is our understanding that these issues will be
addressed by provincial planners to determine the legislative, administrative, licensing
and other options within the province
7. Changes to Scopes of practice issues and delegation of tasks to non-professional staff
and volunteers. These need to be reviewed with respect to licensing practices, labor
agreements and Emergency Legislation.
Holly Campbell
742-3542 Ext:526
I would very much appreciate any feedback. Thanks
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Appendix K07 Volunteers
Fire Department
Ladies Auxiliary & Contacts
SWH – May provide assistance with food in community
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Appendix L
Security
Page 390 of 448
Appendix L01 Security Plan
EMERGENCY PLANNING
Due to the threat of Pandemic Influenza, an Emergency Security Plan must be developed. This
plan must have flexibility and be fluid as the emergency on the ground will change moment to
moment. Keeping in mind that during this emergency the public who are sick and showing
symptoms is going to be directed to an alternative care facility and that the hospitals that
Securitas presently provides coverage for will be operating in a more restricted or locked down
status. With this in mind I have developed a basic plan using the principals and practices that we
used in such emergencies as Flight 111 Air Crash; 911; Hurricane Juan; White Juan; etc.
Hospitals/Present Facilities
The question must be asked; will all these facilities will be operating? Taking the worst case
scenario from a security point of view, I see them operating and doing so 24 hours a day.
Therefore, I suggest that we use a procedure that we have used in number of cases such as strikes
and the above mentioned emergencies. This is to have the Security Officers report to their
respective sites and “hot bed” them. What this means is that the Security Officers would stay in
the facility that they are assigned. Taking turns by shift to sleep either on a couch, an air
mattress, etc as beds will be at a premium. This gives a number of advantages:
• They will not catch or carry the illness to the public by traveling
• They will be able to maintain their focus at the job at hand
• They will be able to rest and maintain the pace longer as by switching to 12hr shifts and
staying has eliminated the extra travel time.
• It gives us a major capability if there is an emergency or immediate crowd control issue.
You wake the other shift and your staff has doubled until more staff can be brought in. If
the flare up or emergency passes, then the shift can just go back to their “down”
positions.
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This scenario is based on the worst case scenario and under the belief that all your facilities will
work on a 24hr basis. After reading and listening, here is the assessment of the facilities in
question:
Annapolis Valley District Health Authority
Eastern Kings Memorial
• 24 hours operation, one Officer per shift, 12 hour shifts
• 2 Officers assigned to the site.
Valley Regional Hospital
• 24 hours operation, 2 Officers per shift, 12 hour shifts
Western Kings Memorial Health Centre
• 24 hours, one Officer per shift, 12 hours
• 2 Officers stationed at location.
Soldier’s Memorial Hospital
Annapolis Royal Community Health Centre
Southwestern District Health Authority
• 24hrs, one Officer per shift, 12 hour shifts
• 2 Officers assigned.
Roseway Hospital
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South Shore District Health Authority
Queens General Hospital
South Shore Regional Hospital
Fisherman’s Memorial Hospital
Please keep in mind that this plan is an assessment and will have to maintain its fluidness as
things unfold on the ground. Vaccine and Antivirals will already be secured under the security
plan submitted under their committee’s area.
Off Site Clinics and Care Facilities
First of all, the clinics have been addressed under the Vaccine & Antiviral’s Security Plan. See
Appendix Q 02 & 03. I believe that there will be more confusion and noise, so the “keep it
simple” method will work best. For care facilities, again it will be based on the structure and
what physical security measures that will allow us. Unfortunately things will be changing
momentarily, especially at these locations. For this reason I believe we go with a three-person
team to start. The team senior will work with the clinic leader or supervisor and will over see
security in side the treatment and waiting area. The second Officer will maintain access control.
The third officer will be on constant patrol, unless otherwise required. Again, I suggest that we
plan to house them in the clinic or extremely close by. As this is just one shift I described, there
would be six Officers assigned to one of these locations. Keep in mind again, that the vaccine
will be secured by the vaccine security plan.
Conclusion
By following this basic and simple plan, especially coming out of the gate; I believe that we will
be able to meet any of your security needs or challenges. By assisting in maintaining order while
dealing with situations from public relations to crises intervention, to full scale lock down.
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Appendix L02 SWH Vaccine & Antiviral Security/Safety Plan
SUPPORT SERVICES
Vaccine & Antiviral Security / Safety Plan
SECURITY:
The plan submitted by Securitas Canada will be implemented in the case of Pandemic Influenza.
This will include:
1. 24 hour security at each storage location and at all hospital sites.
2. Security officer to accompany Materiels Management during any
transportation of vaccine and antivirals.
3. Security Officer present for the loading and unloading of vaccines and
antivirals. Required to sign off on acceptance & delivery.
Noted Concern:
The amount of Security Officers suggested to be available through the
Securitas Canada plan, may be too ambitious. Alternate arrangements
with other Security companies are confirmed as options if this becomes
necessary.
STORAGE:
Vaccines and antivirals will be stored in alarmed fridges. The alarm activates in the boiler room
in the event of a malfunction. Procedures are in place for the Boiler Operator who receives an
alarm. His initial contact is the Facility Shift Coordinator.
The area chosen for the storage of vaccines & antivirals (Pharmacy) is equipped with card access
readers. Access to these areas can be easily restricted to only essential personnel. These doors
are alarmed as well and all personnel who access this area via card will be recorded, including
the time they accessed the area.
TRANSPORTATION:
To be carried out through Materials Management and following the Securitas Canada plan.
Rental vans are to be equipped with cigarette lighters (required for vaccine/antiviral storage
units).
Transportation of vaccine & antivirals to and from clinics will require a Security Officer to
accompany the van driver.
Securitas Canada Pandemic Influenza Plan attached.
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Appendix L03 Vaccine & Antiviral Security Plan - Storage
Vaccines and Antivirals Security Plan For Pandemic Influenza
Storage
This will require one Security Officer 24hours a day at each storage location. These store
locations must be ran in the following manner to ensure proper security protection:
a. All fridges being used to store the vaccines and antivirals must be locked
units. Although a temperature alarm is imperative, a burglar alarm is
not. It would be a nicety. The room that the fridge is in should be a
secured room and it is recommended that it has a card reader system to
indicate you have entered.
b. A Security Officer must be posted in the room containing the fridge 24hrs
per day, 7 days per week. This Officer must be provided with a list of
names of those personnel who have been given authorization to enter the
fridge. The person must show picture identification and this must be
verified against the list of names. The Officer will also need to know the
person or position of whom has authority to authorize the names on the
list or to make exceptions to the list due to emergency operational needs.
Transportation
Transportation of vaccines and antivirals must be done in a vehicle that will allow the driver and
a Security Officer to travel together and still facilitate the proper refrigeration of the vaccines and
antivirals. It is security’s recommendation that you do not use the usual vehicle, but that you
rent a discreet vehicle that could accommodate the above mentioned criteria. By renting a
vehicle it gives you the option to swap it out every couple of days if this becomes necessary.
Also, by using a rental vehicle and taking full insurance it allows you in a case where the vehicle
is damaged either during its duties, by crowds, etc. to pay a blanket deductible (approximately
$500.00) and walk away.
The transportation of the vaccine and the antivirals, should be coordinated between the Security
Officer stationed at the storage facility, the Security Officer assisting in the transport and the
Security Officers at the clinic or facility receiving the goods. This will allow for maximumsecurity protection during these times, which are assessed to be the most vulnerable times from
an external threat to strike.
The procedure should be that the Security Officer must be scheduled and present for the loading,
transportation and unloading. The vaccines and antivirals must be signed for at both ends to
Page 395 of 448
show complete chain of custody. The Security Officer must at all times stay with the vehicle
while it is loaded with the cargo. If he must step away from the vehicle, then another Security
Officer will be required to take over while he is away from the vehicle.
Alternative Care/Off Site Care/ Clinics
Although these sites have not been finalized as of yet, there is a basic format that can be applied.
A minimum of four Security Officers should be used for a simple site where access can be
controlled to one entrance or where no more then two entrances are accessible (on the condition
that the each entrance can be controlled by one Officer). The third Security Officer is your
coordinator. His tasking is to relieve the other Officers for break, coordinate the vaccines and
antivirals arriving and leaving, crowd control inside the facility, and trouble shoot for emergency
responses where security is required. The fourth Officer is to secure and guard the vaccine and
antivirals, and is to follow the same procedure as in the Storage section of this plan.
Keep in mind that this plan must stay fluid as sites become confirmed and the operation gets
underway things will change on a moment to moment basis. Due to this we must be prepared to
ensure that we can reorganize to meet these challenges.
Note:
As it is clear that Security will not be spared from this illness, a contingency plan has been put in
place as follows:
1. If it is in one district at a time or in one district more heavily, reallocation of security
assets form the other districts will be done.
2. If all three districts are affected at the same time, then provincial security assets will
be reallocated to this area.
3. If the province is in crises, then the Atlantic Region or National security assets will be
reallocated as the level of the emergency requires.
Page 396 of 448
Appendix M Funeral Homes
Page 397 of 448
Appendix M01 South West Health Funeral Homes
Location
Digby
Meteghan
Yarmouth
Yarmouth
Barrington
Shelburne
Lockeport
Wedgeport
Pubnico
Funeral Home
Contact
Jayne’s Funeral
Home
Meteghan
Funeral Home
Sweeney’s
Funeral Home
Huskilson’s
Funeral Home
Graham Murphy
455-0229
Member of NS
Funeral Home
Association
No
Carmen
Robicheau
Mike McIsaac
645-2142
Yes
742-3245
No
Harold
Huskilson
875-2368
No
West Pubnico
Funeral Home
Glenn Diggdon
762-3407
Yes
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Number
Appendix M02 Memo from Norma Boudreau
NS Funeral Home Association Contacts:
Glenn Diggdon, Middle West Pubnico 762-3129 or 762-3407 or
John MacKay, Digby 245-5883
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Appendix M03 Funeral Service Association of Nova Scotia Disaster Response
Plan
FUNERAL DIRECTORS ASSOCIATION OF NOVA SCOTIA
DISASTER RESPONSE PLAN
PURPOSE
A disaster is defined as multiple death incidents that overwhelm the available recourses. To
respond to a request for assistance, a trained mortuary response team will aid those who are in
charge of human remains in the event of a disaster. The team comprised of the provincial
association president/vice-president, executive, provincial disaster team coordinator, zone
coordinators, funeral directors, embalmers and assistants, will be available to provide support in
the event of a disaster. Funeral directors/embalmers are restricted to the duties to which they are
licensed to perform as stated in the Embalmers and Funeral Directors Act, Vital Statistics Act
and Health Act.
ORGANIZATION
Provincial: For individuals operating under this plan, the persons responsible for province wide
notification and/or coordination of mortuary activities will be the President of the Association,
the Provincial Executive, and the Provincial Disaster Team Coordinator.
Zone: Qualified Zone Coordinators on the mortuary response team are appointed by the
President of the Association and will be responsible for the coordination of mortuary activities
within their respective zones.
Local: In the event of a disaster, the Chief Medical Examiner for the province is responsible for
the dead. The trained mortuary response teams and other local funeral service personnel will be
available to assist under the direction of the Chief Medical Examiner. The provincial Disaster
Team Coordinator May seek the assistance of additional Zone Coordinators through the
President of the Association.
CONCEPT OF OPERATION
At the request of the Chief Medical Examiner, The President or in his/her absence, the Executive
of the Association will notify the provincial Disaster Team Coordinator.
The Disaster Team Coordinator will aid the Medical Examiner in assessing the incident based on
the number of fatalities and the resources needed.
The Disaster Team Coordinator will notify the Zone Coordinator to set in motion the necessary
response.
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The Disaster Team Coordinator will be authorized to make the necessary arrangements for a
mobile mortuary, when deemed appropriate, and will notify the President of the Association of
the same.
NOTE: In all cases, in the absence of the President, the Vice-President and/or the Executive
will be the responsible party representing the Association. Instructions will be received
from the Chief Medical Examiner or his/her authorized representative ONLY.
MORTUARY SERVICES: MULTI-DEATH DISASTER SITUATIONS
MORTUARY RESPONSE TEAM FOCUS
The mortuary response team focus is to establish the means and methods for the sensitive,
respectful care and handling of deceased human remains in multi-death situations. The mortuary
response team is assigned to be available to aid in sanitation and preservation (i.e. preparation or
embalming as authorized), notification of next of kin, counseling as well as facilitating the
release of remains to next of kin or their representative under the direction of authorized persons.
SCOPE OF OPERATIONS
When multiple deaths occur, and when requested by the Medical Examiner's office, the mortuary
teams will aid in establishing a temporary morgue site and provide sanitary preservation in
preparation for final disposition as directed by the Medical Examiner. Necessary information
about each victim will be compiled and processed for the Medical Examiner.
To assist the Medical Examiner, the Association will maintain a resource manual of the needed
supplies, equipment and personnel. The mortuary response team may also assist in identifying
other necessary resources. (Identify the members of the response team).
SCOPE OF FUNERAL DIRECTOR/EMBALMER ENGAGEMENT
It is important that parameters outlining the role of the funeral director and embalmer be clearly
defined and with in the scope of the profession as defined by The Embalmers and Funeral
Directors Act.
Embalmer - when authorized to embalm and prepare human remains for shipping (local or out
of province), shall be in an established or temporary morgue facility with strict adherence to
OSAH guidelines. The embalmers participation will commence at the temporary morgue
facility. Funeral Director - The funeral director will "take charge" of dead bodies for the
purposed outlined in the Act, burial, cremation, removal or other disposition. The funeral
director shall obtain authorization for the preparation of deceased bodies; obtain the death
certificate, permission to cremate and completion of the Burial Permit as a function of his/her
Divisional Registrar role. Upon request, the funeral director (within the scope of his/her
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profession) will counsel bereaved persons, arrange funeral/memorial services, assist non-local
colleagues by acting on their behalf with client families, arrange shipping and transfer prepared
bodies, ashes to the destination of final disposition.
FUNERAL DIRECTORS/EMBALMERS PROFESSIONAL LIABILITY
It is essential that permission for the embalmer/funeral director to "take charge" of the dead body
be received. Initially a signed death certificate from the last attending physician (medical
examiner) will allow the embalmer to prepare the deceased as requested (for embalming,
identification or cremation). Second, permission must be received from the next of kin, executor
or family representative (funeral director, lawyer, or any other agency acting with authority on
their behalf.)
NOTE: Funeral directors/embalmers cannot act unless legally authorized. All
authorization shall be in writing from the Chief Medical Examiners Office.
SAFETY & HEALTH
The safety and health of the professional is primary in a disaster scenario. It is imperative that
strict adherence to Occupational Health and Safety guidelines (Occupational Health and Safety
Act, Chapter 7 of the Acts of 1996) be followed. In the event that a disaster related injury
(physical or physiological) or death occur, compensation for the injured professional or family is
crucial. If professionals are requested to serve with a disaster response team for the purpose of
assisting the Medical Examiner's Office then they should be protected by a comprehensive health
protection plan provided by Government.
BIOHAZARD
The embalmers first responsibility is to protect the public health. The threat of biological
terrorism and global pandemics is a reality and may be causative in a disaster scenario. The
Health Act 1 (C.) Interprets "communicable disease" and section 51 (1) directs the embalmer not
to embalm any body (procedures prescribed) having died of a communicable disease. There are
non-specified diseases such as Creuzfeldt-Jakob, which embalmers will not embalm if the
cranium had been opened.
In anticipation of the new Level 3 laboratory to be built on site at the QE II, Halifax, the Medical
Examiners Office shall ensure all tissue (complete, partial or minute parts of deceased bodies) be
tested and clearly labeled to identify bio hazards before release to the embalmers for
preparation. The same identification shall be provided to identify tissue, which has been
contaminated with a chemical or radioactive substance.
COMPENSATION
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Remuneration for disaster team personnel will be provided from the responsible level(s) of
government with the assistance of the Medical Examiners Office.
DIRECTION AND CONTROL
When a disaster occurs, the Chief Medical Examiner's office should immediately notify the
association through its office or it officers from a list provided to that office. The Association
will in turn notify the Disaster Team Coordinator. The Disaster Team Coordinator shall activate
the Zone Coordinator team in response to requests of representatives of the Chief Medical
Examiner.
The Zone Coordinator will take charge of the situation as it relates to the mortuary response
team's specific assignments. Assistance from other Zone Coordinators may be requested through
the Association. Each Zone Coordinator must be qualified by training in a program approved by
the Association.
LIST OF ZONES: (Coordinators to be selected)
1. South Shore/South West Nova Zone
2. Valley Zone
3. Cumberland Zone
4. Colchester / Pictou Zone
5. Antigonish / Guysborough Zone
6. Metro Cape Breton Zone
7. Halifax Metro Zone
TEMPORARY MORGUE SITE
A morgue site is to be selected, organized and put into operation if the number of dead exceeds
the resources of the Chief Medical Examiner's office. The Chief Medical Examiner may request
the Zone Coordinator to select the location of the temporary morgue.
The temporary morgue should be located as near as possible to the area with the heaviest death
toll and should have: showers, hot and cold running water, heat and/or air-conditioning,
sufficient electrical provision, drainage, ventilation, restrooms, adequate parking,
communications capabilities and break-off room(s). The facility should be securable for the
protection of human bodies and personal property, sufficiently removed from public view, and
have sufficient space for body identification procedures. It should be subject to partitioning for
separation of functions such as body handling, x-ray, autopsy, record maintenance, interviewing,
etc.
Potential temporary morgue sites are: existing mortuaries, hangers, large garages, National
Forces barracks, gymnasiums, arenas, curling rinks or other options without wooden floors. The
functions carried out at each morgue site will be determined by the prevailing circumstances.
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Once a morgue site has been selected, the Chief Medical Examiner or upon his authority, the
Disaster Response Team Coordinator will organize its operations for the purpose of preparation
and release bodies.
The morgue site may be used for temporary housing of bodies, identification, preservation, as
well as the distribution point for the release of bodies to their next of kin or agent.
Should embalming become necessary, desired or directed by the Chief Medical Examiner or
requested and approved by a representative of the next of kin, the medical examiner may rely on
the disaster response team to organize the operations, equipment, supplies and personnel
required.
RELEASE OF REMAINS
Once the remains have been positively identified, the family or next of kin will be contacted. The
Chief Medical Examiner or the Disaster Team Coordinator will coordinate the release of remains
and personal effects to the next of kin or their representative.
Written authorization shall be obtained prior to any embalming procedures from the responsible
party, i.e., CME, next of kin, legal representative.
In situations where there are unidentified remains, the Chief Medical Examiner shall make the
decision and provide direction regarding their disposition.
Where embalming or preparation is authorized, the procedure will be under the direction of
Disaster Team Coordinator for later transportation to the family's designated funeral home,
cemetery or other designation.
MASS BURIAL GUIDELINES
Mass burial may become necessary when the number of remains cannot be managed, become a
public health concern or in cases when remains cannot be adequately refrigerated, embalmed,
identified or processed in an acceptable time period.
Any decision to begin mass burial must be made at the highest level of provincial government.
Their direction on matters of public health, safety or welfare must be procured before mass burial
can proceed.
The location of a mass burial site must be agreed upon by appropriate government agencies,
taking into consideration the number of remains to be buried as well as distance and
transportation considerations.
Consideration should be given to federal, provincial or municipal owned property, avoiding
right-of-ways, parks, recreational areas, flood control basins, sides of highways or river beds,
along rail lines, in rail yards or under power lines.
Alternate consideration can be given to private property, preferably large open fields or similar
sites. Access and egress are also important factors along with the type of terrain and the
understanding that later exhumation may occur. Such exhumations may be ordered in an attempt
to further identify remains and return them to next of kin.
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PROCEDURES FOR MASS BURIAL BY MORTUARY PERSONNEL
Those remains designated for mass burial should be processed by the Medical Examiners Office
to ensure the following:
Body rechecked for any type of jewelry or other items that may lead to identity
Post mortem information has been properly documented, especially in those areas of scars,
tattoos, deformities and other physical descriptions.Fingerprints have been taken; if not, fingers
rechecked for possible prints to be taken. An additional body tag (preferably metal) has been
attached, properly filled out and placed in a small, zip-lock plastic bag. Body wrapped in plastic
sheeting or disaster pouch and tied/zipped to deter leakage. A second additional tag attached to
the outside of the pouch and containing the body number. If possible, the body placed in a
wooden or metal container for burial. The container should be marked with the corresponding
identification number.
Exact location of each body buried must be recorded on grid maps and must include dates, times
and other information necessary for orderly exhumation at a later time.
Each burial site may also be marked (staked) with the correct corresponding Doe number.
REQUIRED DOCCUMENTAION FOR MASS BURIAL
In the case of large numbers of dead, if anyone is directed to bury a dead human body, then the
following records shall be completed by the medical examiner.
Morgue number, sex, race, age, height, weight, hair color, eye color, scars, tattoos, teeth (natural,
false, or both), missing or artificial limbs.
Date of death and/or date of recovery.
List of all details about clothing: size, color, manufacturer, etc.
List all items found in pockets.
Ink fingers and take fingerprints.
Site of recovery, county of death, place and date of burial.
UNIDENTIFED REMAINS AND/OR TISSUE
Disposition of unidentified remains and/or tissue is the responsibility of the provincial medical
examiner. (Provincial laws may generally predetermine the disposition of the remains/tissue.)
Such remains and/or tissue released to the mortuary response team for disposition should follow
these prescribed guidelines:
Under no circumstances should unidentified or unassociated remains or tissue be commingled
with identified remains. Remains should be prepared by applicable standard preparation
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procedures. Interment in a local cemetery should be the preferred choice. Cremation should be
avoided for religious considerations and availability for identification at a later date.
Religious considerations should be observed with non-denominational rites held at the site of
interment.
Records and procedures for interment should follow the procedures as set forth in the mass burial
section.
TEMPORARY STORAGE vs. BURIAL
Temporary storage of remains or tissue may be the choice rather than immediate burial.
Considerations in this decision would include: time between death and the identification and
return of the remains to the family, possibility of identification, inability to locate or determine
the next of kin and legal considerations. The choice is the responsibility of the medical examiner
or his/her designated representative. If the decision is temporary storage, remains should be
released to the mortuary response team for preparation procedures, pouched and or casketed,
then returned to the medical examiner for storage.
Records and procedures for storage should follow the procedures as set forth in the mass burial
section.
REMAINS NOT RECOVERED
Following exhaustive efforts and resources expended by those involved, once the determination
has been made that one or more remains are unrecoverable, non-denominational memorial
services should be arranged. If more than one, all efforts should be made to notify and include
the surviving family members in this service. Assistance in post-death activities should be
extended to the surviving family members. The family should be given the opportunity to select
the locale of the nondenominational service if so desired.
NATIONAL ASSOCIATION (FSAC) ROLE
Funeral Service Association of Canada (FSAC) shall assume a supporting role to all provincial
associations. Provide logistics to provincial association, federal government, Air Canada liaison,
CN and CPP liaison, education, research, out of province personnel, and other evolving functions
as the plan matures.
REVIEW PROCESS
This plan shall be reviewed periodically under the direction of the Past President, the period of
which shall not exceed five years from the last review.
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"ADDENDUM A" - PREPARATION GUIDELINES
GENERAL
All examinations must be completed and a signed Medical Certificate of Death form received
from the provincial medical examiner before the embalming/preparation takes place. At the
completion of the identification process and with the proper forms, the remains shall be moved to
the embalming area and a notation to this effect should be entered on the master chart. The
embalming/preparation of the remains should be carried our under the direction of the mortuary
response team coordinator. If possible, the wishes of the next of kin and religious considerations
should be observed. If possible the family should give written permission to embalm. All
remains should be treated as if it were a contagious disease case(s). Embalming reports should
be completed on each remains and forwarded to the mortuary response administrative personnel.
The embalming team and its coordinator should determine the classification and method of
embalming procedures. All remains within the same classification should be prepared in the
same manner.
CREMATION
When the next of kin request, direct cremation may be completed in the locality of the disaster.
All standard procedures should be followed, obtaining release and consent forms. Cremated
remains may then be forwarded to the next of kin.
NOTE: Cremation should never be used as a form of disposition for unidentified remains
or tissue. Religious considerations as well as the possibility of future identification affect
this decision.
"ADDENDUM B” - PERSONNEL
This section addresses the personnel that will be necessary for the association disaster team to
effectively respond in a disaster situation.
PERSONNEL:
Association President or Vice-President
Association Executive
Disaster Team Coordinator
Zone Coordinator
Required personnel:
Funeral directors
Embalmers
Assistants
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"ADDENDUM C” - EQUIPMENT AND SUPPLIES
This section addresses the supplies that will be necessary to effectively respond in a disaster
situation. At least the following should be considered.
ADMINISTRATIVE SUPPLIES
Telephone equipment (hard line and cellular)
Facsimile machine
Photocopier
Computer, preferably laptop and printer
Forms
Distribution control chart
Files
Desks, tables and chairs
Pens, pencils, paper, etc.
PREPARATION EQUIPMENT & SUPPLIES
_________________________________________________________________
EQUIPMENT
INSTRUMENTS__
_
Absorbent cotton
Scissors
Aspirator (hydro & electric)
Artery fixation forceps
Casket trucks
Artery tubes, straight
Containers for fresh water and
Artery tubes, curved
water for preparation activities
Containers for drainage
Stop cocks
Combs
Packing forceps
Dressing tables(s)
Hemostats
Hair clippers
Needle holder
Curling irons
Angular forceps
Hair dryers
Spring clamps
Generators
Scalpels
Instrument Tables(s)
Cotton packer
Laundry hamper(s)
Aneurysm hooks
Linen supplies
Separators
Embalming Machine(s)
Grooved director
Preparation tables(s)
Hand Brush
Positioning devices
Suture needles
Razor & equipment
Spatula
Plastic pouches
Spatula (electric)
Plastic garments
Vain tubes
Plastic sheeting
Needle injector(s), needles
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Plastic zip-lock bags
Rubber gloves non-latex
Small speed drill
Isolation outfits-all sizes
Sutures
Rubber tubing (injection)
Rubber tubing (aspirating)
Garden Hose
Utility table
Waster receptacle(s)
Mouth formers
Nasal aspirators
Hypodermic syringes
"Y" injectors
Cavity injectors
Trocar
Trocar buttons
Trocar
Autopsy aspirator(s)
Eye caps
Embalming Fluids and Chemicals:
Arterial Fluids
Cavity Fluids
Pre-injection fluids
Fluid modifiers
Disinfectant spray
Deodorants
Liquid Soaps
Massage creams
Special arterial fluids
Water conditioner
Embalming powder
Hardening compound
Bleachers
Preservative Cauterants
Dry hair shampoo
Cosmetics and accessories
Mastic Compounds
Cosmetic brushes
Multi-Purpose External Seal
Cyanoacrylate Adhesive
Autopsy Chemicals (SynGel HV)
Wax
Tissue builder and solvent
"ADDENDUM C" - MOBILE MORTUARY CONTAINER
The Funeral Service Association of Canada will establish Mobile Mortuary Containers in such
regions of Canada as deemed necessary. The mobile mortuary container is a unit that holds
equipment and non-perishable supplies needed to set up and operate a temporary morgue.
PURPOSE
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When a multiple death incident occurs, the mobile mortuary container will provide the
equipment and nonperishable supplies as a field expectant, where it is essential. The mobile
mortuary container is designed to supply ample inventory with minimal effort on the part of the
requesting organization, and to be delivered in a timely and efficient manner. Please note, once
the request for this unit is made and accepted, our provincial disaster response team will be
activated and be responsible for its operation under the Provincial Medical Examiner and his/her
assigned field agent. Perishable supplies will be obtained directly from suppliers through a
prearranged agreement with the provincial association.
CONTROL
The Funeral Service Association of Canada will maintain ownership, liability (except during
receiving organization's use of the container), and responsibility for the maintenance, upgrading
and control of the container.
PROTOCOL
Any person, agency or governmental body may request use of the mobile mortuary container.
The request may be made through the appropriate Provincial Funeral Directors and Embalmers
Association by providing information regarding the incident. The Provincial Association will
notify the Funeral Service Association of Canada, which will approve requests and make all
arrangements for transportation to the assigned site nearest the incident. It is the responsibility of
the requesting organization to meet, secure, maintain and set up the mortuary container. When
the disaster response team arrives they will work with the medical examiner and the local
organization. However, they will be in control of all remains for embalming and preparation for
local burial or transportation out of province or country.
FINANCIAL OBLIGATION
There will be no charge for the use of the mobile mortuary unit. The requesting organization
will incur the costs for the transportation of the unit, replacement of supplies used during the
incident, refurbishing of equipment, and replacement of lost or damaged equipment. In some
instances where reimbursement of these costs is available, The Provincial Funeral Directors and
Embalmers Association will assume responsibility to have supplies and equipment repaired or
replaced.
INVENTORY
A list of inventory will be included with the unit and should be used at the time the container is
received and returned.
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Appendix N
EMO Municipal Roles
Page 414 of 448
Appendix N01 – EMO Liaison List
Page 415 of 448
Appendix N02 Municipal Government Roles and Responsibilities
ROLES AND RESPONSIBILITIES
MUNICIPAL GOVERNMENT PLANNING CONSIDERATIONS:
Municipalities should develop consequence management guidelines with procedures for health
emergencies to enable local governments, working with the District Health Authorities to
maintain the community of essential services and support to residents. Local all hazards plans
will provide guidance.
The District Health Authority, in collaboration with the Medical Officer of Health, is responsible
for developing a pandemic influenza plan.
PRIORITIES:
The municipality, in consultation with the District Health Authority will activate the necessary
contingency plans and set priorities for:
Continuing of local government.
Maintaining essential public works and municipal services such as water treatment, garbage
collection, utilities etc.
Providing information and advice to the public through regular announcements.
Closure of public buildings where it is deemed to be in the best interest of public safety and
to minimize the spread of influenza.
Work with the District Health Authority to establish alternate care facilities and triage centers
to facilitate the immunization of the public and provide health care in flu treatment settings.
Activating a committee to facilitate mutual aid agreements to assist with maintaining services
(pharmacy, food, banking, gasoline and any other commerce deemed necessary).
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Appendix N03 RCMP Role
(As per NS Department of Health Pandemic Influenza Preparedness Plan)
POLICE / RCMP ROLE:
Provide security for the protection of lives, public and private property and to assist in the
security of the sites designated as alternate care sites and immunization sites and to assist with
the security of the influenza vaccine and antivirals.
PRE-PANDEMIC:
Work with District Health Authorities and local agencies to develop contingency plans for
pandemic influenza
Encourage staff to promote annual influenza vaccine .
Establish a registry of former and retired personnel and suitable volunteers who could be
called upon to assist during times of staff shortage.
Ensure all essential positions are backed up with an alternate.
Review current emergency plans and extract all relevant sections that may be used for
pandemic influenza planning
PANDEMIC:
Designate an individual to report to E.O.C., if and when it is activated
Review contingency plans for pandemic influenza.
Communicate with Municipalities and District Health Authority planning committee
Provide security for the alternate care sites and immunization sites.
Assist with the security of the vaccine and antivirals.
Cease non-essential services when the demand becomes such that there are severe resource
problems.
Communicate gaps to the E.O.C.
Control traffic.
POST-PANDEMIC:
Assess ability to resume normal activities.
Review and revise plans as necessary.
Evaluate the plan and make changes as appropriate
Prepare for second wave.
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Appendix N04 Community Services Role
COMMUNITY SERVICES ROLE:
Assist in the establishment of reception centers, alternate care centers, triage areas, and the home
care program, as appropriate, in support of the District Health Authority pandemic influenza
response.
PRE-PANDEMIC:
Work with DHA and local government to develop contingency plans for pandemic influenza.
Promote influenza vaccine.
Establish a registry of former and retired personnel and suitable volunteers.
Ensure that all essential positions are backed up with an alternate.
pandemic influenza planning
PANDEMIC:
Designate an individual to report to E.O.C. if and when it is activated.
Review and activate plans for pandemic influenza .
In collaboration with the DHA and local government , plan for implementation of alternate
care sites.
Plan for implementation of centers to provide social service assistance and work with mental
health services to provide support.
Communicate with Continuing Care to ensure that home care is being provided as
appropriate.
Assist with the implementation of alternate care sites, as necessary, and in consultation with
the DHA.
Alert the EOC to any critical gaps in the ability to provide essential community social
services.
POST-PANDEMIC:
Assess the ability to resume normal activities.
Report results of assessment to the EOC
Evaluate the response and make revisions in the plan.
Prepare for the second wave
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Appendix N05 Emergency Health Service Role
EMERGENCY HEALTH SERVICES ROLE:
Coordinate emergency medical services and establish and maintain communication with the
District Health Authority in support of a pandemic influenza response.
PRE-PANDEMIC:
Establish plans for response during a pandemic influenza.
Encourage annual influenza immunization.
Establish a registry of former and retired personnel and suitable volunteers
pandemic planning
PANDEMIC:
Designate an individual to report to the EOC.
Activate emergency response plans when necessary.
Implement education program for staff.
Implement communications plan for updating staff.
Transport individuals to hospitals and alternate treatment sites.
Cease non-essential services as appropriate.
Assist at the influenza immunization clinics if staff is available.
Apprise the EOC of gaps in the ability to provide service
POST-PANDEMIC:
Evaluate the pandemic response and made revisions to the plan .
Assess ability to return to normal activity.
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Appendix N06 Fire Department Role
FIRE DEPARTMENTS ROLE:
Assist other emergency services as required.
PRE-PANDEMIC:
Work with District Health Authorities and local municipalities to develop contingency plans
for pandemic influenza.
Promote annual influenza immunization.
Establish a registry of former and retired personnel and suitable volunteers
Ensure all essential positions are backed up with an alternate
pandemic planning.
Educate the staff on pandemic planning and response
PANDEMIC:
Implement contingency plans.
Cease non-essential services
Apprise EOC of any gaps in ability to provide emergency services
POST PANDEMIC:
Assess the ability to resume normal activity.
Report results of assessment to the EOC.
Review and revise plans
Evaluate response to the pandemic
Prepare for the next wave
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Appendix N07 Local Non-Government Organizations Role
Local Non-Government Organizations (NGOs) ROLE:
To ensure continuity of essential business services and to provide support to the District Health
Authority as appropriate.
PRE-PANDEMIC:
Promote annual influenza immunization.
Develop pandemic influenza response plans.
Establish and maintain contact and discussions with the District Health Authority.
Identify essential staff and develop plans for operations when there are shortages of staff and
resources.
Establish a committee to be responsible to meet to ensure essential operations can continue
during the pandemic.
Review current emergency plans and extract all relevant sections that may be used during a
pandemic.
PANDEMIC:
Notify appropriate individuals of the influenza pandemic.
Continue to monitor the progress of the pandemic.
Consider a communications system so more people can stay at home.
Provide education and updates to appropriate staff in the workplace.
Implement contingency plans.
Rotate hours/days of service staff as necessary to provide essential services.
Appoint an individual to provide a report to the EOC on a regular basis.
POST-PANDEMIC:
Assess the ability to resume normal organizational activity.
Review and revise plans as necessary
Evaluate the response and make changes as appropriate.
Prepare for the second wave
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Appendix N08 Public Works Role
PUBLIC WORKS ROLE:
Provision of municipal equipment, personnel and technical expertise in support of the District
Health Authority and Municipal pandemic influenza response.
PRE-PANDEMIC:
Promote annual influenza immunization:
Work with the District Health Authority and local agencies to prepare a pandemic influenza
response plan
Review current emergency plans and extract all relevant sections that may be used for the
pandemic influenza plan.
Educate staff on pandemic influenza.
Establish a registry of former and retired staff and suitable volunteers.
PANDEMIC:
Designate an individual to report to the EOC
Implement the contingency plan
Apprise the EOC of critical gaps in ability to provide essential engineering services.
Work with the District Health Authority to identify alternate facilities for care and clinics.
POST-PANDEMIC:
Assess the ability to return to normal activity.
Report the results of the assessment to the EOC.
Evaluate the pandemic response.
Review and revise plans as appropriate.
Page 422 of 448
Appendix N09 Utilities Role
UTILITIES ROLE:
Support the District Health Authority and local government’s pandemic influenza response
through provision of essential utility services.
PRE-PANDEMIC:
Work with District Health Authority and local agencies to develop emergency plans for
pandemic influenza.
Promote annual influenza immunization
pandemic planning
Educate staff on influenza pandemic planning.
PANDEMIC:
Implement the contingency plans.
Apprise the EOC of gaps in ability to provide essential service
Keep staff informed of the influenza pandemic.
POST-PANDEMIC:
Assess ability to return to normal activity.
Report results to the EOC.
Evaluate the response plan.
Review and revise plans as necessary
Page 423 of 448
Appendix N10 Provincial Medical Officer of Health Role
PROVINCIAL MEDICAL OFFICER OF HEALTH ROLE:
Promote and monitor the pandemic influenza planning in the districts. Take part in the
discussions with the National Pandemic Influenza Planning Committee and advise districts of the
progress.
PRE-PANDEMIC:
Sit on the National Pandemic Influenza Planning Committee.
Promote media releases on influenza.
Promote awareness of pandemic influenza.
Encourage the planning process at the provincial level
Encourage the planning process at the district level.
Monitor and evaluate the district plans.
PANDEMIC:
Assemble the provincial committee.
Monitor the progress of the influenza pandemic across the World, the Country, and the
Province.
Keep all districts and governments updated on the pandemic.
Monitor the communications strategies.
Responds to media requests in collaboration with the districts and municipalities.
Monitors the mass immunization response.
Ensures the equal distribution of vaccines and antivirals.
POST-PANDEMIC:
Evaluate the response provincially
Communicate by conference call with appropriate municipal and district planners and
evaluate response
Advise on revisions to the plan
Evaluate the mass immunization clinics and antiviral clinics and appoint an individual to
evaluate the effectiveness of the programs.
Complete an evaluation of the process.
Discuss the financial issues as appropriate.
Communicate the evaluation to the public and to the District Health Authorities and to the
Local and Provincial Governments.
Communicate and report to the National Committee.
Page 424 of 448
Appendix N11 Pharmacists Role
PHARMACISTS ROLE:
To assist as required during the pandemic by providing education on influenza vaccine
and antivirals.
PRE-PANDEMIC:
Educate the public and colleagues on pandemic influenza
Educate the public and physicians on the appropriate use of antibiotics to prevent drug
resistance.
Educate the public and colleagues on influenza vaccine and antivirals
Promote influenza immunization .
Assist with development of written information for public education regarding the use,
contraindications, precautions, side effects and dosage of antivirals for specific age groups.
PANDEMIC:
Provide information to the public on Influenza vaccine and antivirals.
Provide information on clinic locations for immunization and antiviral clinics
Possibly provide assistance at the antiviral clinics.
Keep other pharmacists up to date on pandemic response
POST-PANDEMIC:
Evaluate the pandemic response and note any role that could have been done by pharmacists
Page 425 of 448
Appendix O Community
Contacts
Page 426 of 448
Appendix O 01 Nursing Homes, Homes for the Aged & Residential care
Facilities
Nursing Homes (NH); Homes for the Aged (HFA) and Residential Care Facilities (RCF) in
South West Nova. The term “SEA” participant indicates a RCF has agreed to admit only
applicants who are deemed fully eligible by the Department of Health and referred to the
facility through the single point of entry (SEA) system. If a facility is not a “SEA” participant,
it means that applicants must apply directly to the facility.
**There are nine RESPITE BEDS in District 2. Please see bottom of page two for location
of respite beds.
Maison an Coucher de Soleil
Saulnierville,
Civic Number: 9671 Hwy # 1
Digby County, Nova Scotia (RCF) (SEA)
Nakile Home for Special Care
Phone: 643-2707 Fax: 643-2862
R.R. Glenwood,
Yarmouth County, Nova Scotia
BOW iWO
Civic Number: 35 Nakile Drive (NH/HFA)
Pont du Marais Boarding Home Ltd.
Box 236, Lower West Pubnico
Yarmouth County, Nova Scotia
BOW 2C0
Civic Number: 1526 (RCF) (Not SEA)
Roseway Manor
P.O. Box 518
Shelburne, Nova Scotia
BOT 1WO
Civic Number: 1704 Lake Rd, Sandy Point
(NH/HFA)
Surf Lodge Nursing Home
P.O. Box 160, 73 Howe Street
Lockeport, Nova Scotia
BOT 1LO
Civic Number: 73 Howe Street (NH/HFA)
Villa Acadienne
P.O. Box 178 Meteghan
Nova Scotia
BOW 21(0
Civic Number: 8403 Hwy 1 (NH/HFA)
Villa St. Joseph du Lac
R.R. 1, Box 810
Page 427 of 448
(Community Services Home)
Phone: 769-2270
Fax: 769-3850
Phone: 643-2707
Fax: 643-2862
Phone: 762-3099
Fax: 762-2072
(Charlene) 762-2268
Phone: 875-4707
Fax: 875-4105
Phone: 656-2014
Fax: 656-2015
Phone: 645-2065
Fax: 645-3899
Phone: 742-7128
Yarmouth, Nova Scotia (NH/HFA)
Tidal View Manor
60 Vancouver ST.
Yarmouth, N.S. (NH/HFA)
Au Logis du Meteghan
Meteghan (RCF) (SEA)
Foyer D’Age D’Or
Meteghan River (RCF)
Celeste Cottage
Methagan (RCF) (Not SEA)
Mary’s Abide – A- While
Shelburne (RCF) (SEA)
Duran’s Sissiboo Rest Care
Sandy Duran (RCF)
Bay Side Home
BrassHill (RCF) (SEA)
Fax: 742-4230
Phone: 742-7853
Local: 259 Fax: 742-1427
Phone: 645-3594
Phone: 769-3244
Phone: 645-2248
Phone: 875-4384
Phone-837-4725
Phone: 637-2098
Fax: 637-3151
Number of beds plus Respite beds, in District 2.
1. Surf Lodge
Lockport………………….....34 beds; 2 respite beds
2. Roseway Manor
Shelburne……………………65 beds; 1 respite bed
3. Nakile Home for the Aged
Glenwood, Yar. Co……….....35 beds; 1 respite bed
4. Tidal View Manor
Yarmouth…………………..103 beds; 2 respite beds
5. Villa Acadienne
Meteghan, Digby Co………..84 beds; 2 respite beds
6. Tideview Terrane
Digby………………………..89 beds; 1 respite bed
Page 428 of 448
Appendix O 02 Boarding Homes
Boarding Homes (District 2)
There are facilities on this list that are licensed as well as accept private pay clients. They are
identified as Residential Care Facilities (RCF). The term “SEA” participant indicates a RCF
has agreed to admit only applicants who are deemed fully eligible by the Department of Health
and referred to the facility through the single point of entry (SEA) system. If a facility is not a
“SEA” participant, it means that applicants must apply directly to the facility.
Yarmouth & County
Glo Estates, Grove Road
(Hazel Olsen) (RCF)(not SEA)
Thelma Brassard
Jean Nickerson
Forest Street
Wilma Jacquard
Brenda Adams
Port Maitland
Sunset Terrace
8 James St.
(Ladies Only)
Sandra Duncanson
(Shared Room for a lady)
Gentle Care Seniors Boarding Home
Lakeside Road
(Cora Garron)
Nature’s Nest
Gavelton
Century Lodge Seniors Home
Helen’s Board and Care
Comeau’s Seniors Residence
23 Grand St.
Vancouver Place Seniors Boarding Home
Port Maitland Seniors Residence
Riverview Seniors Boarding House
(Minimal Care)
Tusket
Huntington Place Seniors Residence
Kleinercare Nursing Services
Senior Residence
Pont du Marais Boarding Home
Lower West Pubnico (RCF) (Not SEA)
Phone-742-7583
Phone-742-7527
Phone-742-8018
742-6335
Phone-649-2077
Phone-742-3322
Phone-761-2509
Phone-742-3922
Phone-648-0053
Phone-742-7299
Phone-742-4786
Phone-749-0195
Phone-742-6060 or 742-5048
Phone-649-2395 or 749-1403
Phone-643-2720
Phone-742-1231 or 742-1792
Phone-742-9333 or 742-5482
Phone: 762-2072
Page 429 of 448
Digby & County
Cliff Haven (Debra Blinn)
88 Montague Row (Non-Smokers)
Joan Germaine
Shore Road
Debbie Veilleux
89 King St.
Joyce Adams
60 Queen St.
Violet Forrest
307 Culloden Road
Phone-245-6234
Phone-245-4541
Phone-245-6104
Phone-245-6168
Phone-245-5624
Bear River Area
Nancy Hilden
32 Morganville Rd
Phone-467-0555
Ray Hannam
Clementsvale
Phone-467-3647
Donna Peck
Bear River (One room w full bath to share
– w/c accessible; Complete care not
available; Is able to provide some personal
care; Special diets available; Transportation
available. (Prefers men)_
Phone-467-3570
Weymouth & Area (Clare)
Cottage Celeste (RCF)(not SEA)
Duran’s Sissiboo Rest Care
Sandy Duran (RCF)(Not SEA)
Au Logis D’Meteghan (RCF)(SEA)
Nora Colwell
Etta LeBlanc
Saulnierville
Geneva Sabean
Weymouth
Leon & Sheila Doty
Ken McAlpine (4 rooms-single; $900/mo)
May have animals; Transportation
available to/from appt.
Linda Amero
Room/Board; Special diets available;
Transportation not available; $500/mo;
Phone-645-3287
Phone-837-4725
Phone-837-5527
Phone-769-2640
Phone-837-5754
Phone-837-4483
Phone-837-4889
Page 430 of 448
May smoke (Prefers men)
Celena Stone
Weymouth N.S.
Phone-837-7719
Phone: 837-4748
Shelburne
Hardt’s Haven Community Residence
4953 JordenFerry
Shelburne
Christa Ward
Shelburne NS
Kim Harding
Shelburne NS
Mary’s Abide-A-While
Water ST.
Shelburne, NS (RCF) (SEA)
Glee De Champ
Edsel Blades
Community Service Homes
Le Maison an Coucher de Soleil
Meteghan (RCF) (SEA)
Bay Side Home
BrassHill (RCF) (SEA)
Phone: 875-3959
Phone: 875-2349
Phone: 875-2838
Phone: 875-4384
Phone: 875-3957
Phone: 875-4774
Phone: 645-3820
Phone: 637-2098
Fax: 637-3151
Page 431 of 448
Appendix O 03 Continuing Care Contacts
Continuing Care
Department of Health
Community Care
Western Region
Access To Services
Home Care
Long Term Care
Adult Protection
Hours of Admission – 0830-1630 – 7 days/week
1-800-225-7225 (Toll Free)
Or contact the Care Coordinator based in the hospital
Pager 1-902-558-8234
After hours Access (1600-0830 7 days/week) is available for
Adult Protection only
1-877-463-2722 (Toll Free)
Page 432 of 448
Appendix O 04 Canadian Cancer Society and Red Cross
Canadian Cancer Society
Yarmouth
Phone: 742-2273
Digby
Phone: 1-902-245-1951
Shelburne
Phone: 1-902-875-2333
Lockport
Phone: 1-902-656-2865
Patient Navigator
Darolyn Walker
Phone: 742-3542 Ext: 523
Red Cross Loan Room
Yarmouth
(Dayton Mall)
Phone: 742-3681
Hours of operation Mon:-Fri.
8:30am-4:30pm
Digby
Phone: 1-902-837-7767
Page 433 of 448
Appendix O 05 Department of Community Services
Department of Community Services
Yarmouth/Argyle
10 Starrs Road
Yarmouth, N.S.
B5A 1E0
Phone: 742-0722
Fax:
742-0747
Intake
Phone: 742-0741
Carl Deveau (Supervisor)
Wayne Robicheau
Phone: 742-7256
Phone: 742-0709
Fax:
742-5291
Barrington
Box 9, Barrington
Shelburne Co., N.S.
B0W 1E0
Phone: 1-902-637-2335
Fax: 1-902-637-2137
Digby/Clare
Box 399, Digby
Nova Scotia
B0V 1A0
Phone: 1-902-245-5811
Fax: 1-902-245-4121
Tri County Housing Authority
368 Main St.
Suite 206
Yaymouth, N.S.
B5A 1E6
Phone: 742-4369
Fax: 749-1254
Page 434 of 448
Appendix O 06 Department of Veteran’s Affairs
Department of Veteran’s Affairs
Counselors:
District:
1) Darlene MacCauley
Pleasant Lake to Little Brook
2) Doug Lee
Church Point to Digby
3) Ray Simmons
Liverpool to Tusket
Phone: 1-800-565-0197
Fax:
Address:
426-2349
P.O. Box 8063
Halifax, N.S.
B3K 5L8
Page 435 of 448
Appendix O 07 Victorian Order of Nurses
Victorian Order of Nursing
Yarmouth
742-4521
Shelburne
875-8657
Barrington
637-2943
Digby
245-2784
Weymouth
837-5115
Page 436 of 448
Appendix O 08 Dalhousie School of Nursing
Dalhousie School of Nursing
Yarmouth Site
Site Administrator:
Adele LeBlanc
Department Secretary:
Liz Prime
Phone: 742-3542 Ext: 214
Phone: 742-3542 Ext: 213
September, 2004
23 First year students
19 Second year Students
13 Third year students
11 Fourth Year Students
Mardi will update re: the role of Students/Professors.
Page 437 of 448
Appendix O 09 Discharge Planning Program First Nations
Discharge Planning Program
First Nations
Acadia Band Office
Phone: 742-0257
Bear River First Nations
Phone: 1-902-467-3802
Services of First Nations is provided in this order post discharge:
If Patient resides on a Reservation arrange through Band Office
If Patient resides outside of Reservation follow up support can be accessed
through Continuing Care. Contact hospital based Care Coordinator
Please Note: There are always exceptions to above guidelines
Page 438 of 448
Appendix O 10 Yarmouth Correctional Centre
Yarmouth Correctional Centre
Yarmouth Correctional Facility
Capacity: 38 Adults
Phone: 742-4211
Yarmouth Police Station: 24-48 hour holding Capacity.
detachment: 742-9106)
Phone: 742-8777 (Rural
Digby Police Station: 24-48 hour holding capacity.
Phone: 1-902-245-2579
Shelburne Police Station: 24-48 hour holding capacity.
Phone: 1-902-875-2490
Family and Children Services
Family and Children Services (Yarmouth)
Hebron Residential Centre
Phone: 742-0700
(Digby)
Phone: 1-902-245-5811
(Shelburne)
Phone: 1-902-637-2335
(Yarmouth)
Page 439 of 448
Phone: 742-8782
Appendix O 11 Home Oxygen Vendors
Home Oxygen Vendor
Vita Air
1-800-361-5939
Medigas
1-800-363-9333
Family First Choice
1-800-565-2021
Page 440 of 448
Appendix O 12 Acadia First Nation Community Contacts
July 2005
Acadia First Nation Community contact telephone list that describes how to reach community
health staff at all times in case of a CDC outbreak. Please contact our Band Councillors first and
use our Health Staff as back up in case a Councillor cannot be reached.
Please note: Councillors covering specific areas should be contacted first. In the event the
Councillor in which you are trying to locate cannot be contacted, please try another Councillor and
then follow with the Band Manager, Community Health Representative, and Community Wellness
Coordinators until someone has been contacted.
Acadia First Nation
Telephone # (902) 742-0257
Fax #
Street Address
City/Province
(902) 742-8854
RR# 4, Box 5914C
Yarmouth, NS
Postal Code B5A 4A8
Courier Address 19 Luxey Lane Extension
Chief Name
Band Manager
Chief Diana Deborah Robinson
Maxine Hamilton
Community Health Nurse Name Judith Camps (Gold River)
CHN Office # (902) 354-5816
CHN Fax #
CHN Address
Health Centre Name
Health Director
(902) 354-5818
same as CHR
Acadia First Nation (Yarmouth) Health Centre
Stephanie Smith
H.C. Office # (902) 742-4337
H.C. Fax # (902) 742-4824
Page 441 of 448
H.C. Street Address
RR#4 Box 5914C
H.C. City/Province
Yarmouth, NS
H.C. Postal Code
B5A 4A8
Courier Address 19 Luxey Lane Extension
Community Health Representative Name Stephanie Smith (Gold River Reserve)
CHR Office # (902) 627-1245
CHR Fax #
(902) 627-1361
CHR Street Address
PO Box 235
CHR City/Province
Chester Basin, NS
CHR Postal Code
B0J 1K0
Appendix O 13 Annapolis Valley Band Contacts
Telephone # (902) 538-7149
Fax #
Street Address
City/Province
(902) 538-7734
PO Box 89
Cambridge Station, NS
Postal Code B0P 1G0
Chief Name
Band Manager
Chief John James Brian Toney
Marilyn Toney
Community Health Nurse Name Roberta Gullage, RN
CHN Office # (902) 538-1444
CHN Fax #
Health Centre Name
Health Director
(902) 538-1353
Annapolis Valley Health Centre
Roberta Gullage, RN
H.C. Office # (902) 538-1444 or (902) 538-1419
Page 442 of 448
H.C. Fax #
(902) 538-1353
H.C. Street Address
PO Box 89
H.C. City/Province
Cambridge Station, NS
H.C. Postal Code
B0P 1G0
Courier Address 121 Ratchford Road
Community Health Representative Name N/A
CHR Office # (902) 538-1444
CHR Fax #
CHR Address
(902) 358-1353
same as Health Centre
Page 443 of 448
Appendix P
First Nations
Page 444 of 448
Appendix P01 Letter to Dr. Scott
Page 445 of 448
Appendix P 02 Letter to Dr. Bailey
Page 446 of 448
Appendix P03 South West Health & First Nations Planning
July 2005
PrePandemic
Emergency
Response
DHA
•
DHA has developed plan.
FNIHB
•
•
Vaccine
•
•
•
Priority lists defined. Health
Care workers at top.
Anyone who will give
vaccine has to be certified.
Assumption – all vaccine
will come through Public
Health to distribute and
administer, including FN’s.
•
•
FN’s have connected with all
EMO’s and have MOA’s. Will
also do their plans as well.
Considering what are the needs
of people isolated in community.
E.g. for food, for medications and
how support can be provided.
DHA needs a list of who these
people are (3 locations Queens, 1 Chester & 1
Yarmouth). Sonya Isaac-Surrette
to obtain.
FN’s – Access to vaccine will be
through DHA System.
Antivirals
•
Access to Antivirals will be
through DHA System.
Clinical
Health
Services
•
Non Traditional Sites will be
under DHA.
Whenever possible people will
remain in own homes.
FN’s have direct contract with
VON for care in home.
Since communities are small,
FN’s hope to be able to care for
own.
•
•
•
Prepandemic
NTS
•
•
FN’s access as per DHA
Clinics.
Will not have resources to
set up additional clinics.
Page 447 of 448
•
Will assess as needed.
Surveillance
•
•
Communication
•
DHA/Public Health have
surveillance system set up –
includes FN’s population.
Should ensure - FN’s gets
information on #’s - part of
Communication Plan
Distribution List.
Have Communication Plan –
Internal & External Messages.
Page 448 of 448
•
•
•
Lab reports all results to
Public Health – includes
FN’s.
Contact list attached.
Communities are small and
person to person
communication is effective.

South West Health`s Draft Pandemic Plan

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