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O =L;Ontario Health Plan for an Influenza Pandemic Overview <1 IEmergency Management Unit Ministry of Health and Long-Term Care June 2005JJ]*Table of Contents  Background Ontario Health Plan for an Influenza Pandemic (OHPIP) Overview Context for Influenza Pandemic Potential Impact in Ontario Ethical Framework Roles and Responsibilities Planning Assumptions Surveillance Vaccines and Antivirals Health Services, including Occupational Health and Safety Emergency Response Public Health Measures Communications Highlights: New in the Next Version of OHPIP (June 2005) Future Planning/Implementation Issues XJPP`PPJ`2   + BackgroundnCanadian Pandemic Influenza Plan released February 2004 Ontario Health Pandemic Influenza Plan released end of May 2004 following series of health stakeholder consultations Work underway to: (1) further develop OHPIP for version 2 release in June 2005 and (2) develop government-wide Coordinating Plan for Pandemic Influenza (led by Emergency Management Ontario) 0o@75=OHPIP OverviewHGoals: Minimize serious illness and overall deaths through appropriate management of Ontario s health care system Minimize societal disruption in Ontario as a result of influenza pandemic Strategic Approach: Be ready  establish comprehensive influenza pandemic contingency plans at provincial and local level Be watchful  practice active screening and monitor emerging epidemiological and clinical information Be decisive  act quickly and effectively to manage the epidemic Be transparent  communicate with health care providers and OntariansZZZTZ^ \ 68\)'Context for Pandemic Influenza Planning ( Activities correspond to new World Health Organization pandemic phases (Inter-pandemic, Pandemic Alert and Pandemic) Aligned with direction in Canadian Pandemic Influenza Plan (CPIP) Provides detail on federal, provincial and local roles/responsibilities and commitments Identifies expectations re. local planning activities Outlines health emergency management approach (e.g. use of Incident Management System and coordination with EMO/other levels of government) Ethical framework for decision-making underscores approach  Evergreen document that will continue to be updated with emerging clinical, epidemiological, and operational information , ,^+Ethical Framework  pOpen and Transparent: decision-making process open to scrutiny and the basis for decisions explained Reasonable: decisions should be based on evidence and be made by people who are credible and accountable Inclusive: decisions should be make with stakeholder views in mind and stakeholder should have opportunities to be engaged in process Responsive: decisions should be revisited and revised as new information emerges and stakeholder have opportunities to voice any concerns they have about decisions Accountable: mechanism should be established to ensure that ethical decision-making is sustained throughout the epidemicpT@ O ] {  l q C!Roles and ResponsibilitiesxFederal Government Vaccine/antiviral procurement and supply to provinces/territories International liaison with World Health Organization (WHO) and other national agencies (e.g. US Centres for Disease Control) Provincial Government Establishment of provincial pandemic plan aligned with CPIP in consultation with Ontario s health stakeholders Outline provincial commitments and activities for pandemic planning and response Provide overall direction and advice on local preparedness and response activities for pandemic influenza (no direct statutory authority to require compliance) Local Government Led by local public health units, establish local pandemic influenza contingency plans congruent with the provincial influenza pandemic plan Provide input, advice and required surveillance data to provincial health authorities PPP`PPP`  %Planning Assumptions4One  three month lead time with additional waves likely Vaccine likely unavailable for first wave/limited supply thereafter Antiviral supply limited and focused on priority groups Centralized supply distribution of personal protective equipment (PPE), vaccines/antivirals, and other equipment through Ontario Government Pharmacy and pre-established distribution points Health Human Resources (HHR) availability during a pandemic severely curtailed (reduced by 40  60% reflecting attack rate, family responsibilities, reluctance to be at risk); HHR planning to use  skills-based vs. discipline-based approach Health services severely curtailed to focus on necessary services Emergency Management Ontario to provide provincial emergency management/EMU & PHD to coordinate response with health sector Provincial Infectious Diseases Advisory Committee (PIDAC) to provide expert scientific/technical advice during pandemic0Z2, u7 SurveillanceThe surveillance section provides information on: Monitoring influenza-like illness (ILI) to detect the pandemic strain early in Ontario through a variety of mechanisms (Febrile Respiratory Illness surveillance, FluWatch Program, laboratory diagnostic testing) Comparing new strains with vaccine composition Tracking the occurrence and severity of outbreaks (based on WHO pandemic phases) Sharing surveillance information with responders to help guide efforts to track, contain and treat the disease(22,U|D"Vaccines and Anti-viralsProvides information on Components of effective antiviral and vaccine programs (security of supply, ability to store, allocate and administer vaccine and antiviral supplies efficiently and appropriately, monitoring safety/efficacy and any adverse events) Emergency Mass Prophylaxis Plan Provincial/federal efforts to secure vaccine/antiviral supply for Ontario Describes priority groups identified by the F/P/T Pandemic Influenza Committee Vaccine Priority Groups: Frontline health care workers and key decision-makers Essential health care providers, public health responders & essential health support services Essential service workers Persons at high risk of fatal outcomes (e.g. elderly, immunocompromised) Healthy adults Children 24 months to 18 years of age\ZZZ,Z,@    7 _,Vaccines and Anti-virals Anti-viral Priority Groups: Treatment (must be administered within 48 hours of onset of symptoms) Persons hospitalized for influenza Ill health care workers and first responders/emergency service workers Ill high-risk persons in the community Ill high-risk persons in institutions Prophylaxis Frontline health care workers and key decision-makers Remaining health care workers Emergency/essential service workers High-risk residents of institutions Person at high risk hospitalized for illness other than influenza F F   f/Public Health Measures  This section outlines required public health measures to help limit the spread/impact of an influenza pandemic, including: Individual measures such as the use of PPE, case and contact management, isolation and individual activity restriction Community measures such as cancelling public gathering and closing schools Ensuring consistency in the provincial approach to influenza containment measures in collaboration with local public health units&{D{D  d-Health Services  Health services outlines approach/activities to: Ensure health settings maintain appropriate occupational health and safety standards through use of PPE and infection control measures Identify necessary health services that will be provided during a pandemic and services that can be curtailed Identify Health Human Resources required during a pandemic and how they will be deployed (focusing on necessary skill sets) Develop an effective system for purchasing, storing and distributing equipment and supplies before and during a pandemic Implement admission/discharge and triage criteria for individuals ill with influenza Guide community, public health and hospital laboratory services &11  e.Emergency Response  {This section outlines the provincial health emergency response, including: Coordination/collaboration between emergency response personnel and health authorities in pandemic planning and response activities (communication mechanisms, clarification of roles/responsibilities, etc.) Establishment of Business Continuity/Continuity of Operations Plans to ensure continuity of necessary services Identification of emergency response resources that can be mobilized to help the health sector respond to a pandemic (including support from Emergency Management Ontario and other Ministries) Activation of the Ministry Emergency Response Plan 2K0K1 | g0Communications  4This section outlines communications measures to: Ensure that Ontario is prepare to respond to public and health care provider communication needs Educate Ontarians about the pandemic plan Provide consistent, coordinated and effective public and provider communications Ensure health care providers have access to transparent, access accurate real time information to help them respond Ensure mechanisms for health care providers to share information with each other and decision-makers to continuously improve Ontario s pandemic response&22  J(,Highlights: New in the Next Version of OHPIP--, Operational Measures (pre-hospital, community, hospital) Admission/discharge criteria for hospitals and critical care units Clinical management guidelines Occupational Health and Safety/Infection Control measures Role of TeleHealth, Infoline, CCACs in triaging people ill with influenza Necessary Health Services Delivery Framework Laboratory guidelines (for public health, community and hospital laboratories) Algorithm for assessing the quantity/type of PPE and clinical supplies required in a range of health care settings Public Health Measures Emergency Mass Immunization Plan & Vaccinator s Manual Necessary Public Health Programs Delivery Framework Enumeration Tool for determining vaccine/antiviral supply requirements Communications Fact Sheets & backgrounders for public and health stakeholders Communications plan including Information Cycle 9o9o  \  p3l1Feedback to Date  Positive response to new layout, cover design, use of diagrams, more  user friendly Strong recommendation for in-depth Table of Contents or mapping Support for ethical framework; some question re practicality of appeal mechanism Support for Occupational Health/Infection Prevention and Control Measures During the Pandemic Period Role for non-acute and community sectors needs enhancement 0X=  m2Release of Plan  Planned release in April/May deferred to allow for greater content Release planned for week of June 13 Stakeholder support in place Method of release not finalized   E#'Future Planning & Implementation IssuesFinancial Costing at provincial and local levels not yet determined Provincial sources of funding for pandemic influenza preparedness (supplies, capital equipment, etc) not identified Emergency funding/compensation policy for workers, businesses during pandemic not established Other Additional operational, public health and communications work/products Consultation with primary 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