The Canadian Pandemic Influenza Plan for the Health
Sector
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Annex A
Planning Checklists
Table of Contents
1.0
Introduction
1.1 Surveillance
Checklist
1.2 Vaccine Programs
Checklist
1.3 Antivirals
Checklist
1.4 Health Services
Emergency Planning and Response Checklist
1.5 Public Health
Measures Checklist
1.6 Communications
Checklist-
2.0 Emergency
Response and Coordination Activities: Checklist for Provinces and
Territories
1.0
Introduction
Planning for a pandemic involves the consideration of what
activities are necessary for optimal management of each stage of
the pandemic. This annex provides a preliminary list of planning
activities developed to facilitate planning at provincial and
territorial (P/T) and local levels. These checklists will need to
be reviewed on a regular basis and updated as they are completed.
These planning activities should take place during the
Interpandemic Period (i.e. WHO Phases 1 and 2) with the
recognition that, when novel strains are detected or pandemic
alerts are issued, they will need to be reviewed and adapted as
necessary.
Activities have been listed and grouped in this annex
according to the following components of the Plan:
- Surveillance
- Vaccine Programs
- Antivirals
- Health Services Emergency Planning and Response
- Public Health Measures
- Communications
The list for the former "Emergency Services" component of the
Plan has been retained for reference purposes and appears
following the Communications component in this annex.
Many of these activities and corresponding federal activities
and responsibilities have been discussed and addressed by the
various pandemic planning working groups. Refer to the
Introduction and Background sections of the Plan for further
information on these roles and responsibilities.
1.1
Surveillance Checklist
- Improve disease-based surveillance, in collaboration with the
Centre for Infectious Disease Prevention and Control (CIDPC),
Public Health Agency of Canada PHAC); includes improvements to
the current system and consideration of enhancements (e.g.
emergency room surveillance and real-time influenza mortality
surveillance).
- Improve virologic surveillance capability by ensuring that at
least one laboratory in the P/Ts has the capability to isolate
and subtype influenza virus.
- Establish links with avian and swine influenza surveillance
contacts within P/Ts.
- Develop and/or disseminate protocols and guidelines for the
prioritization of laboratory services during times of
high-service demand and staff and supply shortages.
- Develop and improve communication mechanisms for the rapid
and timely exchange of surveillance information between P/Ts,
CIDPC and local stakeholders.
- Consider how special studies, identified in collaboration
with CIDPC, may be activated in your jurisdiction.
- Determine what information needs to be collected and how this
will be done (to facilitate the evaluation of surveillance
activities in the Post-pandemic Period, including socio-economic
evaluations).
1.2 Vaccine
Programs Checklist
- Enhance annual influenza vaccination coverage rates in
NACI-recommended high-risk groups, particularly groups with low
coverage levels.
- Increase annual influenza vaccination coverage rates among
health care and essential services workers.
- Increase pneumococcal vaccination coverage levels in
NACI-recommended high-risk groups (to reduce the incidence and
severity of secondary bacterial pneumonia).
- Consider P/T modifications or refinements of nationally
defined priority target groups, depending on local circumstances.
For example, there may be specific groups of people in selected
P/Ts whose absence due to influenza illness could pose serious
consequences in terms of public safety or disruption of essential
community services (e.g. nuclear power-plant operators,
air-traffic controllers at major airports, workers who operate
major telecommunications or electrical grids)
- Develop contingency plans for storage, distribution and
administration of influenza vaccine through public health and
other providers to nationally defined high-priority target
groups, including:
- mass immunization clinic capability in P/Ts,
- locations of clinics (e.g. central sites, pharmacies, work
place),
- vaccine storage capability (i.e. identify current and
potential contingency depots),
- numbers of staff needed to run immunization clinics,
- plans to deploy staff from other areas from within and
outside public health organizations to assist in
immunization,
- advance discussions with professional organizations and
unions regarding tasks outside routine job descriptions during a
pandemic,
- training plans for deployed staff, and
- how to identify and target individuals belonging to priority
groups (recognizing that the strategy will involve immunizing the
whole population as soon as possible but that prioritization may
be necessary for the first batches of vaccine that become
available).
- Explore stockpiling syringes and other immunization clinic
supplies
- Determine how receipt of vaccine will be recorded and how a
two-dose immunization program will be implemented in terms of
necessary recall and record-keeping procedures.
- Determine the number of people in P/Ts who fall within each
of the priority groups for vaccination (e.g. high-risk groups,
health care workers, emergency service workers, specific age
groups).
- Verify the capacity of suppliers for direct shipping to
health districts.
- Develop plans for vaccine security:
- during transport,
- during storage, and
- at clinics
- Ensure that appropriate legal authorities are in place to
allow for the implementation of major elements of a proposed
distribution plan. (For example, will P/T laws allow for
non-licensed volunteers to administer influenza vaccine? Do P/T
laws allow for “mandatory” vaccination of certain
groups if vaccination of such groups is viewed by the P/T public
health officials as essential to public service?)
- Coordinate proposed vaccine distribution plans with bordering
jurisdictions.
- Enhance the surveillance for adverse events following
immunization in collaboration with CIDPC.
- Determine what information needs to be collected and how this
will be done (to facilitate the evaluation of pandemic vaccine
program activities in the post-pandemic period, including
socio-economic evaluations).
- Review and modify plans as needed on a periodic basis.
1.3 Antivirals
Checklist
- Estimate the quantity of antiviral drugs that would be
required to implement national antiviral strategy in your
jurisdiction.
- Inform stakeholders of antiviral strategy implementation
plans, (including expected supply and use).
- Modify and refine the guidance provided by the Antivirals
Working Group, as needed for P/T and local application (e.g. plan
how to distribute available antivirals).
- Determine how stockpiled drugs will be stored, monitored
(e.g. stability testing) and distributed.
- Monitor national antiviral stockpile storage conditions and
shelf-life status on an ongoing basis.
- Determine what information needs to be collected and how this
will be done (to facilitate evaluation of an antiviral response
in the post-pandemic period, including socio-economic
evaluations).
1.4 Health
Services Emergency Planning and Response Checklist
- Develop P/T guidelines (modify federal guidelines) for
prioritizing health care needs and service delivery, accessing
resources and implementing infection control measures during a
pandemic.
- Ensure that liability, insurance and temporary licensing
issues for active and retired health care workers (HCWs) and
volunteers are addressed with P/T licensing bodies. Define the
extent of care that health care workers and volunteers can
perform according to P/T laws and union agreements.
- Purchase in bulk and stockpile extra medical supplies.
Explore the options for stockpiling extra medical supplies and
identify sources for additional supplies.
- Develop mechanisms for coordinating patient transport and
tracking and managing beds (e.g. central bed registries, call
centre, centralized ambulance dispatch).
- Develop detailed regional and facility-level plans for
providing health services during a pandemic, including the type
of care to be delivered at different health care settings and the
triage across sites. Identify human resource, material and
financial resource needs and consider priorities for patient
care.
- Assess health care personnel capacity: estimate number of
HCWs by type (e.g. physician, nurses, respiratory therapists,
radiology technicians, etc), and by work setting (e.g. hospital,
community, long-term care facility, paramedical); estimate number
of non-active HCWs (retired)
- Determine sources from which additional HCWs and volunteers
could be acquired, include Emergency Measures Organizations and
NGOs (Red Cross, St. John Ambulance) in pandemic planning.
- Determine the number and type of health care facilities, and
estimate their capacity (e.g. hospital beds, intensive care unit
beds, swing beds, emergency department, ventilatory capacity,
oxygen supply, antibiotic supply).
- Determine potential non-traditional sites and corresponding
"parent" organiziations for medical care provided they meet the
criteria in Annex F, Infection Control
and Occupational Health. Possible sites could include shelters,
schools, gymnasiums, nursing homes and daycare centres.
- Identify sources of extra supplies needed to provide medical
care in these non-traditional sites.
- Determine the capacity of mortuary and burial services as
well as social and psychological services for families of
victims.
- Coordinate clinical care and health services plans with
bordering jurisdictions to avoid migration to centres of
perceived enhanced services.
- Develop aftercare and recovery plans and guidelines.
- Ensure that guidelines are distributed to regional and local
jurisdictions.
- Determine what information needs to be collected and how this
will be done (to facilitate evaluation of the impact of the
pandemic on health services in the post-pandemic period,
including socio-economic evaluations).
- Review and modify plans as needed on a periodic basis.
1.5 Public
Health Measures Checklist
- Coordinate professional and public education strategy for
each phase. Identify staffing needs and resource requirements for
the management of cases and contacts occurring in your
jurisdictions during the Pandemic Alert Period and Pandemic
Period.
- Train staff that may need to be re-assigned to work on the
pandemic response, and identify what and how other essential and
non-deferrable public health programs could be maintained during
a pandemic.
- Develop protocols for case and contact management, including
the implementation of antiviral strategy, quarantine and
community-based measures.
- Develop protocols for school closures and cancelling or
restricting public gatherings.
- Determine how changes in case and contact management and
community-based control measures will be implemented and
communicated to the public and pandemic responders.
- Engage community stakeholders (e.g. school boards,
businesses) in the planning process for community-based control
measures.
- Assess how border measures may impact your jurisdiction and
inform and plan with stakeholders (e.g. airports) how these
measures can be coordinated.
- Consider how measures to limit the spread of a novel virus
emerging in a community, including "exit screening" (if required)
might be implemented at various levels (e.g. town, urban centre,
region, P/T) within your jurisdiction.
1.6
Communications Checklist
(Refer to matrix in Annex
K, Communications)
2.0 Emergency
Response and Coordination Activities: Checklist for Provinces and
Territories
- Identify the advantages of declaring a P/T emergency during a
pandemic.
- Develop contingency plans to provide food, medical and other
essential life-support needs for persons confined to their homes
by choice or by direction from P/T and local health
officials.
- Ensure communication among P/T Ministries of Health and
emergency responders organizations as well as among other P/T
ministries or departments that would be impacted by a
pandemic.
- Within P/Ts, estimate numbers of emergency services workers
including police, fire, correctional, military, funeral services,
utilities, telecommunications and F/P/T and local leaders (e.g.
political leaders, managers of response teams) essential to
pandemic response.
- Identify military personnel and voluntary organizations that
would assist during a pandemic.
- Develop a list of essential community services (and
corresponding personnel) whose absence would pose a serious
threat to public safety or would significantly interfere with
ongoing response to the pandemic.
- Develop contingency plans for emergency backup of such
services and/or provision of replacement personnel.
- Replacement personnel could come from lists of retired
personnel and/or government or private-sector employees with
relevant expertise.
- Conduct environmental assessments of surge capacity of
hospitals, non-traditional sites and other facilities including
ventilation, water sources, etc.
- Develop aftercare and recovery plans and guidelines.
- Determine what information needs to be collected and how this
will be done (to facilitate the evaluation of the emergency
response in the post-pandemic period, including socio-economic
evaluations).
- Conduct simulation exercise(s)
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