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Responsible to: Regional smallpox lead via Regional Smallpox Outbreak Control Centre Overview of responsibilities. 1. To take enquiries about ill individuals considered to be at risk of having smallpox and, using appropriate risk assessment procedures, to determine whether the Regional Smallpox Diagnosis and Response Team should attend the patient 2. On attending the patient, lead in risk assessment, diagnosis and clinical management of the suspected case 3. Working with other team members, ensure that clinical specimens, information and laboratory results are efficiently dispatched and communicated members, and to those accompanying and attending the patient locally 4. In the event of a positive diagnosis, to supervise the transfer of the patient to an appropriate Care Centre, with full hand-over of all medical and nursing data to the receiving Clinical Care Team 5. Ensure that the Team’s supply of medical supplies is replenished and updated after each deployment 6. To assist, wherever possible with data collection, information and consent procedures and, when indicated, vaccination of local carers and contacts 7. To support the Police in obtaining and preserving evidence for a forensic investigation Detailed task list 1. Making an initial risk assessment  Using clinical and epidemiological information, together with agreed risk assessment criteria, assess the risk that a referred patient requires further investigation for a possible diagnosis of poxvirus infection  The SDE may decide to attend the patient without the other members of the SMART if it seems likely that an alternative diagnosis can be clinically confirmed  If an alternative diagnosis cannot be clinically confirmed, the Team will attend the patient (to take specimens, support the local carers, collate necessary data and ensure the integrity of Infection Control and Public Health measures) 2. Assessing and managing the patient (in liaison with the Infectious Diseases Nurse)  Make an appropriate history and examination, and keep written medical records of the patients assessment, condition, management and progress  Carry out any appropriate near-patient tests (eg blood and urine tests) and record the results  Provide any indicated immediate medical treatment, make and keep adequate prescription and medication records  Take, label and pack Smallpox Diagnosis specimens for dispatch to the Regional Diagnostic Laboratory (and the Reference Laboratory where necessary)  Ensure that local contacts and carers of the patient are not feverish and/or unwell 3. Working and communicating with other Team members



Ensure that the ID Nurse is able to provide care, medication, dressings and necessities such as hydration and nutrition for the patient  Alert other team members to changes in the patient’s condition, or to important features of the history or risk assessment  Make decision as to whether the patient should be transferred immediately to a Care Centre in anticipation of positive diagnostic results  Make and support other contingency decisions in liaison with the Team and local carers  Communicate with Ambulance Personnel and Care Centre Teams, to facilitate the care and transfer of the patient  Ensure efficient exchange of information with the patient’s local carers  Collaborate with the Infection Control Nurse and the Public Health Specialist to ensure the safe handling, packing and disposal of clinical waste and ‘sharps’  Assist with any spillage or other contamination management tasks required to make the environment safe before the Team departs  Provide information for use in dealing with Media Relations 4. Supervise the transfer of the patient  Determine the needs of the patient in preparation for and carrying out transfer to another site  Arrange for the carrying of clinical waste and sharps accompanying the patient to the Care Centre (or to another appropriate facility) for disposal  Provide full medical handover, and pass all patient records and charts to the receiving Carers  Assist and collaborate with Team and Care Centre staff in removing and disposing of contaminated Personal Protective Equipment and clothing 5. Ensure updating of medical supplies for the Team  Work with the ID Nurse to ensure that all used items are listed, and that orders for replacement are immediately made  Also ensure that contaminated but unused items are appropriately documented and disposed of 6. Complete the record of the callout  Work with other SMART members to make an appropriate record of the callout, for use in reporting to RSOCC and CDSC, and for future audit


Responsible to: Regional Smallpox Lead via RSOCC Overview of responsibilities 1. When the SMART is activated on the advice of the Smallpox Diagnostic Expert, the Public Health Physician (PHP) will attend the location of the patient to lead the local public health response. If a patient is transferred to a Smallpox Care Centre on the advice of a SDE, without the deployment of the SMART, the PHP should still be available to carry out Public Health duties at the patient’s initial location. 2. Maintain efficient communications between the SMART and the RSOCC, and the Regional and Reference laboratories. 3. Work with local Security and Police personnel to ensure the safety of the site or area 4. Lead the local Public Health response, including the contact tracing and vaccination, provision of information to local carers and contacts, and investigation of the incident, in accordance with the Smallpox Plan 5. Working with the other SMART members, ensure that the area is decontaminated and left in a safe condition after the patient has been transferred 6. Complete a full report of the episode for the RSOCC Detailed task list 1. . On arrival at the patient’s location  Ensure adequate facilities for reliable communications between the Team, the Regional Control Centre and the Diagnostic/reference laboratory  Assume responsibility for Communications and keep records of communications and eventsEnsure the scene is cordoned off if appropriate  Liaise with police/security operators to ensure safety of premises, Team and others 2. Making an initial assessment and report  In liaison with the SDE, reassess the risk that the patient has smallpox (ie low, medium or high), and communicate this to the Regional Lead  Assess the security of the site, or area, and request support from local Security Personnel or Police (via RSOCC, if necessary).  Inform the Regional laboratory (and National Reference Laboratory, if indicated) that processing of specimens will be required  If the patient is immediately transferred to an isolation facility by the SDE, the PHP and the Communicable Disease Control Nurse should go to the site from where the patient was transferred. 3. Ensure adequate control of infection and Public Health Measures  Work with the Control of Infection Nurse to support appropriate infection control measures, spillage management and immediate decontamination procedures. This may require liaison with community and acute care infection control teams and



trust management (the SMART has executive authority to implement necessary infection control measures) Work with Control of Infection Nurse and other Team members to ensure adequate clinical waste and ‘sharps’ management

4. Whilst a diagnosis of smallpox is being considered/confirmed  Ascertain with team, potential infectious period of patient  Obtain a detailed account of the patient’s movements during the incubation period and while potentially infectious, which will assist in identifying potential source of infection and primary contacts  Initiate contact identification, tracing and categorisation, including healthcare and ambulance personnel  Ensure a reliable means of communicating with contacts who must leave the site for any reason.  Arrange a safe waiting area for remaining contacts  Liaise with local Health Protection team for assistance with urgent tracing of other contacts requiring vaccination and monitoring  Work with other Team members to give information to local carers and residents and keep them updated  Coordinate the collation of data required for Media Relations 5. If smallpox is confirmed clinically by the ID Consultant or following laboratory tests  Inform the Regional Smallpox Control Centre  Support arrangements for transfer of the patient to a Smallpox Care Centre  Supervise the commencement of vaccination of local contacts and carers 6. When the patient has been transferred  Ensure that the area is left in a safe condition and that appropriate decontamination has either been carried out or is in progress  Confirm the end of the incident locally  Hand over to public health teams who will be carrying out contact surveillance and further vaccination activities


Relating to: Public Health Doctor of the SMART Overview of responsibilities 1. When the SMART is activated on the advice of the Smallpox Diagnostic Expert, the Communicable Disease Control Nurse (CDCN) will attend the patient’s location and take a lead in ensuring effective infection control during the deployment. If a patient is transferred to a Smallpox Care Centre on the advice of a SDE, without the deployment of the SMART, the CDCN should still be available to carry out Control of Infection duties at the patient’s initial location. 2. Work with all other SMART members, local healthcare staff, members of other agencies (for instance police, ambulance or security staff) and visitors, to ensure that appropriate infection control measures are taken 3. Lead in clinical waste management 4. Lead in spillage management and decontamination procedures 5. With the SMART Public Health Physician, ensure that the area is decontaminated and left in a safe condition after the patient has been transferred 6. Where necessary, to assist in documentation and Detailed task list 

There may be a need to assist in vaccination of key personnel as alert levels rise


1. If patient transferred to Isolation by SDE – go straight to Isolation facilities to provide patient care. If patient remains at scene:  Provide clinical care as appropriate to include:  Pain relief  Hydration  Nutrition  Airway support  Personal Hygiene and Skin care  Remove jewellery from patient to avoid further skin problems Keep Nursing and Drug Dispensing records Work with other Team members to ensure adequate infections control, ‘sharps’ management and clinical waste disposal procedures Assist where possible with spillage management and decontaimnation procedures If patient is transferred to a Secure Unit or Care Centre Work with Doctor to prepare patient for transfer Assist with giving information to family members Liaise with ambulance teams to facilitate transfer If indicated, act as patient escort


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4. When the patient has been transferred  Assist with packing/labelling of clinical waste/sharps  Assist with any decontamination procedures  Record use or discard of drugs/dressings/equipment, to allow re-ordering for future deployments  Work with Team members to remove and pack/dispose of PPE and any clothing which is contaminated-shower and change if possible.


1. If patient is a child and transferred to Isolation by SDE – go straight to Isolation facilities to provide patient care. If patient is a child and remains at scene, provide clinical care as appropriate (See Diagnostic specialist card: there may be a need to contact children’s or S Social Services in some cases)




ACTION CARD 6: REGIONAL SMALLPOX LEAD  The Regional Epidemiologist (RE) or Regional Director of Public Health (RDPH) who will in turn notify: - Local police forces - Local ambulances - Hospital isolations facilities - Local Consultant in Communicable Disease Control - Local Health Emergency Planning Adviser - Regional Health Protection Agency, Colindale (said CDSC in document) and the Department of Health  There may be the need to be involvement in the training of other PHPs as more RSDRTs are formed and Health Protection and Public Health staff if alert levels increase


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