Health Emergency Management at the Provincial Level – the H1N1 Example ONTARIO AGENCY FOR HEALTH PROTECTION AND PROMOTION 2009 aLPHA Conference Dr. Brian Schwartz Director, Emergency Management Support Ontario Agency for Health Protection and Promotion Scientific Advisor, Emergency Management Branch Ontario Ministry of Health and Long-Term Care Role of the OAHPP in Emergency Situations • Agency Implementation Task Force Ministry/Agency MOU – Agency Mandate: Support role to government in emergency and exigent circumstances Scientific and technical advice, risk assessments, research Role of the OAHPP in Emergency Situations • Scientific Response Team (SRT) focal point for Agency’s role in emergency/exigent circumstances Structured enough to allow for expedited scientific advice Flexible enough to adapt to different events, advice to different settings • Applied to infectious disease related emergencies but other events as well (e.g. CBRN, medical isotopes, etc) OAHPP Incident Management System Command Operations Planning Logistics Finance / Administration Doers Thinkers Getters Payers OAHPP Response to H1N1 Command - Liaison with Chief Medical Officer of Health, Ministry, EEMC - Public communication, overall leadership Operations - Public Health Laboratories - Scientific Response Team Planning - Non-science medium and long-term outlook, scenarios Logistics - Focused on lab equipment and lab processes, Business continuity Finance & Admin - Documentation and cost recovery Incident Command (Director, EMU) Liaison Officer (PEOC Operations) Safety Officer MOHLTC Incident Management System Operations Lead Information Officer (CIB Representative) Planning Lead Logistics Lead Finance and Administration Lead Pre-Hospital Group (EHSB Representative) Public Health Group (PHD Representative) Other Health Care Group (LLB Representative) OHIP Group (RCB Representative) Call Centre Group (TeleHealth, INFOLine, OPA) Incident Action Planning Officer Procurement Group (EMU, CRMB, SFSB) Stockpile Distribution Group (EMU, SFSB) Teleconference Management Officer Continuity of Operations Coordination Officer (EMU) Technical Support Officer (HS I&IT Representative) MEOC Supplies and Equipment Officer Volunteer Coordination Officer (HRB Representative) MEOC Human Resources Officer (HRB Representative) Incident Documentation Officer Incident Status/ Data Officer Demobilization and Recovery Officer Cost Tracking and Compensation Officer Technical Advice (Scientific Advisor) Emergency Financial Stewardship Committee Financial Coordination (CRMB, CFBPB, FMB, SFSB, CCO) Health Human Resources (HHRSD Representative) Leg. and Regs Group (HSSD, CCO, Legal) Emergency Medical Assistance Team (Ornge) Scientific Response Team Research Officer (PHD Librarian) Medical Writer (Contracted with EMU) President and CEO Continuity of Operations Team EEMC MOHLTC EMO Incident Manager EMU MOHLTC PEOC Communications Spokesperson Safety Media Relations Liaison Operations Planning Science Logistics Fin/ Admin Laboratories Scenario Development Internal Planning Surveillance & Epidemiology Modelling Research Clinical Guidelines Infection Control PH Measures Psycho-Social Continuity of Operations Coordination Exec & CEO Support Information Technology Teleconference Management Facilities Documentation Legal Lab Communications Lab Safety Liaison Internal Communications Internal Safety Internal Emergency Medical Response Radiation Environmental Medical Writer Response to MEOC Requests Internal Em. Mngmt: Best Practices Internal Supplies Finance HR Lab Operations Lab Medical Lab Logistics Lab Finance What’s wrong with this picture? Plans are nothing…Planning is everything Dwight D. Eisenhower OAHPP Response to H1N1: Structures & Processes • Scientific Response Team • Liaison with MOHLTC • Support to and from Public Health Laboratory What we expected • • • • Started in Southeast Asia Time to prepare High morbidity & mortality Predilection for risk groups (including elderly and young) • High societal disruption What we got • Started in North America • No time to prepare • Low morbidity and mortality (so far) • Predilection for young risk groups • High media profile OAHPP Emergency Operations Centre 2. Where are we now? What do we know? H1N1 acting like seasonal ‘flu: • R0 likely < 1.5 • Thus far low severity of illness • May recede with warmer weather What do we know? Protective effects: • Age: born prior to 1957 • ?seasonal influenza vaccine Questions • Will H1N1 go away and come back? • Will it mutate into a more virulent strain? • Can a (safe and effective) vaccine be developed? – 1976 swine ‘flu • If so, to whom do we give it? • Do we sacrifice seasonal vaccine?