Incident Response at Public Health Ontario

Lisa Fortuna and Mark P. Nelder Incident Response Public Health Ontario Toronto, Ontario

September 17, 2012

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Outline

• Public Health Ontario

• Daily Monitoring and Issue Triage

• Issue and Incident Response

• Daily Morning Rounds

• Extended Morning Rounds

• Daily Issues Summary & Situation Report

• Examples of Issues and Incidents

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Public Health Ontario - Vision, Mission, Mandate

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VISION We will be an internationally recognized centre of expertise dedicated to the

protection and promotion of the health of Ontarians through the application and advancement of science and knowledge.

MISSION We are accountable to support health care providers, the public health system and partner ministries in making informed choices and taking informed action to improve the health and security of all Ontarians through transparent and timely provision of credible scientific advice and practical tools.

MANDATE To provide scientific and technical advice for those working to protect and promote the health of Ontarians.

VALUES Credible Responsive Relevant Innovative Collaborative Balanced

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Public Health Ontario

legislated objects

Laboratory services

Knowledge, best practices and

research

Data development, collection, use,

analysis and disclosure

Public health research

Bridge infection control and

occupational

health and safety

Education and professional

development

Scientific and technical advice

and support

Contribute to policy

development

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Public Health Ontario - Structure and Function

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PUBLIC HEALTH ONTARIO PROGRAMS

• Infectious disease prevention and control

• Chronic disease, health promotion and injury prevention

• Public health laboratories

• Environmental and occupational health

CROSS-CUTTING FUNCTIONS

• Surveillance and epidemiology

• Knowledge exchange and communications

• Partnerships and stakeholder relations

• Emergency Preparedness (Incident Response)

• Professional development and education

CORPORATE FUNCTIONS

• Human resources

• Legal counsel

• IT support

• Finance

• Facilities

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PHO’s First Four Years: Transfers from MOHLTC

Date Transfer

December 2008 Public Health Laboratories Branch • Services, programs, resources • Approximately 600 MOHLTC staff

April 2010 Core Competencies in IDPC Program Accountability for four health promotion resource centres

July 2010 Regional Infection Control Networks (RICNs) • 14 RICNs aligned with LHIN boundaries

January 2011 Provincial share of the Public Health Research, Education and Development Program (PHRED)

April 2011 Provincial Infectious Diseases Advisory Committees (PIDAC) The Health Communications Unit (THCU)

July 2011 • Just Clean Your Hands Program • Antimicrobial Stewardship Program • Public Health Architecture – transfer of staff and functions

January 2012 Transfer of scientific and technical functions related to immunization and vaccine-preventable disease

April 2012 Alcohol Policy Network 7

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Public Health Architecture

• Programs transferred to Public Health Ontario from the Ministry of Health and Long-term Care (Public Health Division)

• July 1, 2011 • Communicable Disease

• Infection Prevention and Control

• Food Safety

• Surveillance and Epidemiology

• Enteric, Zoonotic, and Vector-borne Disease

• January 1, 2012 • Immunization and Vaccine Preventable Diseases

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Building a shared vision: functions and responsibilities July 2011 Public Health Architecture transfer and decisions

Public Health Ontario

• Surveillance

• Outbreak investigation

• Advice on outbreak control measures

• Scientific and technical advice and support on communicable disease and environmental health matters

• Public health library services

• Other legislated functions (e.g., research, laboratory services, professional development, knowledge exchange)

Ministry of Health and Long-Term Care

• Policy and program development

• Legislation and regulatory development

• Standards, compliance and accountability

• Monitoring, reporting and overseeing performance

• Public health human resources strategy development

• Provincial-level outbreak control

• Long-term planning and setting strategic direction

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Provincial Leadership – Public Health Ontario and the Ministry of Health and Long-Term Care

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Incident Response

Coordination

Issues Management

Focused Briefings on Emerging

Issues

Open, Timely, and Effective Communication

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"I know it was Friday, because that's when all investigations seem to begin, at the start of the weekend."

Berton Roueché (The Medical Detectives)

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Incident Response

• Issue and Incident Response

• Issue and incident triage

• Stakeholder coordination and knowledge sharing

• Incident Mgmt System, Incident Action Plans

• Briefing senior management

• Key liaison w/ PHOL & Program Areas

• Coordination of Cross-functional Teams

• Scientific & Technical requests

• Daily Monitoring

• Daily Issues Summary and Situation Report

• Daily Morning Rounds

• Weekly Extended Rounds

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Public Health Action

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Issue and Incident Response • Incident Management System

• Emergency Preparedness Team

• Incident Action Plans

• Debriefs

• Cross-functional Teams

• Ensure resources are dispatched in a timely and effective manner during all public health issues or incidents

• Scientific and Technical Requests

• Coordination of requests from clients and partners for variety of knowledge products, e.g., Technical Reports, Environment Scans, Statistical Reports, and Literature Reviews

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Command

Operations

Laboratories Surveillance Investigations Epidemiology

Planning

Epidemiology Surveillance

Logistics

Getters

Finance

Payers

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Issues versus Incidents • Issues

• Any problem that may lead to an incident of public health significance

• E.g., cluster of cases, a rare disease, WNV in mosquitoes, a case with a high-profile or public interest, recall of widely distributed food

• Incident • Any event that may disrupt normal public health operations

• E.g., disease outbreak, epidemic, radionuclear leak, weather event

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Daily Monitoring (Mechanisms)

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Issue and Incident Triage

• Issue/Incident Identified, now Consider:

• Number of public health units involved

• Ongoing exposure or transmission

• Morbidity and mortality

• Involvement of out-of-province jurisdictions

• Impact on health care system capacity

• Need for coordinated intervention

• Need for external resources

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Clostridium botulinum

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Issue and Incident Response

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Daily Monitoring - Identifies Issue/Incident

Issue/Incident Triage

Coordination & Communication w/ MOHLTC

PHO Program Area(s)

Public Health Unit(s) CFIA, HC, PHAC

OMAFRA, MNR, MOE

PHO Laboratory

Health Care Facility

Next Steps (Investigation, OICC, OOICC)

Mitigation & Surveillance (PHA, ESD)

Debrief & Review

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Incident Response – A Day in the Life

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Morning Rounds

Assess Overnight

Prepare SIT

Report of Days Issues

and Incidents Coordination of Investigation/Outbreak Meetings

Action Items

Coordination of Scientific & Technical Requests

Communications & Briefings

7:00am 9:00am 3:30pm

Daily Monitoring & Issue/Incident Identification

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Daily Issues Summary and Situation Report

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Daily Issues Summary and Situation Report

• Total 17 Sections

• New, Emerging, or High-Profile Issues

• B - Action Items

• C - Joint Incident Assessments

• D - Today's EARS Flags

• E - Today's TeleHealth Clusters

• F - Curent Enhanced Surveillance Directives (ESDs)

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Updated, Reported on

Daily

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Daily Issues Summary and Situation Report

• Section G - Daily Notifications

• Media Requests

• On-Call Requests

• MOHLTC Requests

• FYIs

• Emergency Management Branch Notifications

• News Releases by Health Organizations

• Publications, Presentations, or Announcements

• International Issues and Incidents

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Updated, Reported on Daily

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Section G - FYIs (Jul 1, 2011 - Jun 30, 2012)

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Daily Issues Summary and Situation Report

• H - Provincial Enteric Clusters or OOICC

• I - National Enteric Clusters or OICC

• J - Current Information on Vector-Borne Diseases

• K - Current CDI Outbreaks in Hospitals and LTCHs

• L - Current Local Investigations or OBs (non-enteric)

• M - Current Prov Investigations or OBs (non-enteric)

• N - CFIA Health Hazard Alerts

• O - OMAFRA and MNR Notifications

• P - PHAC, HC, CNPHI, Provincial Alerts, or Updates

• Q - International Outbreaks or Alerts

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Updated As Information is

Available, Reported on

Weekly

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Sections N, O, P, Q - Notification Sources

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Daily Morning Rounds • When:

• Daily, 8:30 am, approx 10-15 minutes

• High-level representation from: • PHO - Incident Response, Emergency Management, Communicable

Disease Prevention and Control, Communications

• MOHLTC - ACMOH (Chair), Public Health Policy and Programs, Emergency Management Branch, Communications

• Discussion: • Daily SIT Report and contents (Sections A-G)

• Action items

• On-call issues

• Media and communications 25

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Weekly Extended Rounds

• Same participants as Daily Morning Rounds, but with: • Ontario Chief Medical Officer of Health

• Program area experts as needed

• Discussions same as Daily Morning Rounds, but includes: • Daily SIT Report in entirety

• Assess all issues and incidents

• Ongoing OICC/OOICC, CDI, Vector-borne disease, non-enteric OBs

• Respiratory pathogen surveillance from PHOL

• Influenza, Respiratory syncytial virus, Legionella, Pertussis

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Example: West Nile Virus • Notification:

• Increase in cases, high # positive mosquito pools

• Health unit communication

• PHO Assessment:

• Media and public attention

• Health unit assistance? Morbidity and mortality?

• Joint Incident Assessment:

• Initiated during morning rounds, via SIT Report

• PHO and MOHLTC coordinate

• Assess current situation and options

• Public Health Action:

• Increase communication between provincial partners

• Increase public messaging 27

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Example: Enteric Disease Outbreak • Notification:

• NESP, PHA, EARS Flags

• PHO Assessment:

• What is pathogen? Health unit assistance?

• Morbidity and mortality? Media and public attention?

• Joint Incident Assessment:

• Initiated during morning rounds, via SIT Report

• PHO and MOHLTC coordinate

• Public Health Action:

• Issue an Enhanced Surveillance Directive

• Consider OICC, Important Health Notice

• Health Risk Assessment; Health Hazard Alert

• Increase public messaging, targeted communications

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Acknowledgements

• Dr. George Pasut

• Dr. Brian Schwartz

• Amrita Maharaj

• Kyle Boulden

• Erik Kristjanson

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Contact Information

lisa.fortuna@oahpp.ca

mark.nelder@oahpp.ca

or email incidentrepsonse@oahpp.ca

For more information on

Public Health Ontario

please visit our website at www.oahpp.ca

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