PHSA Pandemic Plan 2009 - PANDEMIC INFLUENZA PREPAREDNESS PLAN

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					                            PANDEMIC INFLUENZA

                            PREPAREDNESS PLAN

                             GUIDELINES FOR PLANNING,
                             RESPONSE, AND RECOVERY



Version: 2.4 (Sep 2009)


                                  ***DRAFT***




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  PHSA Pandemic Influenza Preparedness Plan – September 2009
                                   EXECUTIVE SUMMARY




Sometime in the near future, British Columbia will face an influenza pandemic – a global
epidemic caused by a strain of influenza virus that spreads rapidly and causes extremely
high rates of illness and death. While pandemics occurred three times in the 20th
century, no one can predict exactly when the next pandemic will take place. Although
many scientists say it could be within 5 to 10 years, the ongoing outbreak of avian
influenza in Southeast Asia, and the recent outbreak of H1N1 (human swine flu), has led
the World Health Organization (WHO) to suggest that the threat of a pandemic is now at
the highest level since 1968.

According to estimates for British Columbia:
    as many as 3 million British Colombians infected with the virus
        as many as 1.8 million people designated as clinically ill
        over 600,000 people making visits to health-care providers
        over 20,000 people requiring hospital care
        an estimated 7000 deaths from influenza and related conditions
        up to one third of the employed population unable to work for a period of time
        an economic costs to the province ranging from $1 to $2.5 billion

In response to this threat, the Provincial Health Services Authority (PHSA) has written a
comprehensive pandemic influenza preparedness plan, which is based on the framework
recommended by the World Health Organization (2005), and follows from the substantive
pandemic influenza plans of both the federal and provincial governments.

This plan sets out specific objectives that will allow PHSA and related stakeholders to
achieve the following goals: first, to minimize serious illness and overall deaths, and
second, to minimize societal and economic disruption among British Columbians as a
result of an influenza pandemic.

As one of BC’s health authorities, PHSA is part of the BC government’s integrated
response structure. Planning activity occurs at a number of levels;
 The BCCDC and other PHSA agencies are part of a robust province-wide health
   surveillance system, with the necessary national and international linkages
   PHSA representatives actively participate in several provincial health sector pandemic
    planning and implementation advisory committees and technical sub-committees. For
    example, Human Resources, Logistics, Operational, Clinical Practice, and
    Communications

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PHSA Pandemic Influenza Preparedness Plan – September 2009
The plan outlines the specific roles and responsibilities of PHSA, its agencies and
services and related stakeholders during preparedness planning, response, and recovery
from an influenza pandemic. Upon declaration of a pandemic, each agency of the PHSA
will move into operations according to their site-specific plans under the direction of the
PHSA Corporate EOC and the direction of the Chief Medial Health Officer (CMHP) for the
regional health authority where the PHSA agency or services is located.

As a pandemic is, by definition, an event that will affect stakeholders at the municipal,
health authority, provincial, federal, and international levels, the PHSA Pandemic
Preparedness Plan outlines a variety of partnerships essential to all three stages of a
pandemic.

Preparedness planning is an ongoing activity and this plan will be regularly reviewed and
updated. Comments are invited and are to be provided to the PHSA Corporate Directors,
Infection Control & Emergency Management & Business Continuity for discussion and
review.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
Table of Contents:
About this document:.........................................................................................................................7
INTRODUCTION............................................................................................................................8
Description of General Emergency Management..............................................................................8
Pandemic Influenza............................................................................................................................9
     Pandemic Flu Planning Goals...................................................................................................9
     Nature of the Threat...................................................................................................................9
     Pandemic Threat and Risk Assessment......................................................................................9
     Pandemic Influenza Historical Context .....................................................................................9
     Current Risk .............................................................................................................................10
     Current Operational Assumptions ...........................................................................................10
     Early Warnings ........................................................................................................................11
     Effect of Interventions ..............................................................................................................11
Plan Development & Maintenance ..................................................................................................12
     Legislation: ..............................................................................................................................12
  Policy: ..........................................................................................................................................12
     Plan management: ...................................................................................................................12
     Plan amendments:....................................................................................................................12
  Plan Maintenance.........................................................................................................................13
     Plan currency and review:.......................................................................................................13
     Information sources:................................................................................................................13
     Exercises and post pandemic evaluation:................................................................................13
  Planning steps ..............................................................................................................................13
  Referenced response plans...........................................................................................................13
  Infection Control Manual.............................................................................................................14
  Supporting documentation ...........................................................................................................14
  Supplemental Plans......................................................................................................................14
Step 1: PANDEMIC PLANNING ...............................................................................................15
  Description of Services ................................................................................................................15
  Administrative Operations, Facilities and Geographic Areas: ....................................................15
Communications ..............................................................................................................................16
  Overview......................................................................................................................................16
  Stakeholders.................................................................................................................................16
     Internal Stakeholders ...............................................................................................................17
     External Stakeholders ..............................................................................................................17
  Strategic Considerations ..............................................................................................................17
Clinical Coordinating Strategies ......................................................................................................18
  Surveillance..................................................................................................................................18
  Internal Clinical Management......................................................................................................19
     Infection Control Precautions: ................................................................................................19
     Anti-viral and Vaccine .............................................................................................................19
     Site Safety.................................................................................................................................20
Health Service Delivery/Business Continuity .................................................................................20
Ethical Framework...........................................................................................................................20
Resource Management.....................................................................................................................20
  Human Resources (See Worksheet 4)..........................................................................................20
  Psychosocial Support ...................................................................................................................21

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PHSA Pandemic Influenza Preparedness Plan – September 2009
  Logistics (see Worksheet 5).........................................................................................................21
     PHSA Pandemic Stockpile .......................................................................................................21
     Critical resources.....................................................................................................................21
  Contracted Services and/or Alternate Service Delivery ..............................................................22
  Finance.........................................................................................................................................22
Education and Training....................................................................................................................23
Step 2: PANDEMIC RESPONSE (COMMAND & CONTROL) .............................................24
  General purpose ...........................................................................................................................24
Response Structure...........................................................................................................................24
  Structure system...........................................................................................................................24
  Provincial Health Services Authority Corporate EOC Roles and Scope.....................................24
Activation.........................................................................................................................................25
  Authority for activation................................................................................................................25
  States of Emergency ....................................................................................................................25
  Activation triggers .......................................................................................................................25
  Activation Levels .........................................................................................................................26
  Alert Systems:..............................................................................................................................26
     WIC..........................................................................................................................................26
     ETEAMS..................................................................................................................................26
     FAN OUTS ..............................................................................................................................27
  Organizational Responsibilities: ..................................................................................................27
Communications ..............................................................................................................................27
  Roles and Responsibilities ...........................................................................................................27
  PHSA Spokespersons ..................................................................................................................28
     Communication Lead ...............................................................................................................28
     Key Spokespersons...................................................................................................................28
     Key Messages...........................................................................................................................29
  Risk Communication ...................................................................................................................29
  Notification Process .....................................................................................................................30
     Integration of communications staff into notification procedures...........................................30
     Notifying communications staff of other health partners ........................................................30
Clinical Coordinating Strategies ......................................................................................................30
  Surveillance: ................................................................................................................................30
  Internal Clinical Management......................................................................................................31
     Infection Control Precautions: ................................................................................................31
     Site Safety: ...............................................................................................................................31
     Anti-viral and Vaccine .............................................................................................................31
Health Service Delivery/Business Continuity: ................................................................................31
     Internal infrastructure dependencies:......................................................................................32
Ethical Framework...........................................................................................................................32
Resource Management.....................................................................................................................32
  Human Resources ........................................................................................................................32
  Psychosocial Support ...................................................................................................................32
  Logistics.......................................................................................................................................33
     Acquiring Authority .................................................................................................................33
     PHSA Authority:......................................................................................................................33
     PHSA CEOC Authority: ..........................................................................................................33
     Monitoring of Critical Supplies ...............................................................................................33

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PHSA Pandemic Influenza Preparedness Plan – September 2009
    Completing a Request for Resources or Assistance Form.......................................................33
  Finance.........................................................................................................................................33
Step 3: RECOVERY – POST PANDEMIC ................................................................................34
  Transition from Response to Recovery........................................................................................34
  Service Interruption Assessments ................................................................................................34
  Communications: .........................................................................................................................34
    Notification ..............................................................................................................................34
    Staff..........................................................................................................................................34
  Health Services Delivery/Business Continuity............................................................................34
    Client Services .........................................................................................................................34
    Site ...........................................................................................................................................35
  Resource Management:................................................................................................................35
  Restoration of Services: ...............................................................................................................35

ANNEXES
1.         PHSA Infection Control Plan
2.         Corporate Service Supplemental plans (Internal)
3.         Completed Business Continuity plans (internal)
4.         Alternate Service Delivery/Contracted Services’ plan

ATTACHMENTS
1.         Outline of Provincial Plan
2.         EM&BC Policy (EMBC 100)
3.         Staff in Health Authority Count
4.         PHSA Pandemic information and communication development and distribution
5.         ILI Outbreak Summary Report Form (BCCDC)
6.         Federal roles and responsibilities
7.         Principles of infection control (BCCDC PIPP)
8.         PHSA Proof of Immunization form
9.         List of pandemic stockpile inventory
10.        PHSA supply / activation level table
11.        PHSA Finance policy for activation of emergency/disaster costs
12.        PHSA Activation Levels
13.        Organizational charts:
               a. Level 1 MOC
               b. Provincial Public Health
               c. PHSA response
14.        Key provincial and health authority responsibilities (BCCDC PIPP)
15.        Public information communications flow
16.        PHSA request for resource




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PHSA Pandemic Influenza Preparedness Plan – September 2009
About this document:
The PHSA’s Pandemic Preparedness Plan is a working document that will be frequently
updated to meet the ever-changing challenge of pandemic influenza planning and
preparedness. It is to be used by the PHSA Corporate Directors, Infection Control &
Emergency Management & Business Continuity, as the lead document when dealing with
most public health emergencies involving infectious disease threats, and when
responding to requests for assistance from PHSA’s stakeholders.

This document is based on and has been designed to mirror the British Columbia
Pandemic Influenza Preparedness Plan – Guidelines for Planning, Response, and
Recovery (August 2005), to ensure that the province, PHSA, and its agencies and
services will be working together in a consistent manner. (Attachment 1). Furthermore,
this plan is intended to augment the regional health authority plans to ensure a
coordinated and collaborative approach is achieved.

The plan is broken down into two parts. Part I is the PHSA Preparedness, Planning, and
Response Plan. For internal use, this document will guide the Corporate Director,
Infection Control (and other employees) of PHSA in planning for, responding to, and
recovering from an influenza pandemic. The plan will also assist key stakeholders in
making the best decisions possible when faced with such an emergency through the use
of a functional approach to emergency management.

Part II of this plan comprises of a series of annexes. These annexes include PHSA-
specific information and data regarding response procedures and highlight resources
available to health services personnel in the event of a pandemic.

This plan is prepared to provide guidance to the staff and physicians of PHSA and to
assist the executive in the conduct of, response to, and initial recovery from, a major
pandemic occurrence. The plan itself is intentionally brief. However, it is supported by
Annexes and Appendices as well as Attachments that supplement the core plan content.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
INTRODUCTION
The impact of a virulent virus causing an influenza pandemic on the population and
economy of the Province of British Columbia is likely to be very significant, sustained and
widespread. Based on extrapolation from previous pandemics major effects may well
include:

   as many as 3 million British Colombians infected with the virus
   as many as 1.8 million people designated as clinically ill
   over 600,000 people making visits to health-care providers
   over 20,000 people requiring hospital care
   an estimated 7000 deaths from influenza and related conditions
   up to one third of the employed population unable to work for a period of time
   an economic costs to the province ranging from $1 to $2.5 billion

These estimates are based not on a worst-case scenario, but rather on the assessed
impact of the 1957 and 1968 influenza outbreaks which were considered mild when
compared with a devastating outbreak in 1918.

Such a widespread outbreak of illness has significant implications for every sector of
society and clearly underscores the need for anticipatory planning particularly in the
health sector. PHSA as an integral participant in the delivery of health service in British
Columbia and is, therefore, undertaking an initiative of pandemic planning as part of its
preparation for such an eventuality in tandem with its operational partners.


Description of General Emergency Management
This Pandemic Preparedness Plan is one component of the PHSA’s commitment to an
Emergency Management Program that includes all hazards threat identification, risk
assessment and impact analysis, as well as prevention and mitigation activities aimed at
removing or diminishing identified threats.

Preparedness activities include the preparation of this Pandemic Preparedness Plan,
Response and Operational Continuity Plans, exercising the plan, training staff,
development of pandemic management policy, protocols, procedures and priorities, as
well as response support activities including a clear, well practiced concept of operations,
concept of communications, organizational structure and safe practices for supporting the
response. This plan also recognizes ongoing operational activities which include attention
to human resources, provision of contracted services, reinstatement of service to patients
and reactivation of facilities and infrastructure if they have been disrupted.

This Plan along with other PHSA Agency and corporate-specific Agency/Service
Pandemic Response Plans fit together to form a comprehensive approach to this threat
thereby achieving the emergency planning objectives of PHSA.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
Pandemic Influenza
Pandemic Flu Planning Goals
Although the pandemic itself cannot be prevented, effective pre-planning can mitigate its
impact. Accordingly, the provincial goal of this Pandemic Influenza Preparedness Plan is
to minimize rates of:
 Infection
 Death
 Illness
 Suffering
 Minimization of social and economic impacts.

Nature of the Threat
Influenza is mainly spread by the respiratory route, through droplets of infected
respiratory secretions or by fine respiratory aerosols produced when an infected person
talks, coughs or sneezes. It may also be spread by hand or face contact after touching a
person or surface contaminated with infectious droplets.

People who acquire infection will become ill and can pass on the infection after an
incubation period of one to three days.

People are highly infectious from the onset of symptoms for at least four to five days
although this may be longer in children and people who are immunocompromised.
Approximately 10% of people are likely to become infectious only just before the onset of
symptoms.

Pandemic Threat and Risk Assessment
The pandemic threat, risk and vulnerability analysis for PHSA has been prepared by
BCCDC to identify the principle operational concerns and mitigation actions required.
These findings, constraints and intended actions are summarized in the PHSA Infection
Control Manual (Annex 1) and supporting documentation, signage and instructions to
staff.

Pandemic Influenza Historical Context
It appears inevitable that sometime in the future British Columbia will face an influenza
pandemic. It is unlikely that it will originate in British Columbia but rather it will be caused
by a strain of influenza virus that spreads rapidly, causes high rates of illness and death
and originate from a part of the world where transmissibility from animals or birds to
humans occurs with some frequency. It is not possible to predict when this will happen
but recent evidence of strains of the disease in domestic foul and wild birds in 2005 and
2006 have produced a heightened awareness about the possibility of pandemic in the
healthcare community, media, political arena and in the general public.

Influenza pandemics have enveloped the Globe periodically throughout history with
devastating effects. Three pandemics occurred in the last century alone:



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PHSA Pandemic Influenza Preparedness Plan – September 2009
   1918/19-named the Spanish flu
   1957/58-named the Asian flu
   1968/69 named the Hong Kong flu

During each pandemic episode up to a third of the population were affected with illness
with mortality in the thousands. Along with this death toll there was also associated
economic and social disruption which had devastating effects on both local and global
economies. The most severe pandemic in 1918/19 is estimated to have killed between
20 and 40 million people worldwide.

Current Risk
It is generally considered that the conditions in which a new virus might emerge and
spread continue to exist and may be increasing which suggests further pandemics of
influenza are probable. The timing, extent and severity remain uncertain, but sufficient
information known from previous pandemics indicate a likely range of impacts. The
continuing appearance of strains of H5N1 in domestic and wild bird populations in the Far
East and Europe and the April 2009 outbreak of H1N1 (human swine flu) provide added
evidence that the disease has the potential to erupt at any point in the future. Recent
indications are that animal or birds to human transfer has occurred but there is yet no
indication of a new strain yielding transmissibility from human to human.

It is generally assumed that there will be a period of one to six months between the time
an influenza pandemic strain is first identified globally and the time that outbreak first
appears in British Columbia. However, the global movement of people by air could
significantly reduce lead time. Within six to nine weeks from arrival in BC it is anticipated
that most communities in the province will be affected and that the impact will continue
for at least six to nine months thereafter.

The latest advent of an influenza outbreak of a novel virus with swine originating in
Mexico has demonstrated how quickly person-to-person contact of a viral respiratory
disease can propagate from an index source.

Current Operational Assumptions
In gauging the impact of a pandemic upon an organization, it is important to make some
basic assumptions about the conditions, which may exist at that time.

Unlike natural disasters (where any disruption is likely to be facility or hardware-related),
disruption to business operations due to a pandemic can be anticipated to be primarily
human-resource related.

BCCDC advises that organizations should plan for up to 20% - 30% staff absenteeism for
periods of about two weeks at the height of a severe pandemic wave and lower levels of
staff absence for a few weeks either side of the peak.

Overall a pandemic wave may last about 12 to 14 weeks. Note that the pandemic may
come in two or more waves of varying severity over time. The second may be the most
severe.

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PHSA Pandemic Influenza Preparedness Plan – September 2009
Staff absenteeism may be a result of the following reasons:
    illness / incapacity (suspected / actual /post infectious)
    need to stay at home to care for the ill.
    feel safer at home (e.g. to keep out of crowded places such as public
       transportation)
    provide day care if schools or other institutions are closed
    fulfilling other voluntary roles in the community
A pandemic may have other indirect impacts on programs, for example:
    supplies of materials needed for ongoing activity may be disrupted due to
       transportation disruptions or delays
    availability of goods and services maybe impacted (including the affects of
       maintenance on key equipment) because of the inability of vendors or contractors
       to fulfill their obligations
    demand for services may increase (internet access is a possible example)
    demand for services may decrease (patients may choose not to attend clinics that
       do not treat life threatening issues)

Early Warnings
The World Health Organization [WHO] working with health agencies around the world,
hopes to provide early warning of the initiation and arrival of pandemic influenza.
Influenza outbreaks will occur not just once but in a series of waves that may strike
different parts of Canada and the province of British Columbia at different times and with
varying levels of intensity. It is the intention of the federal and provincial governments,
through the Provincial Health Officer, to provide as much warning as possible that a
pandemic influenza outbreak is imminent and to provide ongoing insight into the levels of
pandemic influenza activity following the recognition of an outbreak.

Effect of Interventions
A person may be placed on home isolation if they have an infectious illness such as
influenza. Isolation means staying at home, not going outside, not going to work, school
or other public places and not meeting with other people. While at home, the person who
is sick should stay isolated or away from other household members as much as possible.
Guidelines for individuals on home isolation are available at www.bccdc.org and the
PHSA staff intranet (POD).

Vaccines if available, will afford the greatest reduction in illness and lessen the impact on
health and other services. However, even the best influenza vaccines do not
provide100% protection – when vaccine and circulating virus strains are well matched,
vaccination may be expected to reduce infection by approximately 75 percent.

Early antiviral treatment (within 48 hours of onset of illness) should shorten the period of
illness, may ameliorate symptoms and could reduce hospitalizations by an estimated 50
percent. However, the effectiveness of antivirals in a pandemic and particularly in
reducing mortality in cases of severe disease is uncertain.


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PHSA Pandemic Influenza Preparedness Plan – September 2009
Plan Development & Maintenance
Legislation:
Under provincial legislation, the Ministry of Health Services, led by the Provincial Health
Officer (PHO), has the lead authority in all three stages of this plan.

The influenza pandemic response plan at PHSA is tailored to reflect and/or augment
guidelines provided by:
 Provincial Health Services Authority Plan
 BC Centre for Disease Control
 BC Provincial Pandemic Influenza Plan
 BC Ministry of Health
 Canadian Pandemic Influenza Plan (CPIP)
 Public Health Agency of Canada
 World Health Organization

Policy:
The Emergency Management & Business Continuity - EMBC100 policy (attachment 2)
provides the foundation for the broader PHSA Emergency Management program of
which this plan is only one part. The policy ensures that there is identification of the
threats to patients, visitors, staff, and facilities and infrastructure in PHSA and the ways in
which these threats may be mitigated or prevented. It also identifies the need for an
integrated response to a specific incident or threat(s). The program supports appropriate
staff preparedness and training in conjunction with partner agencies. The policy
recognizes and supports the need for organized recovery from the consequences of an
actual incident or group of incidences. In addition, the policy recognizes the importance
of staff preparedness and self-reliance in order to ensure that an adequate level of
preparedness in PHSA is attained.

Plan management:
The PHSA Corporate Directors, Infection Control & Emergency Management & Business
Continuity maintains this plan in collaboration with the Emergency Management &
Business Continuity Department. This plan is prepared in conjunction with the respective
health authorities in which each agency/site is situated and the BC Centre for Disease
Control (BCCDC).

The PHSA Corporate Directors, Infection Control & Emergency Management & Business
Continuity shall be responsible for ensuring that this plan is maintained in a state of
readiness for both exercises and actual events.

Plan amendments:
Comments on the content and recommendations for changes or additions should be
directed to the PHSA Corporate Directors, Infection Control & Emergency Management &
Business Continuity.

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PHSA Pandemic Influenza Preparedness Plan – September 2009
This plan is consistent with both the PHSA Emergency Plan and the PHSA Corporate
Response and Continuity Plan and forms a threat specific Annex to it. This plan is also
consistent with the PHSA Emergency Management and Business Continuity Policy found
in the attachment 2 of this plan.

Plan Maintenance
Plan currency and review: This Plan shall be kept current and reviewed quarterly.
Each copy of this Plan is distributed to a registered owner and revisions will be provided
electronically to plan holders within two weeks of finalized updates.

Information sources: Staff in the agency/service shall assist in ensuring that this plan
is up-to-date. New or updated information from any external sources shall be solicited
and incorporated prior to each review.

Exercises and post pandemic evaluation: Well-documented exercises, response
to Medical Health Officer Warnings and Alerts, and actual utilization of the Plan in the
event of a major pandemic outbreak will provide guidance on items which require
updated or revised amendments. Debriefings, hot washes, and after action reports will
be utilized as a mechanism to incorporate lessons learned, best practices, and to ensure
continuous quality improvement.

Planning steps
The management of a health response will be undertaken in three stages that correspond
to pre-established thresholds:

PHSA Pandemic             Description                               WHO phases
steps
Step 1 – Planning All levels of PHSA will undertake                 Phase 1-4
                  appropriate pandemic planning and
                  preparedness initiatives
Step 2 – Response A full emergency response is initiated            Phase 5-6
                  during this stage including public health
                  measures, infection control, antiviral
                  treatments and vaccination
Step 3- Recovery  The primary focus of this stage is to             Phase 1
                  deactivate pandemic response activities,
                  review their impact and identify lessons
                  learned.

Referenced response plans
Some partners and jurisdictional authorities and related organizations internal/external to
PHSA have prepared their own Pandemic Plans, including regional health authority
plans. References to these Plans are made as appropriate.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
Infection Control Manual
PHSA has a comprehensive Infection Control Manual that has been developed by the
Infection Control Committee and the Infection Control Practitioners to provide a guide to
policies, protocols and response practices regarding the spread of all types of infection at
the PHSA or its agencies/services. It provides specific guidelines for the management of
a respiratory disease outbreak in the community and infection control measures that
would be taken throughout PHSA in addition to those measures outlined in this plan.

Supporting documentation
The Plan is supported by the staff and emergency management contact numbers, duty
administrative cell phone number, office and EOC contact numbers. It also relies on the
most appropriate means and contact information for both partner and supporting
agencies and organizations. This information is maintained by the Emergency
Management & Business Continuity Department.

Supplemental Plans
Each agency of PHSA will ensure that they have a Pandemic Response Plan and will
follow the PHSA plan maintenance schedule to ensure regular updates/revisions are
made. Because of the specialized nature of our patient population and the complexity of
the health care services, many of the direct patient care agencies of PHSA utilize
templates specific to their type of service. However the PHSA Pandemic Assessment
package must be completed as a supplement to the PHSA Pandemic Influenza
Preparedness Plan.

PHSA Corporate Services and Agencies that do not provide direct patient care must also
have a Pandemic Response Plan. A supplemental pandemic plan template is available
from EM&BC. The Assessment package for PHSA services will be attached to this plan
as a supplemental annex.

All PHSA agency/service pandemic response plans are an annex to this plan and when
available can be obtained from the POD site.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
Step 1: PANDEMIC PLANNING

The preparedness phase of this Plan envisages that a number of actions taken now will
significantly reduce dislocation of clinical service delivery and supporting operational
activities as well as offset any staff disquiet that would surround an imminent pandemic
influenza outbreak.

This preplanning stage includes identifying emergency management activities, staff
communications, surveillance at PHSA facilities, management and prioritization planning
of clinical health services, operational continuity planning for support services, and
antiviral / vaccination strategies.

Description of Services
The plan provides the overarching context for PHSA’s agencies and services, including:
 BC Cancer Agency
 BC Centre for Disease Control
 BC Children’s Hospital and Sunny Hill Health Centre for Children
 BC Mental Health & Addiction Services (Forensic Psychiatric Services Commission,
   Riverview Hospital, Child and Youth mental health and addiction services provided at
   BC Children’s Hospital, Provincial Specialized Eating Disorders Program)
 BC Provincial Renal Agency
 BC Transplant Society
 BC Women’s Hospital and Health Centre
 Cardiac Services BC
 PHSA Laboratories
 PHSA corporate and clinical support services and departments

Administrative Operations, Facilities and Geographic Areas:
While pandemic exposure could arise throughout all of PHSA’s operational and
administrative areas, it is also possible that pandemic conditions could arise that are
restricted to one facility or location alone. The basic principles developed in this plan are
applied to both the general and the specific situations within the organization.

However, each site will rely on its own pandemic response plan matched to its operating
location and health region. While the majority of PHSA agencies and services are
located within Vancouver Coastal Health (VCH), there are PHSA employees located in
offices and centres within other geographic health authorities. Attachment 3 provides a
list of PHSA facilities, centres and offices operating within the jurisdiction of health
authorities other than VCH.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
Communications

Overview
PHSA responsibilities in the pre-pandemic period include the development and testing of
regional and local communication networks and the definition of communication roles and
responsibilities at the PHSA, agency/service, site and facility levels. During a pandemic
responsibilities are to ensure clear direction to health care workers is provided and to
maintain essential health service delivery levels, as well as ensuring timely and regular
updates are provided to other stakeholders, provincial officials, public and the media as
required. In the post-pandemic period, the primary responsibilities are to relay when
facilities will resume normal operations and inform the public. Furthermore, in conjunction
with the regional health authorities, the public and media will be kept informed about local
and regional outcomes of the pandemic.

The federal government has lead responsibility for informing health providers and the
public about the pandemic’s international and national impact and about infection control
measures taken at the national level (e.g., closing ports or airports). The provincial
government, through the Public Affairs Bureau, will provide public information about
provincial measures (e.g., restricting public events).

Communications planning is a vital part of pandemic planning. The Ministry of Health
Public Affairs Branch (HPAB) is working with health authorities and other organizations to
assist in the development of a coordinated response in the event of a pandemic. The BC
government, health authority and local government pandemic communication plans must
be compatible with the BC Emergency Management Structure (BCERMS). BCERMS
provides a common organizational structure and control, and enhances communication
between agencies responding to an emergency or disaster.

Clear communication before, during and after a pandemic will facilitate implementation of
the pandemic response, allow healthcare workers to function most effectively, and
address fears and concerns among the public.

The overall objectives of the communications plan are to:
 Provide clear, accurate messaging to internal and external stakeholders during all
   pandemic phases
 Ensure timely communications by a variety of means appropriate to the target
   audience
 Incorporate risk communication principles in all messaging.

Stakeholders
The Plan outlines the specific roles and responsibilities of internal and external
stakeholders during preparedness planning, response, and recovery from an influenza
pandemic and where applicable provides for the inclusion of First Nations.

Upon declaration of a pandemic, a PHSA agency or service will move into operations
according to the response stage of this plan and will coordinate with the PHSA Corporate


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PHSA Pandemic Influenza Preparedness Plan – September 2009
EOC and with the regional Chief Medical Health Officer (CMHP) responsible for the
health authority in which the PHSA agency or service is physically located.

Internal Stakeholders
Communication to staff and other healthcare workers involved in the pandemic response
must:
 Allow staff to understand their role in a pandemic response
 Ensure staff know how to protect themselves, their families and their patients or
  clients
 Provide accurate information regarding the pandemic
 Address concerns in a timely manner

Internal communications is a vital component of a response plan. Fan out systems will
be needed to communicate with staff in a timely manner. As well alternate modes of
communications can be a valuable tool. Optional methods of communications such as
WIC (Wallace Wireless) and E Teams provide an ability to coordinate alerts as well as a
mechanism for sharing of information in real time.

External Stakeholders
Communication to external stakeholders, including the public and the media must:
 Provide instructions for cases, contacts and family members regarding prevention and
  treatment
 Clearly describe the PHSA planned pandemic response at each stage
 Ensure that any PHSA messaging to the public or media is coordinated and/or
  consistent with the general information provided by the regional health authority’s
  public health division and aligns with the PHO’s directives as indicated by PHSA’s
  Infection Control.

Strategic Considerations
Provincial/territorial health ministries and/or health authorities assume lead responsibility
for public communications within their jurisdiction.

The Public Health Agency of Canada is the lead organization for public communications if
the pandemic has moved beyond a single province or if a national emergency has been
declared. Specific responsibilities include disease surveillance and national guidelines
for infection control.

PHSA patients and clients are unlikely to distinguish between levels of government in the
event of a health emergency. Public communications among all involved organizations
must be coordinated and consistent. Links to central (single) sources of information
should be used whenever feasible and practical.

Public communications around an influenza pandemic will occur in the international
context. Key audiences, especially the media, will access various information sources
from around the globe including the World Health Organization.



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PHSA Pandemic Influenza Preparedness Plan – September 2009
The communication demands of an influenza pandemic will likely be intense and the
complexities unprecedented therefore requiring a streamlined and coordinated
communication process which engages all relevant stakeholders and partners. In order
for communications to be consistent and timely, processes need to be established to
ensure centralized information and to minimize any duplication. In addition to the full
scope of each organization’s communications capacity, it is recognized that in order to
optimize resources, organizations will need to work collaboratively in finding solutions
that enable a comprehensive and effective communication strategy at all levels of
government.

Clinical Coordinating Strategies
PHSA’s unique mandate and structure facilitates the delivery of specialty health services
within all five of the geographical health authorities, which translates into having access
to five Chief Medical Health Officers. This unique access to Public Health
communications and directives during a Pandemic will be coordinated through PHSA’s
Infection and Control Services. Communication with Regional Health Authorities, Chief
Medial Health Officer will be through normal communication routes – each facility will
receive and seek information as they would during non pandemic times. If you are
unclear as to how you receive and/or seek information on Public Health and specifically
Pandemic related, please connect in with your Infection Control officer. See attachment 4

Surveillance
In Canada the federal government bears responsibility to establish surveillance networks.
Influenza surveillance takes place in cooperation with provincial and regional
epidemiologists and sentinel physicians. Weekly or bi-weekly FluWatch reports are
published. The main regional responsibility is to participate in the development of
provincial surveillance network and ensure timely reporting of influenza activity to the
province and other key stakeholders.

FluWatch is found at: http://www.phac-aspc.gc.ca/fluwatch/index.html. The BCCDC
Epidemiology Department provides an Influenza Like Illness Outbreak form to be utilized
when reporting any residential or work related outbreaks. (attachment 5)

In the interpandemic period, regional health authorities undertake surveillance for local
influenza activity in order to:
   Monitor for the introduction and spread of influenza and other respiratory viruses
    within the region;
   Allow for rapid identification and control of facility outbreaks, to minimize morbidity
    and mortality of vulnerable populations;
   Provide information on influenza epidemiology to hospitals, long term care facilities
    and physicians;
   Provide regional information to provincial and federal authorities that will contribute to
    National surveillance information.

When a pandemic is declared, surveillance activities will be directed by the Public Health
Agency of Canada and directed provincially by the BCCDC. PHSA agencies and services


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PHSA Pandemic Influenza Preparedness Plan – September 2009
will participate in these activities, and will enhance regional surveillance activities to
monitor for the introduction and spread of the pandemic viral strain.

Roles and responsibilities for regional health authorities, provincial and federal
governments are outlined in Attachment 6.

Internal Clinical Management

Infection Control Precautions:
A comprehensive infection prevention and control program forms the basis of a
successful pandemic influenza plan at PHSA. Adherence to infection prevention and
control policies and procedures is imperative to minimize the transmission of influenza
whether or not vaccine and antiviral medications are available. Any site specific control
policies are attached in the agency and/or corporate services’ specific supplemental plan
(annex 2)

Infection control guidelines are implemented by the Infection Control Services within each
PHSA facility as guided by provincial and federal strategies. Occupational Health and
Safety within each facility will also provide input into infection control procedures for staff
members to utilize in order to minimize exposure to the virus in their respective work
environments.

In addition, the Public Health division within each regional health authority provides
geographically specific information for each PHSA facility. During a pandemic it is
important for administration to ensure that they are in communication with the health
authority in which their facility resides.

In the event that a PHSA facility or service does not have a designated Infection Control
Practitioner, guidelines outlined in Attachment 7 may be utilized. These guidelines are
for the management of pandemic influenza in traditional and other settings and are based
on published guidelines from the Public Health Agency of Canada, as well as the
Canadian and British Columbia Pandemic Influenza Plans.

Anti-viral and Vaccine
The use of anti-viral and vaccines during a pandemic will be coordinated and/or
instructed through PHSA for all non direct patient care workers. It may be that
administration of anti-virals and/or vaccines will be arranged through the regional health
authority in which the facility resides. Therefore, staff priority groups (described in the
Resource management section) should be identified during the pre-planning stage and
indicate the health authority in which they are located. When obtaining immunization out
of PHSA a “Record of Immunization” card should be filled out and submitted to your
OH&S staff. (attachment 8)

Facilities that provide direct patient care must, in addition to establishing staff priority
groups, ensure that patients are also prioritized and any special considerations identified.
The distribution and administration of the anti-viral and/or vaccines for staff at these



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PHSA Pandemic Influenza Preparedness Plan – September 2009
facilities is coordinated through their OH&S Department with input from Infection Control
Services.


Site Safety
During a pandemic access to facilities may be restricted using triaging, screening or self
assessment protocols. Facilities within PHSA that deliver direct patient care may need to
consider the provision of Security or other manpower/supply resources to ensure that
facility access is managed appropriately.

Health Service Delivery/Business Continuity
Business impact assessment and business continuity strategies are facilitated by the
PHSA EM&BC division. Once implemented, business continuity plans augment the
pandemic response plan and will address specific agency business processes, their
priority, inter-dependencies, potential mitigation strategies and recovery solutions.

In receiving facilities such as C&W and BCCDC surge capacity issues will need to be
addressed.

Ethical Framework
It is important to recognize the need to have a mechanism for the ability to determine
priorities based on an established ethical framework. Those agencies and/or services
that do not have an ethical framework should consult with their assigned emergency
planners to provide suggestions and/or protocols that might be best suited to their
business.

Reference to any existing BCP plans, will be found in Annex 3

Resource Management
During an influenza pandemic it is recognized that certain resources, such as manpower
and pandemic supplies, may be in short supply therefore resulting in a potential risk that
they may become a critical resource. Therefore, a comprehensive mechanism to ensure
optimal utilization and distribution of these resources has been established at PHSA.
The following sections outline some considerations that may require further exploration
during specific phases of a pandemic as well as any mechanisms currently implemented
by PHSA

Human Resources

   Determination of essential service levels / workforce requirements in each
    program/department
   Baseline of staffing requirements and mechanism to track absenteeism in pandemic
    response phase
   Determine internal staff priority groups and estimate of essential service staff requiring
    antivirals and/or vaccines


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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Development of a mechanism to ensure PHSA’s agency programs or facilities are
    appropriately represented in the regional health authority(ies) that possess the public
    health jurisdictional responsibility
   Estimates for dispensing of anti-virals and vaccines
   Identified alternate personnel pools and training for dispensing of antivirals and
    vaccines
   Ethical issues
   Employee Wellness and Safety
   Volunteer Management and additional staffing strategies

Psychosocial Support
The goal of the Ministry of Health Services’ Disaster Psychosocial Project is to develop a
Provincial framework to address the provision of pre, during and post-disaster
psychosocial services. The project addresses the need for the immediate development
and implementation of workforce resiliency programs and disaster psychosocial services
in British Columbia’s health sector. The research on SARS and other recent public
health emergencies underscores this imperative. A failure to provide adequately for the
psychosocial needs of these first receivers will not only put healthcare workers at risk, it
could also undermine the overall pandemic response capacity.

Psychosocial response involves a range of supportive services with those who are
affected by an emergency or disaster, including the promotion of individual, family and
community resiliency. These various services are used to help diminish long term psycho
social effects, to clarify the current situation and to improve adaptive coping strategies.

For updates and additional information, visit the Disaster Psychosocial Project page on
the Ministry of Health Services – Emergency Management Branch website.

Logistics

PHSA Pandemic Stockpile
As directed by the Ministry of Health in 2006, and implementing outcomes identified
during the novel virus H1N1 outbreak in April of 2009, PHSA has increased its stockpile
of supplies deemed to be essential during a pandemic to 24 weeks. Initially set at a 10
week supply, recent usage history indicated the need to further increase these supplies
to 24 weeks. A complete list of the inventory can be found in attachment 9. This stockpile
is rotated through the normal usage to reduce loss due to expiration and ensure current
product style. This stockpile inventory list will be reviewed every May by a team
comprised of at least one representative from: PHSA Supply Chain, PHSA Infection
Control, and a Clinical Leader, under the direction of PHSA Emergency Management and
Business Continuity.

Critical resources
As a preparatory measure, PHSA has pre-identified some supplies and materials as a
critical resource. These items are as follows (but are not limited to):
 Ventilators
 Staff

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   N95 masks
   Syringes
   Beds & mattresses
   Stretchers

Internally, PHSA will liaise with all agencies, services and corporate departments to
coordinate allocation of resources currently in circulation and in general stock, which
have been pre-identified as critical or with the potential to become a critical resource.
During WHO’s Phase 5 PHSA may determine allocation of resources based on needs
identified across PHSA. During WHO’s Phase 6 PHSA will determine allocation of
resources based on needs identified across PHSA. (Attachment 10)

Contracted Services and/or Alternate Service Delivery
PHSA has identified the following contracted services and where possible, have
requested that their pandemic plan be completed. Any plans that were made available
are attached as Annex 4.
 House keeping and environmental services
 Protection services
 Plant services
 Food services

The following questions should be addressed regarding affiliates/Bill 29 contractors to
ensure that they are sufficiently equipped to provide services and maintain bio-security in
the event of a pandemic.
 Will Contractors be able to supply sufficient numbers of skilled staff in the event of a
   pandemic?
 Do contractors have access to adequate training/education regarding standards to
   ensure their employees are aware of how to behave, work and react to a pandemic?
 Are there new protocols that employers will wish implemented in the event of a
   pandemic? (e.g. new or expanded cleaning routines?)
 Will Contractors assure the health system that they will supply the necessary
   protective equipment to their employees?
 Are there adequate safety supplies required during a pandemic available for Contract
   employees?
 Will Contractors be expecting to pass on overtime costs necessitated by supplying
   workers in a Pandemic?

Finance
PHSA Emergency Management & Business Continuity in conjunction with PHSA finance,
have issued protocol for accounting procedures in the case of an emergency or disaster
such as H1N1 or flood in order to provide a mechanism to track costs associated with
response to the ‘event’ and to provide documentation to validate cost overruns. This is to
be achieved by using a project code that will be activated by a very specific procedure as
outlined in the attachment PHSA Accounting Procedures for Emergency / Disaster codes
(Attachment 11).



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PHSA Pandemic Influenza Preparedness Plan – September 2009
Education and Training
   Assess requirements and provide education to health care providers on the care and
    management of persons suffering from influenza and its complications.
   Education of infectious control guidelines for prevention and personal protection
   Develop strategies to ensure competency of staff that may be performing new tasks.
   Training such as EOC roles and cross training where appropriate
   Provide mechanism for staff education on latest preventative measures and PPE
    recommendations




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PHSA Pandemic Influenza Preparedness Plan – September 2009
Step 2: PANDEMIC RESPONSE (COMMAND & CONTROL)
General purpose
The general aim of this Pandemic Influenza Preparedness Plan is to develop a clear,
concise overview of operations, communications, organizational structure, roles and
responsibilities in order to facilitate response and recovery resulting from a pandemic
occurrence. This plan also serves as a training and exercising resource.

Response Structure
Structure system
The British Columbia Emergency Management Response Systems (BCERMS) will be
utilized for the PHSA response to a pandemic outbreak.

Location: The primary location for the Corporate EOC is at Boardroom A, 7th floor, 1380
Burrard Street, Vancouver, BC. The secondary EOC is located at the Boardroom, 4th
floor, East Tower, City Square, 555 West 12th Avenue.

Provincial Health Services Authority Corporate EOC Roles and Scope

PHSA EOC
 Coordinate all PHSA response and recovery activities
 Collate sit reps (situation reports) from agencies and/or corporate services
 Provide overall delineation of response
 Liaise with BC Health Authority Shared Services Organization (SSO)
 Planning/intelligence for Advanced Planning Unit
 Coordination of policy requests
 Coordination of PHSA messaging

Agencies
 Coordinated agency response and recovery for their site(s)
 Provide direction and coordination to all personnel assigned to site for response and
  recovery
 Provide PHSA CEOC sit reps (situation reports) for each operational period as
  directed by EOC director

Corporate Services
 Under overall direction of PHSA CEOC
 May be assigned operational and support roles within PHSA, agencies and/or
  services
 When assigned to an operational and support role work is coordinated by assigned
  agency/service

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Provide regular updates to PHSA logistics sections

Activation
Authority for activation
The PHSA Pandemic Influenza Response Plan should be activated as soon as the PHO
declares the beginning phase of a pandemic. Furthermore, it will be vital for PHSA
agencies and services to monitor the effectiveness of their plans as they are activated,
and to adapt or refine them when needed to reflect the changing nature of a pandemic
emergency.

Internal Activation:
The PHSA Corporate EOC can be activated, fully or partially. The level to which the
CEOC should be activated will depend on the scale, scope and stage of an event. The
CEOC can expand or contract on an as needed basis and only the CEOC functions
required need to be activated and staffed accordingly.
 The CEOC is activated at the direction of the PHSA COO and/or delegate.
 The EOC Director (VP, Clinical and Support Services) or the Corporate Director of
   Emergency Management is contacted to initiate the flowchart process.
 The EOC Director will initiate the call out utilizing the PHSA CEOC Response Guide.
 The EOC Director will establish the CEOC management team and will ensure that the
   affected agencies and/or services have activated their plans to the appropriate level.
 The EOC director will activate the PHSA Infection Control Team.

External Activation:
External activation may occur at the request of a health region MHO, the Ministry of
Health Services or the Provincial Medical Health Officer.

Termination and/or Downgrade:
Termination or downgrade authority determined by the agency and/or in conjunction with
the PHSA EOC.

States of Emergency
This Plan can and may be activated without a Declaration of a Local Provincial or State of
Emergency. If a Declaration has been made to respond to threatening pandemic
conditions, this Plan will automatically be in force.

Health authorities do not have powers to make Declarations. However, Medical Health
Officers have extensive powers to protect public health and may advise appropriate
authorities on the necessity for states of emergency. These states of emergency may
allow external authorities to direct PHSA facilities or its agencies/services to undertake
certain actions or provide certain services appropriate to the conditions found at the time.

Activation triggers
A number of circumstances could prompt activation of this plan. These include:



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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Identification of potential or actual disease outbreaks that could rapidly expand across
    multiple countries, regions or provinces
   Identification of a potential or actual case in Canada in a province other than British
    Columbia
   Identification of a potential or actual case in British Columbia including the
    identification of PHSA patients presenting with significant influenza symptoms.
   Response to requests to assist other facilities or jurisdictions with their response
   Response to a formal request by external agencies identified “Authority to Activate –
    External Activation”.

Activation Levels

 Level 1            Readiness
 Activation         Activated at the request of Executive
 Level 2            Partial Activation
 Activation         Executive Policy Group direction (Chief Operating Officer)
 Level 3            Full Activation
 Activation         On the direction of the PHSA Policy Group

For description details refer to Attachment 12.

Alert Systems:
PHSA utilizes the following alert systems:

WIC
Wallace Wireless – Is a software program set up on blackberries and can be used for the
mass notification, access and sharing of information to a predefined group of incumbents
expected to respond. Wallace Wireless provides a powerful cost effective easy to use
total solution for business efficiency and continuity. Site wide licenses have been
purchased and the software is installed on all selected blackberries. Access can be
coordinated through PHSA Security Services and/or Emergency Management &
Business Continuity.

ETEAMS
E Team is a web based, software package for Emergency Management information
collection, e-storage and partner sharing. The licenses have been purchased by the
Ministry of Health and will be used by all Health Authorities. It also provides Awareness
and Situational Readiness through its National Centre for Crisis and Continuity
Coordination to both government and private sector. Currently PHSA is in the process of
implementing ETeams and ensuring that the appropriate personnel are trained to the
level required. This software will be utilized during a response and those trained alerted
to login to the system.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
FAN OUTS
Callback will be activated using fan-out contact numbers including home phone, cellular-
phone, blackberry or, in the event that telephone service is unavailable, by using third-
party direct contact if at all possible.

Organizational Responsibilities:
Roles and responsibilities in an emergency are legislated by the Emergency Program
Act and are shared among provincial ministries and authorities as well as crown
corporations. The lead authority for pandemic influenza planning and response is the
Ministry of Health, headed by the Provincial Health Officer.

The organizational charts (Attachments 13 (a, b, c)) outline the chain of command, which
incorporates four sections under the overall leadership of an Emergency Operation
Centre (EOC) Director. As required, each of the four sections (logistics, planning, finance,
and operations) is appointed a Chief by the CEOC Director. The Chiefs, when required,
appoint leaders to sub-functions filling various crucial roles. This structure limits the span
of control of each position or function in an attempt to distribute the work proportionately.

   Site EOC Identification
   PHSA Public Health EOC Response

External:
 Regional Health Authority(ies) (Including MHO)
 MOHS
 Local Authority (if applicable)
 PHEM
 PHAC

Communications
The Provincial Health Services Authority’s Communications Department is responsible
for information dissemination within the corporation. The Communications Department
will provide updated information on POD and/or in the form of Communication Bulletins.
Any patient or family inquiries should be directed to HealthLink BC at 811 (24/7). For the
latest updates please visit the www.gov.bc.ca/health website.

Roles and Responsibilities
In the event of a pandemic, communication responsibility and information flow are
outlined in the following way:
   The BC Ministry of Health, through the Office of the Provincial Health Officer (PHO), is
    the lead in the province during a pandemic/communicable disease outbreak. The
    PHO is the main provincial spokesperson and is responsible, with advice from the BC
    Centre for Disease Control (BCCDC) for the decision to declare a pandemic in the
    province.
   The Ministry of Health Emergency Management Branch, in conjunction with the
    Provincial Emergency Program (PEP) under the Ministry of Public Safety and Solicitor
    General, is responsible for ensuring plans at the provincial, regional and local level

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PHSA Pandemic Influenza Preparedness Plan – September 2009
    are activated. BC’s well-tested emergency management structure has established
    functional links between ministry emergency operations and the provincial emergency
    management structure.
   The Public Affairs Bureau (PAB), Ministry of Health, will have primary responsibility for
    communications support for the PHO. It will work closely with emergency
    communication contacts at PAB headquarters and PEP to promote coordination and
    understanding of roles between public health agencies and the agencies responsible
    for consequence management.
   The British Columbia Crisis Communications Strategy for Major Provincial
    Emergencies outlines current provincial emergency and disaster communications
    principals and protocols. It recognizes the importance of coordinating public
    communications in affected areas, and for linking up all engaged partners under the
    British Columbia Emergency Response Management Structure.
   Medical Health Officers, in consultation with the PHO and Health PAB, are the
    designated spokespeople in their provincial region of responsibility.
   The BCCDC will provide technical medical support to the PHO. Information will be
    shared on a consistent and immediate basis between these offices.
   PHAC will support provincial efforts and continue to lead anti-viral acquisition and
    vaccine development. PHAC will also continue to link with the WHO for monitoring
    and surveillance.

Attachment 14 outlines key provincial and health authority communication
responsibilities.

PHSA Spokespersons
Communication Lead
The Vice President Communications & Research Administration, as primary
communication lead, is responsible for communications execution in conjunction with the
PHSA designated Medical Health Officer role, and for liaison with and updating Board
and Executive Leaders Council. The Senior Director, External Relations will coordinate all
information released to the media; ensure key messaging is consistent with the regional
Chief Medical Health Officer or designate and PHSA’s designated Medical Health Officer;
recommend appropriate response strategies; approve all written, electronic, or
photographic information for media use; and act as official spokesperson as needed.

Primary: Vice President Communications & Research Administration
Secondary: Senior Director, External Relations

Key Spokespersons
As per the media relations/spokesperson policy, the official spokesperson during a
pandemic is the Chief Executive Officer or designate. In the case of a pandemic or
influenza outbreak, the PHSA Medical Health Officer equivalent may also be a primary
designate for speaking to and answering media queries.


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PHSA Pandemic Influenza Preparedness Plan – September 2009
Key Messages
Key messages will be developed in partnership with the Ministry of Health and BCCDC,
and will be coordinated with messages from the regional health authorities, the Public
Health Agency of Canada and the World Health Organization. As information will have
the propensity to change quickly, PHSA messaging should focus on strategies in place to
address the pandemic, reassure the public and what the public can do to protect
themselves –e.g.: hand washing. Given the unknown nature of how the situation will
arise, actual key messages will be developed at the time and should also incorporate the
following:

For the Public:
 Where pandemic has been declared and details that can be provided
 Information for the general public is available at www.healthlinkbc.ca or 8-1-1 24 hours a
   day/seven days a week if they have questions, concerns or are feeling ill.
 For regional specific information, people should check the regional health authority
   website for their area
 Details about specific agencies or sites as they become available
 Information on where to get influenza vaccine when available, and eligible groups
 Individuals with flu and flu-like symptoms should stay home – instructions on when to
   seek medical care

For Staff:
 The central source for information will be the PHSA intranet - POD
 In the event of an emergency or pandemic situation, a staff and/or patient toll free
   Information Hotline is available (866-543-5663) for regular updates
 If urgent staff clinics are to be erected, list time/location/necessary documentation
   needed for influenza vaccinations
 Instructions in the event of staff illness or illness among family members

Risk Communication
Public perception of risk, and the associated response to that perception, is an important
factor in considering communication strategies for a pandemic. There are several
features about a pandemic that will elevate public perception of risk:
1) Fear of the unknown: The pandemic will be caused by a new viral subtype previously
    unknown to most of the population, and initially little information may be available
    about the nature of the virus.
2) Dreaded outcome: High morbidity/mortality may be associated with a pandemic strain.
3) Involuntary – not under one’s control: It may be very difficult to prevent exposure to a
    pandemic virus; few prevention tools will be available initially.
4) Inequitable: The pandemic strain may affect vulnerable members of the population,
    such as children, to a greater degree; inequitable access to antivirals and vaccine.

There are several important principles of risk communication that can be employed to
address the perception of risk and the concerns of the public. These include:
 Providing knowledge to the public for good decision-making; ensure information is
   timely and accurate and explain recommendations.
 Build trust; use a trustworthy spokesperson that is empathetic, competent and honest.

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Engage stakeholders to resolve conflicts or concerns; identify moral or ethical issues,
    such as distribution of limited antivirals and vaccine, and allow stakeholder feedback
    regarding these decisions. Allow the public and health professionals to ask questions,
    and provide timely answers.

Risk communication is most effective when it focuses on what is being done rather than
on what is not being done.

Notification Process

Integration of communications staff into notification procedures
Communications staff will be integrated into the notification processes within the PHSA
Pandemic Influenza Preparedness Plan. It is the responsibility of emergency managers in
the implicated agencies and services to ensure that their own organization’s
communications staff is alerted to a developing problem.

Notifying communications staff of other health partners
The Public Health Agency of Canada will be responsible to ensure communications staff
from the provinces and territories has been notified. This will be done through the Health
Emergency Communications Network.

Regional health authorities will be responsible for notifying PHSA agencies, facilities and
services within their jurisdictions about information of a regionally-specific nature. PHSA
communications staff will also be required to liaise with other key communications
stakeholders within the BC Ministry of Health and the regional health authorities.
(Attachment 15)

Clinical Coordinating Strategies
Infection Control of PHSA is responsible for ensuring that PHSA is involved in the overall
coordination and response to an influenza outbreak within PHSA.

Surveillance:
In Canada the federal government bears responsibility to establish surveillance networks.
Influenza surveillance takes place in cooperation with provincial and regional
epidemiologists and sentinel physicians. Weekly or bi-weekly FluWatch reports are
published. The main regional responsibility is to participate in the development of
provincial surveillance network and ensure timely reporting of influenza activity to the
province and other key stakeholders.

FluWatch is found at: http://www.phac-aspc.gc.ca/fluwatch/index.html. The BCCDC
Epidemiology Department provides an Influenza Like Illness Outbreak form to be utilized
when reporting any residential or work related outbreaks. (attachment 5)

When a pandemic is declared, surveillance activities will be directed by the Public Health
Agency of Canada and directed provincially by the BCCDC. PHSA agencies and services


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PHSA Pandemic Influenza Preparedness Plan – September 2009
will participate in these activities, and will enhance regional surveillance activities to
monitor for the introduction and spread of the pandemic viral strain.

Internal Clinical Management

Infection Control Precautions:
Internal infection control guidelines are implemented by the Infection Control
Department’s within each PHSA facility as recommended by provincial and federal
coordinating strategies. Occupational Health and Safety within each facility will also
provide input into infection control procedures for staff members to utilize in order to
minimize exposure to the virus in their respective work environments. In the event that
the facility or service does not have a dedicated Infection Control Department, guidelines
outlined in Annex 2 may be utilized.

In addition, the Public Health division within each regional health authority provides
geographically specific information for each PHSA facility. During a pandemic it is
important for staff at facilities to ensure that they are in communication with the health
authority that their facility resides.

Site Safety:
During a pandemic access to facilities may be restricted using triaging, screening or self
assessment protocols. Facilities within PHSA that deliver direct patient care may need to
use the provision of Security, and/or other manpower resources to ensure that visitors
and patients adhere to the facilities’ infection control strategy. Specific agency or service
information will be located in worksheet 3 of the Assessment package.

Anti-viral and Vaccine
The use of anti-viral and vaccines during a pandemic will be coordinated through PHSA
for all non direct patient care workers. It may be that administration of anti-virals and/or
vaccines will be arranged through the regional health authority for which the facility
resides. Priority groups determined during the pre-planning phase are outlined in the
supplemental plans.

Facilities that serve PHSA’s direct patient/clients will have their anti-viral of vaccines
distributed through their Infection Control or OH&S and should be outlined in their
supplemental plans in Annex 2.

Health Service Delivery/Business Continuity:
Each business unit or program within the Agency/Service will have a variety of steps,
actions and limitations that will influence their ability to adequately prepare for and
respond to a pandemic influenza.

Each operating unit will assume various roles and responsibilities during the planning
stages in order to identify those essential actions that will ensure continued delivery of
clinical services or support services in the period leading up to and during an outbreak.



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PHSA Pandemic Influenza Preparedness Plan – September 2009
Internal infrastructure dependencies:
   public affairs and communications
   human resources
   finance
   facilities & planning
   supply chain
   IM/IT
   emergency management & business continuity
   Other

Ethical Framework
Any ethical frameworks or decisions required to maintain certain levels of service
established during the planning stages will be found in the agency and/or corporate
services’ supplemental plan in Annex 2.

Resource Management
Internally, PHSA will liaise with all agencies, services and corporate departments to
coordinate allocation of resources identified as critical or with the potential to become a
critical resource requirement. The PHSA CEOC will determine allocation of resources
based on needs identified across PHSA.

Externally, PHSA CEOC will coordinate with the Ministry of Health Services, for specific
health related supplies and the Provincial Emergency Program for non health related
supplies through the Ministry Operation Center (MOC) utilizing the established
mechanisms.

The PHSA CEOC Planning Section, working with the Logistics Section, will monitor and
track all supply levels and notify CEOC regarding any deficits - actual, potential or
perceived - and manage procurement and/or replenishment of supplies. All agencies,
services and corporate departments will utilize the “Request for Resources or Assistance”
to request resources. (Attachment 16)

Human Resources
During the planning stages identification of human resource capacity, baseline staffing
and determination of essential service levels was identified. Results of this can be found
in the departmental/agency supplemental plans.

Furthermore, prioritization of internal staffing groups for the administration of anti-virals
and/or vaccines was identified, as well as, any alternate personnel pools including
training for the administration of vaccines.

Psychosocial Support
Psychosocial response involves a range of supportive services with those who are
affected by an emergency or disaster, including the promotion of individual, family and
community resiliency. These various services are used to help diminish long term psycho
social effects, to clarify the current situation and to improve adaptive coping strategies.

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PHSA Pandemic Influenza Preparedness Plan – September 2009
For updates and additional information, visit the Disaster Psychosocial Project page on
the Ministry of Health Services – Emergency Management Branch website.

Logistics

Acquiring Authority

PHSA Authority:
All requests for material or human resources will be requested through normal process
with authority for processing the request being identified to the Agency, Services and/or
Corporate Departments by PHSA Supply Chain or Human Resource.

PHSA CEOC Authority:
All request for material or human resources requested by an Agency will be requested on
a Request for Resources or Assistance form, signed off by the Agency EOC Director if
activated, or by the Agency Leader if not activated, forwarded to the CEOC Operations
Section and as appropriate Branch Coordinator for approval and processing. All request
for material or human resources requested by a PHSA Service or Corporate Department,
will be requested on a Request for Resources or Assistance form (attachment 16),
forwarded to the PHSA CEOC Operations Section and appropriate Branch Coordinator in
the PHSA CEOC for approval and processing.

Monitoring of Critical Supplies
   Corporate Emergency Operation Centre Activated:
    The PHSA CEOC Planning Section, working with the Logistics Section, will monitor
    and track all supply levels and notify the CEOC regarding any deficits-actual, potential
    or perceived – and manage procurement and/or replenishment of supplies. All
    agencies, services and corporate departments will utilize the Request for Resources
    or Assistance form to request resources.

   Corporate Emergency Operation Centre Not Activated:
    The PHSA Supply Chain will monitor and replenish as per normal operating
    procedures, unless directed by PHSA Executive Leadership or Emergency
    Management & Business Continuity to put in place an extraordinary monitoring
    system.

Completing a Request for Resources or Assistance Form
Can be downloaded from the POD and is also attached as Attachment 16. The
completed form should be e-mailed to (CEOC Operations Section e-mail address) or
faxed to (fax number to be confirmed on activation). Request for Resources or
Assistance forms should never be e-mailed to a personal e-mail address.

Finance
Activation of cost centre(s) and/or project codes are outlined in Attachment 11.



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PHSA Pandemic Influenza Preparedness Plan – September 2009
Step 3: RECOVERY – POST PANDEMIC
Transition from Response to Recovery
Recovery activities are initiated during the pandemic influenza response as facilitated by
the Planning section however the majority of actions will occur during the post-pandemic
influenza period. The conclusion of the pandemic will be declared by the PHO.

Recovery activities include addressing psychosocial impacts (for staff and clients),
financial ramifications, risk management effects, (i.e. legislative, contractual, or liability
issues). As well, identification and resumption of critical processes halted during the
response will be re-established to the pre-pandemic levels or to the new levels of service.

Post-event activities will also include the identification of evidence-based practice
changes and review of the response process to ensure best practices are captured and
continuous quality improvement mechanisms implemented.

Service Interruption Assessments
The development of aftercare and recovery plans and guidelines is underway. Main
components, features and issues are outlined in the following list.

Communications:

Notification
   To staff
   Community
   Contracted Services
   Agencies
   Others

Staff
   Immediate emotional needs
   Long term emotional needs
   Critic of response

Health Services Delivery/Business Continuity

Client Services
   Are there services that were postponed due to the response that need to be
    reinstated?
   Are there services that were initiated due to the response that need to be cancelled or
    extended?
   Are there clients whom services will need to be re-evaluated as a result of the event?
   Are there new services required long term as a result of the event?


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PHSA Pandemic Influenza Preparedness Plan – September 2009
Site
   Physical needs
   Equipment needs
   Recommendation to improve response capabilities

Resource Management:
Acquired Equipment
 Have you rented, leased, purchased or borrowed items for the response that need to
  be returned
 Have you lent out equipment that will need to be returned

Supplies
 Will you need to replenish supplies
 Do you need to return any borrowed supplies

Paper work
 Staff payroll documentation
 Activity Log records

   Financial processing and documentation
   Seek Financial redress
   After-Action Reports

Restoration of Services:




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                        Attachment 1
 REGIONAL HEALTH AUTHORITY (HA) PANDEMIC INFLUENZA PREPAREDNESS
                       PLANS CHECKLIST

PLAN DEVELOPMENT AND MAINTENANCE
   Does the HA/HSDA have a policy statement requiring a Pandemic Influenza Preparedness Plan
    (PIPP)?
         o If yes, who is responsible for developing it?
   Does the HA/HSDA have a PIPP
   Has the HA/HSDA Plan been developed in consultation with First Nations?
   Has the HA/HSDA Plan been developed in consultation with the BCPIAC, all HA/HSDA municipalities,
    private industry and other stakeholders?
   Does the HA/HSDA have a policy regarding approval of, and authorization of, changes to the Plan?
   Is someone designated to coordinate reviews and updates of the HA/HSDA Plan (i.e., when further
    federal or provincial guidelines are available and/or at regular intervals)?
   Is a distribution list for the HA/HSDA Plan maintained?
         o Are there processes for people to receive plan amendments?
         o Does the HA/HSDA Plan outline relevant legislation?
   Does the HA/HSDA Plan address roles and responsibilities for each pandemic phase, including
    possible 2nd and 3rd waves?
   Is someone designated to coordinate the exercises/simulations?
   Does the HA/HSDA Plan indicate the need for HA/HSDA as well as community exercises?
   Is there a process for lessons learned from the exercises to be incorporated into the HA/HSDA Plan?
   Does the HA/HSDA Plan address staff education as well as other education of community stakeholders
    regarding the plan?
   Has the HA/HSDA Plan been incorporated into or referenced in existing emergency preparedness
    plans within the HA/HSDA (e.g., facility plans, outbreak plans)?
   Does the HA/HSDA Plan require post-pandemic evaluation of the Plan and Plan revisions based on
    the evaluations?
         o If yes, who is responsible for that evaluation?

COMMAND AND CONTROL
   Does the HA/HSDA Plan include a description of the Command, Control and Management structure
    and functions specific to pandemic response?
   Has the role of senior management been defined?
   Have the organizational responsibilities been described?
   Have all the necessary responsibilities been assigned?
   Does the HA/HSDA Plan identify “back-up” personnel for each responsibility and for the MHO and
    other key personnel?
   Does the HA/HSDA Plan address training needs for those with pandemic-related responsibilities?
   Does the HA/HSDA Plan identify areas where Emergency Operations Centres (EOCs) are needed
    (e.g., HA, HSDAs, municipalities)?
   The HA/HSDA Plan allow for participation in regional/local EOC(s) and in the Provincial Regional
    Emergency Operations Centre (PREOC)?
   Have communication links between the HA/HSDA EOC(s) and municipal EOC’s been identified?
   Is there a system for ensuring that all relevant personnel are alerted to the arrival of an influenza
    pandemic and the need for them to assume their pandemic-related responsibilities?
   Does the HA/HSDA Plan identify personnel by job title who are to receive information to the BCPIAC,
    the PHO and/or BCCDC regarding:
             o A - Surveillance
             o B - Health Services
             o C - Vaccine and Antiviral Delivery
             o D - Communications (including provincial teleconferences)

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Does the HA/HSDA Plan require post-pandemic evaluation of the Command, Control and Management
    structure and functions, and revisions based on the evaluation?
            o If yes, who is responsible for that evaluation?

COMMUNICATIONS
   Does the HA/HSDA Pandemic Influenza Preparedness Plan (PIPP) have an Emergency Preparedness
    and Emergency Communication component?
   Does the HA/HSDA Plan address emergency preparedness and emergency communications in each
    of the pandemic phases?
   Does the HA/HSDA Plan include a contact list of local/regional emergency managers (e.g., public
    health, government, utilities)?
   Does the HA/HSDA Plan outline agreed-upon coordination mechanisms with all municipalities in the
    HA/HSDA?
   Does the HA/HSDA Plan outline agreed-upon emergency communication mechanisms with all
    municipalities in the HA/HSDA?
   Does the HA/HSDA Plan identify “essential service” positions?
         o Does the HA/HSDA Plan estimate the number of essential service workers, based on current
             definitions?
         o Does the HA/HSDA Plan provide strategies for educating and training essential service
             workers regarding pandemic planning and emergency response?
   Does the HA/HSDA Plan include strategies for providing information on pandemic influenza, infection
    control, self-care, etc. to municipalities and essential service workers?
   Does the HA/HSDA Plan identify local/regional private industries that could assist in
    pandemic/emergency planning and response?
   Does the HA/HSDA Plan define agreed-upon role(s) these local/regional private industries can play in
    pandemic/emergency planning and response?
   Does the HA/HSDA Plan include strategies to ensure that these local/regional private industries are
    kept informed of pandemic developments and planning?
   Does the HA/HSDA Plan identify local/regional organizations that could assist in pandemic/emergency
    planning and response?
   Does the HA/HSDA define agreed-upon role(s) these local/regional organizations can play in
    pandemic/emergency planning and response?
   Does the HA/HSDA Plan include strategies to ensure that these local/regional organizations are kept
    informed of pandemic developments and planning?
   Does the HA/HSDA Plan include strategies to ensure that these local/regional organizations are kept
    informed of pandemic developments and planning?
   Does the HA/HSDA Plan identify those volunteer groups that could assist in pandemic/emergency
    planning and response?
   Does the HA/HSDA Plan define agreed-upon role(s) these volunteer groups could play in
    pandemic/emergency planning and response (e.g. retired or student health care professionals who
    could contribute to the health services response)?
   Does the HA/HSDA Plan include strategies to ensure that these volunteer groups are kept informed of
    pandemic developments and planning?
   Has the HA/HSDA contacted the RCMP/police and fire departments, in consultation with municipalities,
    regarding the HA/HSDA Plan?
   Does the HA/HSDA Plan outline communication mechanisms between the HA/HSDA and RCMP/police
    and fire departments?
   Has the HA/HSDA contacted ambulance service providers, in consultation with municipalities regarding
    the HA/HSDA Plan?
   Has the ambulance service pandemic capacity been determined?
   Have alternative patient transport methods been identified?
   Has the HA/HSDA consulted with municipalities regarding mechanisms to provide non-medical support
    (i.e. food, snow shovelling) for persons confined to their home and for pandemic-specific support
    needs?
   Does the HA/HSDA Plan discuss the possibility of closing public facilities and cancelling public events?
   Does the HA/HSDA Plan include pandemic mortuary, burial and funeral requirements and plans based

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PHSA Pandemic Influenza Preparedness Plan – September 2009
    on consultations between the HA/HSDA, BC Coroners Service, municipalities and local funeral
    directors?
   Does the HA/HSDA Plan identify available and/or needed psychological/mental health services based
    on discussion with local agencies and municipalities?
   Does the HA/HSDA Plan identify available and/or needed social services based on discussion with
    local agencies and municipalities?
   Does the HA/HSDA Plan identify arrangements agreed-upon with the municipalities regarding facilities
    that could be used as non-traditional health care sites (e.g., alternate care centres, triage centres,
    immunization sites)
   Does the HA/HSDA Plan require post-pandemic evaluation of the Emergency Preparedness and
    Emergency Communication component and revisions based on the evaluation?
   If yes, who is responsible for that evaluation?

SURVEILLANCE
   Does the HA/HSDA Plan contain a Surveillance component?
   Does the HA/HSDA Plan address surveillance in each of the pandemic phases?
   Has the HA/HSDA Plan assessed identified gaps and made recommendations regarding improvements
    to local influenza surveillance systems?
   Does the HA/HSDA have a system for monitoring school absenteeism (i.e. >10%) during the influenza
    season, with emphasis on laboratory confirmation early in the season?
   Does the HA/HSDA have a system for influenza and ILI outbreak reporting in hospitals, long term care
    facilities (LTCF) and other community settings during annual influenza seasons?
   Does the HA/HSDA have a process for reviewing surveillance mechanisms on a regular basis with
    partners and stakeholders?
   Has the HA/HSDA identified which personnel/organizations (including physicians and sentinel
    physicians) should regularly receive influenza surveillance data?
   Has the HA/HSDA explored the feasibility of monitoring workplace absenteeism among large
    employers, including the HA/HSDA, for baseline data, for annual surveillance and/or for pandemic
    surveillance?
   Does the HA/HSDA Plan identify groups for surveillance that are not currently routinely monitored (e.g.
    preschools, emergency rooms) that may need to be monitored immediately before and during a
    pandemic?
   Does the HA/HSDA Plan address mechanisms for rapid dissemination of surveillance data (e.g.
    broadcast fax, e-mail, website)?
   Does the HA/HSDA Plan address the local monitoring and dissemination of information regarding
    virologic, epidemiologic and clinical findings associated with a pandemic strain?
   Who is responsible for disseminating surveillance information (e.g., MHO, CMHO)?
   Is there a back-up position identified to receive and communicate influenza surveillance data in the
    absence of the person identified above?
   Does the HA/HSDA Plan include strategies to raise awareness of physicians and other health care
    providers regarding pandemic planning and yearly epidemics?
   Has the HA/HSDA assisted BCCDC in the recruitment of sentinel physicians for routine annual ILI
    surveillance?
   Does the HA/HSDA currently have at least 1 sentinel physician or 1 per 100,000 population where
    feasible? If not, are there plans to attain this goal?
   Has the HA/HSDA, with the support of BCCDC if necessary/appropriate, identified additional sentinel
    physicians that could be called upon during immediate pre-pandemic and pandemic phases for ILI
    surveillance of special populations such as student health facilities, emergency rooms, the military,
    and/or travel destinations (e.g. Whistler)?
   Does the HA/HSDA Plan address more timely methods for receiving information from within the HA
    regarding hospitalization and deaths attributed to influenza?
   Does the HA/HSDA Plan address specimen collection processes and transportation of specimens to
    the Provincial Laboratory?
   Does the HA/HSDA Plan address monitoring hospitalizations and severe clinical syndromes
    recognized to be associated with pandemic influenza during the pandemic phase?
   Does the HA/HSDA Plan address processes for collaboration in special studies during the pandemic?

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Does the HA/HSDA Plan address processes for collaboration in special studies in the post-pandemic
    period?
   Does the HA/HSDA Plan indicate that the Surveillance component will be evaluated in the post-
    pandemic period and that the Plan will be revised based on the evaluation?
   Does the HA/HSDA Plan include the following contact information:
   Laboratories and laboratory directors?
   Sentinel physicians?
   Schools participating in ongoing surveillance?
   Emergency rooms, daycares etc.

VACCINE DELIVERY
   Does the HA/HSDA Plan include a vaccine delivery component?
   Does the HA/HSDA Plan recognize the need to administer the vaccine as it is available as quickly as
    possible?
   Does the HA/HSDA Plan incorporate the assumption of need for 2 doses likely 1 month apart?
   Does the HA/HSDA Plan include plans for administering vaccine by priority group?
   If vaccine is limited, does the HA/HSDA Plan include delivering 2 doses of vaccine to priority groups for
    whom there is sufficient supply?
                                                     nd
   Does the HA/HSDA Plan include delivering the 2 dose of vaccine 1 month after the first (while
    continuing to provide initial doses)?
   Does the HA/HSDA Plan include immunizing 75% of the population with 2 doses within 4 months?
   Does the HA/HSDA Plan include educating the public about pandemic vaccine?
   Does the HA/HSDA Plan include educating health care providers (and other key groups) regarding the
    pandemic vaccine?
   Does the HA/HSDA Plan address policies and procedures regarding obtaining informed consent?
   Does the HA/HSDA Plan identify vaccine distribution “border” issues that will need to be coordinated?
   Does the HA/HSDA Plan include strategies to improve influenza vaccine coverage in the pre-pandemic
    period?
   Does the HA/HSDA Plan include strategies to improve appropriately targeted pneumococcal vaccine
    coverage in the pre-pandemic period?
   Does the HA/HSDA Plan include strategies for reaching each of the priority groups?
   Does the HA/HSDA Plan include estimates of priority groups as nationally defined?
   Has the HA consulted with municipalities regarding preliminary estimates of essential service workers?
   Does the HA/HSDA Plan include contingency plans for mass immunization delivery throughout the HA?
   Has the HA consulted with municipalities regarding facilities that would be required as immunization
    sites during the pandemic?
   Does the HA/HSDA Plan include a process to maintain cold chain requirements of the vaccine
    (including additional and back-up storage sites with back-up generators)?
   Does the HA/HSDA Plan address training all staff (and particularly new, recruited, and alternate care
    workers) in the proper handling of vaccine?
   Does the HA/HSDA Plan address vaccine storage locations, capacity, equipment, supplies, staffing
    and security requirements for various pandemic scenarios?
   Does the HA/HSDA Plan address vaccine transport within the HA?
   Does the HA/HSDA Plan include measures by the HA to ensure security of the vaccine once delivery
    has been accepted (including storage, transport, clinics, handling, personnel)?
   Has there been consultation in the pre-pandemic period with RCMP/police regarding vaccine security?
   Does the HA/HSDA Plan include a security audit in the pre-pandemic period?
   Does the HA/HSDA Plan address crowd control at immunization sites?
   Does the HA/HSDA Plan include estimates of the amount of needles, syringes and other vaccination
    program supplies required for the various scenarios?
   Does the HA/HSDA Plan include measures to ensure adequate supplies?
   Does the HA/HSDA Plan include biomedical waste management, including containers, transportation
    and disposal?
   Does the HA/HSDA Plan include sample/template worksheets for recording immunizations?
   Does the HA/HSDA Plan include processes to account for all vaccine received?

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Does the HA/HSDA Plan include processes for monitoring vaccine coverage, effectiveness and
    adverse reactions?
   Does the HA/HSDA Plan include processes to minimize wastage of vaccine?
   Does the HA/HSDA Plan outline one or more position(s) designated to record and summarize data on
    a regular basis and for submission to BCCDC?
   Does the HA/HSDA Plan include systems to recognize, report and assess adverse reactions?
   Does the HA/HSDA Plan include systems to communicate information regarding adverse reactions to
    physicians, emergency rooms, etc. within the HA/HSDA during the pandemic?
   Does the HA/HSDA Plan include estimated human resource requirements for vaccine delivery
    according to the various scenarios?
   Does the HA/HSDA Plan include human resource plans to obtain required manpower?
   Does the HA/HSDA Plan include risk management measures regarding the temporary pool of alternate
    workers?
   Does the HA/HSDA Plan include identification of alternate vaccine administrators?
   Does the HA/HSDA Plan address training needs of alternate vaccine administrators?
   Does the HA/HSDA Plan address the need for an extended period of time to provide “catch-up”
    immunization programs if these were suspended during the pandemic?
   Does the HA/HSDA Plan indicate that the Vaccine Delivery component of the Plan will be evaluated in
    the post-pandemic period and revised based on the evaluation?
   Does the HA/HSDA Plan include general public information about the need, efficacy and safety of the
    influenza vaccine?

ANTIVIRAL DELIVERY
   Does the HA/HSDA Plan include an antiviral delivery component?
   Does the HA/HSDA Plan describe how to deliver available antivirals?
   Does the HA/HSDA Plan recognize the need to administer antivirals as quickly as possible?
   Does the HA/HSDA Plan include strategies for reaching each of the priority groups?
   Does the HA/HSDA Plan include estimates of priority groups as nationally defined?
   Has the HA consulted with municipalities regarding preliminary estimates of essential service workers?
   Does the HA/HSDA Plan include educating the public about the need, efficacy and safety of antivirals?
   Does the HA/HSDA Plan include educating health care providers (and other key groups) regarding
    antivirals?
   Does the HA/HSDA Plan address policies and procedures regarding obtaining informed consent?
   Does the HA/HSDA Plan include a mechanism for tracking antiviral adverse events?
   Does the HA/HSDA Plan identify antiviral distribution “border” issues that will need to be coordinated?
   Does the HA/HSDA Plan include processes to maintain cold chain requirements (including additional
    and back-up storage sites with back-up generators)?
   Does the HA/HSDA Plan address training all staff (and particularly new, recruited, and alternate care
    workers) in the proper handling of antivirals?
   Does the HA/HSDA Plan address antiviral storage locations, capacity, equipment, supplies, staffing
    and security requirements for various pandemic scenarios?
   Does the HA/HSDA Plan address antiviral transport within the HA?
   Does the HA/HSDA Plan include measures to ensure security of antivirals once delivery has been
    accepted (including storage, transport, clinics, handling, personnel)?
   Has there been consultation in the pre-pandemic period with RCMP/police regarding security?
   Does the HA/HSDA Plan include a security audit in the pre-pandemic period?
   Does the HA/HSDA Plan include estimates of the amount of needles, syringes and other vaccination
    program supplies required for the various scenarios?
   Does the HA/HSDA Plan include measures to ensure adequate supplies?
   Does the HA/HSDA Plan include a sample/template of worksheets for recording antivirals?
   Does the HA/HSDA Plan include processes to account for all antivirals received?
   Does the HA/HSDA Plan include processes for monitoring antiviral coverage, effectiveness and
    adverse reactions?
   Does the HA/HSDA Plan include processes to minimize wastage of antivirals?
   Does the HA/HSDA Plan outline position(s) designated to record and summarize data on a regular


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PHSA Pandemic Influenza Preparedness Plan – September 2009
    basis for submission to BCCDC?
   Does the HA/HSDA Plan include systems to recognize, report and assess adverse reactions?
   Does the HA/HSDA Plan include systems to communicate information regarding adverse reactions to
    physicians, emergency rooms, etc. within the HA/HSDA during the pandemic?
   Has the HA/HSDA developed a mechanism for assessing antiviral effectiveness?
   Has the HA/HSDA developed a mechanism for recording and reporting antiviral effectiveness?

HEALTH SERVICES
   Does the HA/HSDA Plan include a health services component?
   Does the HA/HSDA Plan address this component in each of the pandemic phases?
   Has the HA/HSDA Plan been reviewed with appropriate partners and stakeholders?
   Have the available federal and provincial guidelines been reviewed and modified as required?
   Does the HA/HSDA Plan include the distribution of federal/provincial/local guidelines in pre-pandemic
    and pandemic periods?
   Does the HA/HSDA Plan assess bed capacity, estimate the capacity required for the HA/HSDA using
    pandemic impact projections and identify options for meeting this capacity?
   Does the HA/HSDA Plan identify the # of ventilators in the HA (mechanical ventilation machines; do not
    include BIPAP, CPAP machines)?
   Does the HA/HSDA Plan identify the # of ventilators in the community (dental offices, veterinary clinics)
    that could be accessed?
   Does the HA/HSDA Plan include strategies to increase # of ventilated beds, including staffing
    considerations?
   Does the HA/HSDA Plan address the capacity to be as self-sufficient as possible and to be prepared to
    deal with influenza co-morbidity with reasonable expectations of successful outcome?
   Does the HA/HSDA Plan reference providing/obtaining specialized and tertiary care for patients to/from
    other HA’s?
   Does the HA/HSDA Plan identify how triage would be managed?
   Does the HA/HSDA Plan include a telephone triage component?
   Has the HA/HSDA met with municipalities regarding non-medical support needs for persons confined
    to their homes?
   Does the HA/HSDA have a process for defining emergent/urgent services?
   Does the HA/HSDA plan address the following:
   Management of pneumonia?
   Use of ICUs?
   Extubation?
   Care of long term care residents during pandemic?
   A review of guidelines as needed on a periodic basis?
   Does the HA/HSDA Plan include the collection of data regarding the impact of the pandemic on health
    services during the pandemic?
   Does the HA/HSDA Plan deal with providing information to, and modifying expectations of the public
    regarding provision of health services during the pandemic?
   Does the HA/HSDA Plan include strategies for promoting self-care for influenza?
   Does the HA/HSDA Plan include infection control guidelines?
   Does the HA/HSDA Plan address workforce requirements for the HA/HSDA using pandemic impact
    projections?
   Does the HA/HSDA Plan include a human resource plan for hiring additional health care workers
    during the pandemic that includes issues such as: scope of responsibilities, registration requirements,
    criminal record checks, foreign trained workers, liability and other insurance coverage, and training?
   Does the HA/HSDA Plan include strategies to recruit non-active or retired health care workers within
    the HA when required?
   Does the HA/HSDA Plan address the use of health care students?
   Does the HA/HSDA Plan include strategies for an increased role of volunteers?
   Has the HA/HSDA consulted with municipalities regarding the availability and role of volunteer
    organizations and potential alternate service providers?
   Does the HA/HSDA Plan include a training plan for the use of alternate care workers (non-active,


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PHSA Pandemic Influenza Preparedness Plan – September 2009
    retired, out of scope, etc.) and volunteers?
   Has the HA/HSDA reviewed its insurance policies regarding use of alternate care workers and
    volunteers?
   Has the HA/HSDA reviewed its insurance policies regarding providing services in alternate care
    settings?
   Has the HA/HSDA identified collective agreement issues in light of pandemic manpower requirements?
   Does the HA/HSDA Plan include discussions with staff and professional associations?
   Does the HA/HSDA Plan include guidelines and/or options for employees who are required to work but
    who also have ill family members who need to be cared for at home?
   Are the Vaccine Delivery and Health Services components of the HA/HSDA Plan coordinated to ensure
    sufficient resources to administer the vaccine as quickly as possible when it is available?
   Does the HA/HSDA Plan include critical incident stress management?
   Does the HA/HSDA Plan include a review of guidelines as needed on a periodic basis?
   Does the HA/HSDA Plan include the recovery of health services (e.g. overcoming backlog of
    postponed surgeries) in the post-pandemic period?
   Does the HA/HSDA Plan indicate that the Health Services component will be evaluated in the post-
    pandemic period and revised based on the evaluation?

COMMUNICATIONS DEPARTMENTAL PLAN
   Does the HA/HSDA Plan have a Communication component?
   Does the HA/HSDA Plan address this component in each of the pandemic phases?
   Has the Communication component been reviewed with partners and stakeholders?
   Does the HA/HSDA Plan identify key audiences, local groups, organizations and individuals who need
    to be kept informed?
   Does the HA/HSDA Plan identify local strategic considerations: possible scenarios, issues, and
    opportunities in each phase of the pandemic?
   Does the HA/HSDA Plan outline the need for consistent messaging with provincial and federal
    messages?
   Does the HA/HSDA Plan outline mechanisms for rapid communications with key audiences?
   Does the HA/HSDA Plan identify a communications response team during the pandemic phase?
   Does the HA/HSDA Plan outline liaison with local media, including whether a special media center will
    be required and identification of media spokespersons?
   Does the HA/HSDA Plan include an influenza information line(s) to take calls from the public during the
    pandemic?
   Does the HA/HSDA Plan designate a position responsible for providing information to/coordinating with
    the Provincial Regional Emergency Operations Centre?
   Does the HA/HSDA Plan outline how coordination issues with bordering jurisdictions (e.g. other HA’s,
    First Nations communities) will be addressed?
   Has the HA/HSDA Plan been shared with the PHO’s office?
   Does the HA/HSDA Plan indicate that the Communication component will be evaluated in the post-
    pandemic period and that the Plan will be revised based on the evaluation?
   Does the HA/HSDA Plan outline agreed upon communication mechanisms between and among all
    municipalities in the HA/HSDA?
   Does the HA/HSDA Plan address communication needs for private industry and other non-
    governmental stakeholders?
   Does the HA/HSDA Plan identify the method for notifying and updating each municipality within the
    HA/HSDA regarding the confirmation of onset of pandemic influenza in Canada?
   Has the HA/HSDA developed communication tools for informing staff about pandemic planning (e.g.
    fact sheets, articles in staff newsletters, websites)? If willing, please provide an electronic copy to
    Epidemiology Services at the BCCDC (epidserv@bccdc.ca)




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                             Attachment 2




Category: Emergency Management and Business Continuity
                                                     Reference Number: EMBC 100
Subject/Title: Emergency Management &
Business Continuity                                  Effective Date: December 9, 2009
Approved by: Vice President Corporate
                                                     Revision Number:
Services and Chief Financial Officer

1. SCOPE/PURPOSE
Emergency Management & Business Continuity Service, embracing PHSA’s Four Strategic directions is
committed to improving quality and safety for employees, physicians, clients, contracted workers,
volunteers and visitors. This will be accomplished through the creation and maintenance of a risk based
Emergency Management & Business Continuity program(s) that will build organizational resilience and
capacity, minimize patient harm, and protect the safety of all during emergency events, and at some sites,
act as a First Receiver in the larger Health EM system. Emergency Management & Business Continuity
program(s) will comply with all applicable legislation and regulations.

This Policy details the guiding principles that will enable PHSA Corporate Services and Agencies (here
after referred to as PHSA) to effectively implement and maintain mitigation, preparedness, response and
recovery activities to prepare and enable them to manage their response, continue critical services and
return to an acceptable state of operations as soon as possible after an emergency.


2. POLICY

PHILOSOPHY
Emergency Management & Business Continuity Services’ philosophy is to enable operational self
sufficiency through leadership, policy direction, consultation and training. This will enable Agencies,
Corporate Services, programs, departments and individuals to gain confidence in their ability to respond to
and recover from events which overwhelm their normal day-to-day operations.

VISION

Readiness and resiliency in support of quality health care

MISSION
To develop, deliver and sustain an integrated, comprehensive, evidence based emergency management
and business continuity program that supports patients, staff and continuity of services


DEFINITIONS
Emergency Management: refers to a comprehensive risk management process comprised of hazard/risk
analysis, description of context, mitigation, preparedness, response and recovery.



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PHSA Pandemic Influenza Preparedness Plan – September 2009
Incident Command Systems: a system that defines the roles and responsibilities to be assumed by
personnel and the operating procedures to be used in the management and direction of an emergency
incident and running of an Emergency Operation Centre.

Hospital Incident Command System: a health care-model as defined above.

The British Columbia Emergency Response Management System (BCERMS): is a comprehensive
management scheme that ensures a coordinated and organized provincial response and recovery to any
and all major emergency incidents.

Business Continuity Management: a holistic management process that identifies potential impacts that
threaten an organization and provides a framework for building resilience and capacity for an effective
response to safeguard the interests of key stakeholders, reputation, brand and value creating activities.

Business Continuity Planning: the process of developing arrangements and procedures in advance of an
event or major incident that enables an organization to responds in such a manner that critical business
functions continue with planned levels of interruption or essential change.

First Receiver Site: an acute care venue that must develop EM plans to continue to provide resuscitation,
stabilization and treatment of casualties arriving from by pre-hospital services or self transit during and for
some time after an event. The site preparation must include planning for the least amount of down time,
and is expected to continue to function in less than optimal conditions.


RESPONSIBILITIES
PHSA Strategic Planning & Priorities Committee / Executive Leaders Council
   Reflects emergency management & business continuity strategies in the corporate strategic plan.
   Provides resources for an Emergency Management and Business Continuity program.
   Provides leadership in the management and policy direction of serious emergency events.
   Ensures Corporate Services and Agency representation on the PHSA Emergency Management &
    Business Continuity Council.
   Receives updates on emergency management initiatives through the PHSA Emergency Management
    & Business Continuity Council.


PHSA Emergency Management & Business Continuity Council
   Provides direction, advice and guidance to the development and advancement of a risk based
    Emergency Management and Business Continuity program.
   Champions and fosters program initiatives to ensure that disaster and business continuity plans are
    standardized, current, coordinated, effective and exercised at each designated PHSA site
   Provides direction, advice and guidance to the annual development of the Emergency Management
    and Business Continuity goals, objectives and priorities
   Monitors business continuity planning in critical business areas across the organization


Presidents, Vice Presidents, Executive Directors
   Provide leadership to the emergency management and business continuity initiatives in their portfolios
    and ensure representation on facility, and program Emergency Management and Business Continuity
    working committees and/or groups.
   Champion and foster program initiatives to ensure that disaster and business continuity plans are
    standardized, current, coordinated, effective, and exercised within their portfolios.

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PHSA Pandemic Influenza Preparedness Plan – September 2009
Emergency Management & Business Continuity (Disaster Response) Working Groups
   Develops, maintains and exercises a comprehensive emergency management & business continuity
    plan for the area of responsibility.
   Reviews area emergency management & business continuity plans annually and revises as necessary.
   Tests staff fan-out/call-back systems to a minimum of once a year.
   Facilitates delivery of emergency management education to staff and conducts exercises to test
    effectiveness of facility or local area plans.
   Monitors business continuity planning in critical business areas within their area of responsibility and
    incorporates into emergency plans. Ensures liaison with associated areas and services on which their
    service area is dependent
   Ensures adequate physical resources are available to respond to significant emergency events.
   Supports local leadership in the management of emergency events and events which require activation
    of the Emergency Operation Centre.
   Supports the selection of staff for training in EOC and emergency response operations
   Ensures contracted services and volunteer services are involved in emergency preparedness activities.


Program Directors, Managers and Supervisors
   Develop departmental procedures to be followed during the activation of their response plans.
   Submit Department plans to their Emergency Management & Business Continuity working group to
    ensure a coordinated response and for inclusion in their Emergency Operation Centre Plans.
   Develop Business Continuity Plans to be implemented in the event the delivery of health services will
    be impaired.
   Ensure that appropriate departmental Emergency Response resources/supplies are available in the
    event of an Emergency activation.
   Ensure that appropriate education/training is provided to staff to make certain that response processes
    are performed in a safe manner.
   Maintain a record of employee Emergency Response education/training.
   Generate and maintains employee fan-out/contact lists on a bi-annual basis


Employees and Physicians
   Ensure familiarity with and follow PHSA Emergency Response protocols as well as any specific
    Departmental Emergency Response procedures.
   Attend prescribed education and training programs
   Ensure that personal contact information is current and accurate.
   Work as required in an emergency. Recognising that, in an major emergency event, changes to normal
    job activities and locations may be required with minimal notice.


Emergency Management & Business Continuity Service Team
   Provides consultation, education and subject matter expertise to guide compliance with legislative,
    regulatory and best practice standards in Emergency Management and Business Continuity.


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PHSA Pandemic Influenza Preparedness Plan – September 2009
   Works with the Ministry of Health to implement province wide initiatives for emergency management
    and business continuity in the health care sector
   Coordinates and implements PHSA’s Emergency Management Plans according to identified priorities
    and integration with the ICS, HICS, the British Columbia Emergency Response Management System
    (BCERMS), the Ministry of Health.and the Provincial Emergency Program
   Develops a Business Continuity Program ensuring the resiliency and consistent application of PHSA’s
    plans.
   Develops and standardizes Emergency Management and Business Continuity policies and guidelines.
   Establishes an “all-hazards” approach to Emergency Management and builds protocols and processes
    that address alternate sources of essential utilities, provides back-up communications, communicable
    disease management and mass decontamination capabilities.
   Links Emergency Management plans with other PHSA organization plans such as Protection Services,
    Fire Safety, Employee Wellness and Safety, Risk Management, Communications and Facilities.
   Fosters relationships with external community/agency Emergency Management partners ensuring
    appropriate linkages with PHSA Emergency Management plans.
   Reports and provides relevant information on all aspects of Emergency Management and Business
    Continuity to the Emergency Management and Business Continuity Council.
   Establishes an Emergency Preparedness culture within all levels of the organization, including the
    promotion of personal preparedness for all PHSA employees, physicians and volunteers.
   Develops a wide-range emergency management and business continuity training and education
    program including application, evaluation and adaptation.
   Responds to emergency events, as a consultant and technical expert in the activation and operation of
    the Emergency Operation Centres, interoperability with external agencies, to enhance situation
    awareness and assists in the collation and compilation of critical data.



3. APPENDIX
Guiding Documents

   CSA Z1600 – Standard on Emergency Management and Business Continuity, 2007
   National Framework for Health Emergency Management, Guideline for Program Development, 2004
   Ministry of Health, Population Health & Wellness, Core Public Health Functions for BC, Evidence
    Review, Health Emergency Management, 2006
   Ministry of Health, Population Health & Wellness, Core Public Health Functions for BC, Model Core
    Program Paper: Health Emergency Management, with revisions 2008
   PHSA Emergency Management and Business Continuity Council, Terms of Reference, 2008
   British Columbia Risk Management Branch – Business Continuity Policy
    http://www.fin.gov.bc.ca/ocg/fmb/manuals/CPM/16_Business_Continuity_Mgmt.htm
   PHSA Strategic Plan, 2007


Acknowledgments
   Fraser Health Authority
   Calgary Health Region



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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                 Attachment 3

    Staff in Health Authority count




                              Vancouver   Vancouver
                                                      Fraser Health   Interior        Northern
                               Coastal      Island
Children’s
Sunny Hill
Women’s
Cancer
Riverview
Forensics
CDC
Cancer
Renal
Cardiac
Transplant
PHSA Labs
Prov. Language
Services
Prov. Blood
Coordinating Office
IMIT
HR
Supply Chain
Facilities
Finance
Alternate Service
Delivery




    Version: 2.4 (Sep 2009)                                                               47
    PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                                                                     Attachment 4

        PHSA Pandemic Information & Communication
               Development and Distribution     Related to communicable
                                              disease, environmental health
                                                                                                         assessment & surveillance,
                                                                                                          outbreak & environmental
                                                                                                         health issue management,
                                              Public Health Agency of                                    medical/scientific analysis,
                                                 Canada (PHAC)                                             communication issues
                                                    Information                                          management, ministerial &
                                                                                                        public advisories. Exclusive of
                                                                                                                primary care.


                                                 Provincial Health
               Ministry of Health                  Officer /CDC                       MHO Council/PICNET
                   Services                        Public Health                      Decide on Recommendation
                                                 Emergency EOC




        RHA MHOs distribute
        information to health
         facilities within that                                            PHSA Pandemic Infection Control
                                                                                   Eva Thomas
                  RHA



                                                                               Approval of IC directives
 VIHA    NHA      IHA      FHA          VCH                                Development & approval of PHSA-
 MHO     MHO      MHO      MHO          MHO                                     wide communications



  PHSA Hospitals also have direct
communications with their Regional
       (geographical) MHO                              Infection Control directives distributed to:
                                                         RVH/FPS*
                                                         C&W
                                                         CDC
                                                         BCCA* (Vancouver, Fraser Valley, Abbotsford, Kelowna & Victoria)
                                                         CDC* (STD, TB)
                                                         BCT* (Ambulatory Clinics)
                                                         Corporate




                                                                                  PHSA Corporate
                         Requires PAB




                                                     PHSA Corporate                                                 PHSA Corporate
                                                                                  Communications
                                                     Communications                                          Communications ensures a
                           Approval




                                                                                   issues internal
                                                liaises with agency based                                        link between Agency
                                                                                     PHSA-wide                Websites and Regional HA
                                                 communication teams to
                                                                                information via POD,
                                               identify/distribute infectious                                infectious disease and their
                                                                                Agency Intranet Sites
                                                 disease and their control                                   control directives for public
                                                                                 & staff distribution               and professional
                                                 specific communications
                                                                                         lists

                                         Agency Communications are Responsible for all Operational communication to
                                                            staff, clinicians and their patients

   Version: 2.4 (Sep 2009)                                                                                                                    48
   PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                             Attachment 5




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                   Attachment 6
Federal Roles and Responsibilities
Note: the following is adapted from the Pan-Canadian Pandemic Contingency Planning Checklist
for Federal/Provincial/Territorial Orders of Government. For a comprehensive list of federal
roles and responsibilities, see the Canadian Contingency Plan for Pandemic Influenza.


PRE-PANDEMIC
Pre-pandemic: Emergency Response
   review current emergency legislation
   consider the need for declaring a national emergency during a pandemic
   clarify the roles and responsibilities of federal and provincial/territorial emergency response
    organizations
   clarify the roles of military personnel in a pandemic
   ensure communication between Emergency Preparedness Canada and other federal ministries
    or departments affected by a pandemic
   identify resources to be used in a pandemic
   identify funding available (e.g. Joint Emergency Preparedness Program)
   develop an Emergency Response section for the Canadian Contingency Plan
   develop guidelines re: the provision of food, medical and other essential life-support needs for
    persons confined to their homes during a pandemic
   develop definitions of Emergency Service Workers
   develop guidelines to assist provinces and territories with identifying essential community
    services and developing plans for emergency back-up of essential services
   develop aftercare/recovery plans/guidelines
   conduct a simulation exercise

Pre-pandemic: Vaccine
   increase domestic vaccine manufacturing capacity
   institute multi-year vaccine procurement process
   develop stockpile of fertilized hens’ eggs and other essential raw materials
   through the National Advisory Committee on Immunization, recommend annual influenza
    vaccine formulations to be used in Canada, based on World Health Organization (WHO)
    recommendations
   develop guidelines on priority groups for pandemic influenza vaccination in times of short
    supply
   coordinate the development of mass immunization campaign frameworks, in collaboration
    with provincial, territorial and local stakeholders
   develop guidelines/plans for vaccine security
   develop guidelines re: stockpiling of supplies used for vaccination
   develop guidelines re: monitoring of distribution, uptake wastage and disposal/return of
    vaccines
   coordinate the development of protocols for vaccine safety and efficacy studies
   develop systematic signal generation protocol for Vaccine Associated Adverse Effects
    (VAAEs)
   develop assessments for adverse side effects and vaccine benefits


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PHSA Pandemic Influenza Preparedness Plan – September 2009
   develop and coordinate federal/provincial/territorial management framework for responding to
    VAAEs
   identify the regulatory requirements for release of a safe and immunogenic pandemic influenza
    vaccine
   collaborate with all stakeholders to develop informed consent protocols
   address liability in the event of vaccine adverse effects
   review and modify plans as needed

Pre-pandemic: Antivirals
   develop guidelines for the use of antivirals during a pandemic
   develop a protocol for the surveillance of drug resistance
   develop protocols with the regulator for adverse events, post marketing surveillance and
    withdrawal/recall
   develop guidelines regarding anti-influenza drug supplies, including stockpiling, bulk
    purchasing and possibility of domestic supply
   develop guidelines for delivery/administration of antivirals
   develop guidelines re: monitoring distribution, uptake and wastage
   develop guidelines re: antiviral security
   review and revise guidelines periodically, as needed

Pre-pandemic: Clinical Health Services
   develop a Health Services section for the Canadian Contingency Plan
   develop resource management guidelines for acute care facilities
   develop guidelines for health care workers and volunteers doing alternative work during a
    pandemic
   develop guidelines for utilization of non-traditional settings for the provision of health care
   develop guidelines for clinical management of influenza and its complications
   develop patient management options in the event of extreme resource shortages
   develop institution infection control guidelines
   develop community infection control guidelines
   develop occupational health guidelines
   develop aftercare/recovery plans/guidelines
   review and modify guidelines periodically, as needed

Pre-pandemic: Surveillance
   enhance the national FluWatch surveillance system
   improve disease-based surveillance in collaboration with the provinces/territories
   provide regular assessments of provincial/territorial laboratory diagnostic capacity
   ensure standard protocols for laboratories (e.g. specimen collection, handling, transportation)
    are supported by enhanced proficiency testing
   develop guidelines re: laboratory supply issues and address supply/procurement requirements
    in the event of scarce resources
   develop guidelines for antiviral susceptibility testing during a pandemic
   establish linkage between human and avian/swine influenza surveillance
   continue to participate in WHO influenza surveillance


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PHSA Pandemic Influenza Preparedness Plan – September 2009
   provide financial and technical support to international laboratory surveillance in conjunction
    with the WHO
   develop and test (in collaboration with provinces, territories, local public health officials,
    clinicians and academics) special studies protocols which can be activated at the time of a
    pandemic to: document outbreaks in different population groups, determine age-specific
    mortality and morbidity, describe unusual clinical syndromes and conduct effectiveness
    studies of vaccination, treatment or chemoprophylaxis
   enhance (in collaboration with provinces/territories) VAAE surveillance
   develop guidelines/mechanisms for surveillance of VAAEs relating to influenza vaccination
    during a pandemic
   develop systematic signal generation protocol for VAAEs
   develop/improve communication for the rapid and timely exchange of surveillance information
    within Canada, across North America and internationally

Pre-pandemic: Communication
   ensure continual “marketing” of annual and pandemic influenza to maintain awareness of
    issues
   continue to build relationships/credibility with national media contacts and public re:
    pandemic influenza
   continue to educate the media about influenza and pandemic influenza
   enhance CIDPC’s secure Web site
   develop a public Web site
   support other pandemic planning activities
   support the Canadian Coalition for Influenza Immunization campaign
   develop a national communication strategy and implementation plans, addressing the need for
    coordinated response, consistent messaging and rapid dissemination of information
   develop public education/awareness campaigns for all target groups including health care
    workers, emergency responders, governments and non-governmental organizations
   develop inventories of existing communication systems (hardware and software)
   identify gaps in the existing systems that will require additional resources
   develop a visual identity (brand, logo or “look”) for pandemic influenza
   plan for translation of media messages
   pilot test communication systems
   establish/enhance communication links with international partners

PANDEMIC
Pandemic: Emergency Response
   fully activate emergency response plan, including aftercare/recovery plans/guidelines and
    modify if required
   ensure communication with international and provincial/territorial stakeholders
   possibly declare a national emergency

Pandemic: Vaccine
   in consultation with WHO, recommend the appropriate composition of the pandemic vaccine
    for the Canadian population
   ensure that appropriate confirmatory studies/clinical trials are carried out

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   recommend the appropriate dosage and schedule for pandemic vaccine
   license or release vaccine for use
   identify production capacity for vaccine
   participate in international coordination for potential purchase and/or sale of domestically
    produced vaccines and establishment of distribution networks among countries
   provide equitable distribution of vaccine to provinces and territories
   meet with partners and stakeholders and review major elements of vaccine allocation and
    distribution plan
   revise, as needed, recommended priority group for vaccination based on epidemiology of the
    pandemic
   redistribute vaccine as needed
   monitor WHO-coordinated vaccine trials
   monitor vaccine coverage, effectiveness and adverse reactions in collaboration with
    provinces/territories

Pandemic: Antivirals
   review WHO guidelines on best use of available antiviral drugs
   revise, as needed, priority groups for antivirals based on epidemiology of the pandemic
   fully activate antiviral drug plan
   communicate with provinces/territories

Pandemic: Clinical Health Services
   review plans and guidelines; modify if necessary
   support provinces/territories to operationalize their health services plans

Pandemic: Surveillance
   monitor bulletins from WHO regarding virologic, epidemiologic and clinical findings
    associated with novel strain; disseminate information to provinces/territories
   obtain reagents from WHO Collaborating Centres to detect and identify novel strains and the
    best methods to isolate new strains
   review case definition developed by WHO and accept or modify for Canadian population
   meet with partners and stakeholders to review major elements of enhanced surveillance
    activities and modify plans as needed
   fully activate surveillance activities in collaboration with provinces/territories
   consider (in collaboration with provinces, territories, local public health officials, clinicians
    and academics) special studies protocols which can be activated at the time of a pandemic to
    document outbreaks in different population groups, determine age-specific mortality and
    morbidity, describe unusual clinical syndromes and conduct effectiveness studies of
    vaccination, treatment or chemoprophylaxis

Pandemic: Communication
   modify communication plans and materials as needed
   fully activate pandemic communications plan
   identify communications team and national media spokespersons
   ensure consistent coordination and messaging

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PHSA Pandemic Influenza Preparedness Plan – September 2009
   coordinate communication activities with provinces/territories
   ensure communication with international partners and close monitoring of messaging from the
    WHO, the U.S. and other countries
   be prepared to respond to external messages
   ensure that adequate hardware, software, human resources and logistics are in place to
    implement the communications plan

POST-PANDEMIC
Post-pandemic: Emergency Response
   evaluate the pandemic emergency response
   revise emergency response section of pandemic plan, based on evaluation
   if a state of emergency was declared, end it

Post-pandemic: Vaccine
   evaluate pandemic vaccination program
   revise vaccine section of pandemic plan, based on the evaluation
   return to pre-pandemic influenza vaccine activities

Post-pandemic: Antivirals
   evaluate pandemic antiviral program
   revise antiviral section of pandemic plan, based on the evaluation
   return to pre-pandemic use of antivirals

Post-pandemic: Clinical Health Services
   evaluate health services response during the pandemic
   evaluate adequacy of clinical guidelines used during the pandemic
   evaluate adequacy of alternate sites used during the pandemic
   conduct studies to determine the clinical significance of the pandemic strain
   revise the health services section of the pandemic plan, based on evaluations
   develop plan for recovery of health services (e.g. overcoming backlog of postponed surgeries)

Post-pandemic: Surveillance
   evaluate pandemic surveillance systems
   revise surveillance section of pandemic plan, based on the evaluation
   return to pre-pandemic surveillance activities
   assess pandemic’s impact on the health care system, as well as its social and economic impact

Post-pandemic: Communication
   evaluate communications during the pandemic
   revise communication section of pandemic plan, based on evaluation
   re-establish pre-pandemic lines of communication and discontinue enhanced communication
    activities

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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                        Attachment 7


Principles of Infection Control (obtained from BCCDC PIPP)

Mode of Transmission
Influenza is transmitted by:
     Droplet contact of the oral, nasal or possibly conjunctiva mucous membranes with the
       oropharyngeal secretions of an infected individual.
     Indirect contact from hands and articles freshly soiled with discharges of the nose and
       throat of an acutely ill individual.
     Droplet transmission from the respiratory tract of an infected individual.
     Possibly by the airborne route (controversial) during aerosolizing procedures.

Period of Communicability
The period of communicability of influenza is 24 hours before the onset of symptoms and 3 to 5
days after the onset of symptoms may be as long as 7 days (may be longer in children and some
adults).

Note: Influenza A and B virus can survive on hard surfaces for 24 to 48 hours, on softer, porous
surfaces for 8 to 12 hours and on the hands for up to 5 minutes.

Incubation Period
The incubation period is 1 to 3 days.

Infection Control Practices
Most health care settings in PHSA use similar systems of infection control precautions, but may
refer to them by different names, such as routine practices or standard precautions. These systems
may vary slightly from facility to facility, but the guiding principles are the same. In this
document, the term routine practices will be used.

Interpandemic Period
During the inter-pandemic years, the Health Canada guidelines recommend that in addition to
routine practices, which should be taken for the care of all patients, additional precautions (droplet
and contact precautions) should be taken for paediatric and adult patients with influenza or who
present with an acute, respiratory illness. Children and adults, who are both physically and
cognitively able to practice good hand hygiene and good personal hygiene, should be encouraged
to do so. General infection control guidelines that apply to all settings and all those involved in
providing health care are discussed in this section. Specific infection control guidelines are
discussed in the rest of this section.

Routine practices
Routine practices are the infection prevention and control practices used in the routine care of all
patients at all times in all health care settings. Routine practices outline the importance of hand
hygiene; the need to wear gloves, masks, eye protection or face shields, and gowns when contact
with blood, body fluids, secretions or excretions is possible; the cleaning of patient-care

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PHSA Pandemic Influenza Preparedness Plan – September 2009
equipment; cleaning of the environment; the handling of soiled linen; waste disposal procedures;
patient placement procedures and precautions to reduce the possibility of Health Care Workers
(HCW) exposure to blood borne pathogens and other infectious pathogens.

Additional Precautions
Additional precautions are required when routine practices are not sufficient to prevent
transmission. In Vancouver, these additional precautions may be referred to by different names.
For example, transmission based precautions include droplet, airborne, and contact precautions;
category specific precautions include strict, respiratory and enteric precautions. Both are based on
the mode of transmission and have been designed to meet the specific needs of the institution. In
this document, additional precautions will be used. In addition to routine practices, contact and
droplet precautions may be required in certain situations to prevent transmission of influenza.

Droplet Precautions
Droplet precautions for influenza during the inter-pandemic years include the use of personal
protective equipment, such as a mask, goggles or a face shield when providing care, placing the
patient in a private room or cohorting the patient with another patient with influenza. Droplet
precautions with the addition of a particulate respirator (N95 mask) should be practiced during any
procedure that may result in aerosolization, for example, respiratory intubations, bronchoscopy,
and cardio-pulmonary arrest management.

Contact Precautions
Contact precautions for influenza during the inter-pandemic years include wearing gloves and
gowns when providing care to the patient and when in contact with frequently touched
environmental surfaces or objects that may be contaminated, placing the patient in a private room
or cohorting the patient with another patient with influenza.

Droplet and contact precautions in regards to pandemic influenza are addressed in each specific
section and are described in general in Routine Practices and Additional Precautions for
Preventing the Transmission of Infection in Health Care for each of the health care settings.

Hand Hygiene
Hand hygiene is an important step in preventing the spread of infectious diseases, including
influenza. Hand hygiene can be performed with soap and warm water or by using waterless
alcohol-based hand sanitizers. Waterless alcohol-based hand sanitizers are especially useful when
access to sinks or warm running water is limited. Placing alcohol based hand sanitizers at the
entrance of facilities is useful in preventing transmission of infectious diseases. Hand hygiene
procedures using both soap and water, developed for the Canadian Pandemic Influenza Plan, are
included in the Forms and Tools section of this section.

Note: Hospital germicides, household-cleaning products, soap, and hand-wash or hand hygiene
products readily inactivate the influenza virus. Therefore, special antiseptic hand hygiene products
in health care settings or antibacterial hand hygiene products in home settings are unnecessary.

Basic Hygiene Measures
Basic hygiene measures should be reinforced and people should be encouraged to practice them to
minimize potential influenza transmission, e.g. use disposable, single-use tissues for wiping noses;
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PHSA Pandemic Influenza Preparedness Plan – September 2009
covering nose and mouth when sneezing and coughing; hand washing/hand hygiene after
coughing, sneezing or using tissues; and the importance of keeping hands away from the mucous
membranes of the eyes and nose.

Strategically placed alcohol based hand sanitizers and boxes of tissues may enhance personal
hygiene practices.

Patient Placement
If possible, patients with symptoms of an influenza or influenza like illness (ILI) should be
separated from those without symptoms. Ill patients should:

        Be placed in a single room or cohorted with another patient with an ILI.
        Have dedicated bathrooms.
        Be separated by at least one-meter distance in other locations (avoid crowding).

Other Activities to Limit Spread of Influenza
As much as possible, staff working with symptomatic patients should avoid working with patients
who are not symptomatic (staff cohort). This can be accomplished as follows:

        Attempt to assign the same staff to assist symptomatic patients.
        Keep symptomatic patients in room until symptoms cease.
        Limit movement and activities of patients including transfers within the facility.
        Limit unvaccinated visitors.
        Avoid group activities.

Use of Masks during an Influenza Pandemic
In this context, masks refer to surgical or procedure masks, not special masks or N 95 masks.
There is a lack of evidence that the use of masks has prevented the transmission of influenza
during previous pandemics. Masks should be worn by HCW’s as outlined in routine practices
when splashes or sprays of blood, body fluids, secretions or excretions to the mucous membranes
of the mouth are possible. Masks may be useful in the pandemic alert and early pandemic periods
during face-to-face contact with coughing individuals, especially when immunization and antiviral
are not yet available. The use of masks may not be practical or helpful when transmission is
widespread in a facility and in the community.

A particulate respirator (N95 mask) should be worn by the HCW during contact with patients who
have an undiagnosed cough that may be caused by an organism that is spread by the airborne route
e.g. TB, chickenpox, measles or during aerosolizing procedures with a patient suspected or known
to have an organism spread by droplet transmission.

Pandemic Period
Routine practices and additional precautions to prevent the transmission of infection during a
pandemic are important. Some infection control strategies may be achievable only in the early
pandemic period and other recommendations may not be achievable as the pandemic spreads and
resources (equipment, supplies, private rooms, and human resources) become scarce. The
complexity of management of high-risk patients will be greatest in acute care hospitals that will

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PHSA Pandemic Influenza Preparedness Plan – September 2009
continue to admit patients with other communicable respiratory diseases. It is possible that
infection control resources may need to be prioritized to the acute care settings.


                The strict adherence to HAND HYGIENE recommendations is the
                cornerstone of infection prevention and control and may be the only
                preventive measure available during a pandemic.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                             Attachment 8




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                  Attachment 9


                                  ***LIST OF PANDEMIC STOCKPILE INVENTORY***




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                            Attachment 10


                          Pre WHO          WHO Pandemic Phase 5-6
                          Pandemic Phase   No EOC       Any EOC Activated
                          1-4              Activated
 All Material Supplies    Normal           Normal       Normal
 Human Resources          Normal           Normal       Normal
 Pandemic Stockpile       PHSA             PHSA         PHSA CEOC
 Critical Material
                          Normal           Normal            PHSA CEOC
 Supplies
 Critical Human
                          Normal           Normal            PHSA CEOC
 Resources




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                                     Attachment 11



                                                        PHSA

                          Accounting Procedures for Emergency / Disaster Costs
                Issued by Emergency Management & Business Continuity (EM&BC) and Finance

Purpose
In case of an emergency / disaster such as H1N1 or flood, INCREMENTAL costs directly related to the event need to
be tracked. The intent is to provide a mechanism to track costs associated with response to the “event” and to provide
documentation for Agencies and Corporate Services to validate cost overruns. This includes costs incurred that go
beyond costs that would have been incurred had an emergency/incident/event not occurred. This is NOT to guarantee
or offer reimbursement. However, if possible, PHSA will submit a request for reimbursement through the Ministry of
Health Services and/or the Provincial Emergency Program.

Project Code
A project code will be used to achieve this purpose. The first project code AOD00001 was set up and was activated
for the H1N1 pandemic, and the next project code AOD00002 was then set up to be ready for activation with the next
“event”. Each time the “next-in-line” project code is activated the subsequent project code will be set up for
subsequent events. By having the project code, a report of all costs related to the event can be easily generated and
analyzed.

Procedures
    o    Activating project code –
         –    PHSA Vice President, Clinical and Support Services, or alternate PHSA Corporate Director, EM&BC, is
              responsible for
                            1. making the decision to activate the “next-in-line” project code,
                            2. determining the name of the project code, and
                            3. informing Business Planning (BP) of EM&BC.
         –    BP of EM&BC is responsible for sending the request to activate the project code.
    o    Setting up project code -
         –    BP of EM&BC is responsible for setting up the project code.
         –    Once the project code is activated, the “next-in-line” will be set up by the BP of EM&BC.
    o    Communicating the use of project code –
         –    When a decision is made to activate the project code, BP of EM&BC will
                            1.  inform BP directors of all agencies the activation of the project code and for what
                                purpose / incident, and
                            2.  provide a guideline of how to use the project code to BP directors. (See Appendix A
                                and B).
         –    BP directors will
                            1.  provide the guideline to department managers,
                            2.  consult department managers whether they require access to the project code, and
                            3.  inform BP of EM&BC which Department Combo (BU-Dept-Site) are to be granted
                                access to the project code and whether Payroll and ePro are required.
         –    BP of EM&BC will fill out and forward the Chart of Account forms (COA) to activate the Department
              Combo as requested.
         –    Any addition or deletion of Department Combo should be directed to BP of EM&BC by BP directors.
         –    The set up of any new departments in relation to the event should also be done through BP of EM&BC.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
    o    Deactivating project code –
         –    PHSA Vice President, Clinical and Support Services, or alternate PHSA Corporate Director, EM&BC, is
              responsible for making the decision to deactivate the project code, and informing BP of EM&BC.
         –    BP of EM&BC is responsible for sending out the request to deactivate the project code and informing
              BP directors of all agencies involved of the deactivation.
         –    BP directors are responsible for advising department managers of the change and stop using the project
              code.
    o    Monitoring of the project costs –
         –    Department managers are responsible for the incremental costs and explanation of any cost overruns.
         –    Finance and BP will make any necessary accounting reallocations.
         –    Finance and BP will provide reporting as directed by the Ministry of Health Services and/or the
              Provincial Emergency Program.
    o    Definition
         –    Incremental Cost: cost incurred in relation to activities in response to the Emergency/Disaster that go
              beyond cost that would have been incurred had the Emergency/Disaster not occurred.
         –    BP of EM&BC: Business Planning representative for Emergency Management & Business Continuity




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                                     Appendix A


Notification of the activation of Emergency / Disaster project code - from BP of EM&BC
We have activated a project code AODxxxx, Description to be used across agencies to capture INCREMENTAL costs
in relation to Description of the event. This will enable us to capture the incremental costs organization wide for
reporting purposes. Please advise if you are expecting to incur incremental costs in relation to Description of the
event and will therefore need to activate this project code in your agency. Please provide BU-Fund-Dept-Site combo
required and state whether Payroll and ePro use will be required. Please forward the following guidelines to the
department managers to assist in making the decision. (Guidelines in Appendix B)




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                                     Appendix B

    Guidelines for using Emergency / Disaster project code

    o    The project code is to be used for tracking INCREMENTAL and LEGITIMATE costs incurred in relation to
         activities in response to the Emergency / Disaster. This means costs that go beyond costs that would have
         been incurred had an emergency/incident/ event not occurred.
    o    Costs coded to the project are NOT intended to guarantee or offer reimbursement.
    o    The project code is used within the departments. The department managers are responsible for the costs
         incurred and explaining any cost overruns.
    o    While it is important to distinguish the incremental costs and normal operating costs, the department
         managers should also consider if the relevant costs are significant enough to warrant the cost of the
         administrative effort required to track.
    o    The activation of the combo can be done at a later date when the costs grow to a material amount.
    o    The department managers are responsible for completing eForms if any payroll costs will be coded to the
         project.
    o    The approvers / requestors of the department will code expenses as they would normally be coded but add
         the AODxxxx project code to the end. If they are using ePro, they can follow the instructions below.
    o    The existing approvers / requestors of the department will be defaulted for the project code combo. (BP of
         EM&BC will look up the Financial Signing Registry FSR for the department). If other approvers /requestors
         should be designated for the project code, please indicate so when the request is sent to BP of EM&BC.
    o    BP financial analysts will assist in reporting, analyzing the project costs, and make the appropriate
         reallocation.

Instructions to add the project for all lines of the requisition in ePro.

1) Click on Edit Defaults




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PHSA Pandemic Influenza Preparedness Plan – September 2009
2) Enter the project, HIT OK




3) Check Mark All, HIT OK




4) Save and Submit as usual.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                               Attachment 12

Activation Levels- Description

 Level 1            Readiness
 Activation         Activated at the request of Executive
                     Emergency Operations Centre (EOC) established to provide
                       agency/service wide planning coordination and direction
                     Provide intelligence and situational awareness
                     Ensure all relevant plans reviewed and updated
                     Key management positions of the EOC activated (Director,
                       Information Officer, Public Health Liaison Officer, Liaison
                       Officer, Planning Section Chief, Logistics Section Chief)
                     Move to a more coordinated and centralized approach to
                       information sharing and dissemination through the EOC
                       operational structure
                     Documentation consolidated and disseminated as appropriate
                     Activate coordinated liaison to affected partners
                     Some after-hours stand-by staffing may occur
                     Preparations for preparing to move to level 2.

 Level 2            Partial Activation
 Activation         Executive Policy Group direction (Chief Operating Officer)
                     More enhanced state of readiness – staff working longer hours
                       in Operations Centre, greater staffing of EOC positions etc.
                     Monitoring internal staffing conditions
                     Longer term planning
                     Routine operations may be curtailed to manage the response
                     Evaluating situational awareness and continuing readiness of
                       agencies and services
                     Daily reporting (Sitreps) from agencies and services and to
                       other HAs and other levels of government as needed

 Level 3            Full Activation
 Activation         On the direction of the PHSA Policy Group
                     Operations Centre staffed 24/7 and/or required
                     Other business activities may be deferred or curtailed
                     Full detailed activities in several key areas:
                       Operations/Planning/Logistics/Finance/Admin




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                                                       Attachment 13(a)


                            Severe Respiratory Illness April 2009 - Level 1 MOC Activation
                            Ministry of Health Services/Ministry of Healthy Living and Sport


                                                 Minister of Health   Minister of Healthy
                                                     Services          Living and Sport




                                                 Deputy Minister       Deputy Minister
                                                     MoHS                  MHLS



                                                        Executive Policy
                                                            Group
                                                          Leads: Wendy Hill
                                                           Andy Hazlewood

                       BC Centre for
                      Disease Control               Ministry Operations Centre
                                                              Director
                                                    Eric Young/Rebecca Harvey
                        Public Health
                         Agency of
                          Canada


 External Partners                         Liaison                                 Information                      External Partners
   Operational                              Officer                               Officer – PAB                 Communications Directors
(eg. BCAS, Health                       MoHS/MHLS                                 MoHS/MHLS                        (eg. BCAS, Health
  Authorities etc.)                                                                                                  Authorities etc.)
                                 Teri Collins/Brian Emerson                       Rodney Porter




              Operations                   Planning                      Logistics                Finance / Admin
                                         EMU/HAD/PHO




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        PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                                                                                          Attachment 13(b)
                                                       Provincial Public Health Emergency Management



                                                    PHSA                      Provincial Health Officer
                     Central                                                 Ministry of Healthy Living and Sport
                                                                                 Ministry of Health Services
                   Coordination                                             Ministry Operations Centre Director
                     Group

                                                     Policy
                                               Dr. Bob Brunham
                    Provincial
                   Emergency
                   Coordination
                                                                                      Public Health
                     Centre
                                                                                    Incident Manager
                                                                                          BCCDC
                                                                                    Dr. David Patrick

                           Public & Stakeholder Information -         Information
                                                                        Officer
                                                                       PHSA, PAB
                                                                      Roy Wadia
                                                                                                                     Risk / Safety
                                                                        Liaison                                         Officer
                                                       - MOHS           Officer                                      BCCDC & MOF        - Worker Care
                                                                     BCCDC, MOHS                                     Nick/Natalia
                                                                   Dr. Bonnie Henry

                                                                                                                                                   Finance /
                                  Operations                                                                        Logistics
                                                                                                              BCCDC, PHSA, et al                 Administration
                                                                                                                                                BCCDC, PHSA, MOF
                                                                                                                Natalia/Tony
                                                                                                                                                 Sasha Kavner


                                                                                                                                                   Time
                       Operations Scientific                                                                        Service
   Business                                          Operations                                                                                    Management
                            Advisor                                     Planning                                    Branch
Continuity (WLO)                                      Delivery                                                      -IMIT &
                           Dr. Danuta                                                                                                              Purchasing &
Dr. Nick Foster                                                                                                     Communications
                          Skowronski              Dr. Bonnie Henry (& Natalia Skapski)                                                             Procurement
                                                                                                                    -First Aid
                                                                                                                    -Food Services                 Cost
                            Epidemiological                             Situation                                                                  Accounting
                            Investigation          Rx Biological        Reporting                                   Support
                            Surveillance           Fawziah Marra                                                    Branch                         Compensation
                            Travis Hottes                               Advanced Planning                           -Facilities                    & Claims
                            Naveed Janjua          Health               & Mitigation                                -Supply
                                                   Authorities                                                      -EOC Support
                            Laboratory                                  Technical
                                                                                                                               - Check-in
                            Support                                     Specialists
                                                                                                                               - Personnel
                            Mel Krajden                                                                             -Ground Support
                                                                        Documentation
                            Other                                       Tony Correia/
                                                                        Angela Sammon                                      EOC SUPPORT FUNCTIONS
                                                                      Demobilisation
                            Infection
                                                                      & Recovery
                            Control
                            Bonnie Henry                                Resource
                                                                        Status

                                       ADVISORY AND SERVICE DELIVERY




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           PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                                                                                                                       Attachment 13 (c)

H1N1 DRAFT – 3 – May 2009
                                                                                                                                                                                     PHSA Board


                                                                                      Provincial Health Services Authority                         PHSA Policy
                                                                                                  EOC Director                                       Group
                                    Min Of Health
Min Of Health Provincial
     Health Officer
  IHA                    Public Health                                                                           Safety Officer
                          Emergency                                    Information Officer
  VCHA                   Management
  VIHA
                                                           PHSA Infection Control &                              Liaison Officer
  FHA                                                           Patient Risk
  NHA



                                            Operations Section                                                                                                                                      Finance & Admin
                                                                                                                        Planning Section Chief             Logistics Section Chief
                                                  Chief                                                                                                                                               Section Chief




                                                             Operations Branch              Operations Branch                Situation Reporting
   Operations Branch              Operations Branch
                                                           Infrastructure Support                                                    Unit                            IMIT
   Direct Patient Care            Non Direct Patient                                        Business Support
                                                                                                                                                                 Communications                        Time Unit
                                                                                                                                                                    Branch
                                                                                                                             Advanced Planning
                                  BC Renal Programs                     IMIT               Quality Safety Risk                     Unit
    Children’s &                                                                                                                                                   Supply Unit
                                                                                                                                                                                                   Compensations &
     Women’s                                                                                                                                                                                         Claims Unit

                                                                                          Strategic Planning &            Documentation Unit
                                   Cardiac Services                Supply Chain              Transformation
        MH&AS                                                                                                                                                Transportation Unit                  Cost Accounting Unit
                                                                                                                             Resource Tracking
                                   Provincial Blood              Alternate Services           Emergency                            Unit
    BC Cancer                     Coordinating Office                 Delivery                Management                                                                                            Enterprise Risk
                                                                                                                                                                 Facilities Branch
     Agency                                                                                                                                                                                          Management
                                                                                                                               Recovery Unit
                                                                 Human Resources           Decision Support
    BC Transplant                                                                                                                                                 Contract Mngt
                                                                                                                                                                     Branch
                                                                                                                          Demobilization Unit
                                                                      Facilities           Internal Insurance
         BCCDC                                                                                                                                                   Personnel Unit

                                                                                                                             Technical Experts
                                                                  Communications          Business Processes
     PHSA Labs

                                                             Provincial Language
                                                                                                Finance
                                                                   Services




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   PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                                                Attachment 14



Key provincial and health authority communication responsibilities

                    Provincial                                 Health Authority
                 Responsibilities                               Responsibilities
   Establish appropriate spokespeople for         Use a central spokesperson to gather
    all external provincial communications.         and disseminate information to the
   Alert health care providers and the             public and media as needed.
    public when PHAC declares a national           Liaise with other local and regional
    pandemic and when the PHO declares              stakeholders (such as emergency
    its arrival in BC.                              responders and essential service
   Liaise with health authorities and the          providers) as needed.
    Provincial Emergency Program to                Liaise with provincial authorities.
    coordinate the dissemination of                Notify the public of any extraordinary
    information to the public and media at          infection control measures, such as
    the provincial level.                           school or business closures or other
   Provide information to the public and           limits on the public assembly.
    the media about basic infection control        Provide clear, consistent information
    measures, such as washing hands.                and guidelines to care providers for
   Provide information (either directly or         delivering health services during the
    through health authorities) to support          pandemic, including isolation and other
    the public in treating influenza at home.       infection control strategies.




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                             Attachment 15



Public Information Communications Flow




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PHSA Pandemic Influenza Preparedness Plan – September 2009
                                                             Attachment 16


REQUEST FOR RESOURCE FORM




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PHSA Pandemic Influenza Preparedness Plan – September 2009

				
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