Subject: Vaughan Community Health Centre Emergency Management Manual

Manual: Staff

Policy Number: 8.17

Pages: 23

Implementation: Feb.2010

Revised: Jan. 2014; Dec. 2014 Next Review: Dec. 2015

Cross Reference: Early or Emergency Closure policy; Pandemic Influenza Plan

Approved By: Executive Director

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Table of Contents

EXECUTIVE SUMMARY .................................................................. 3

PLAN CONTRIBUTORS .................................................................. 4

PANDEMIC INFLUENZA PLAN ........................................................ 4

POLICY ON EMERGENCY MANAGEMENT .......................................... 5

ITEMS TO CONSIDER DURING AN EMERGENCY ............................... 6

EXTERNAL ORGANIZATIONAL AUTHORITIES ................................... 7

Ministry of Health Emergency Management Branch ................................... 7

Emergency Management Ontario ............................................................ 7

Ministry of Labour ................................................................................. 7

York Region Public Health Branch ........................................................... 7

City of Vaughan ................................................................................... 8

LEGISLATIVE CONTEXT ................................................................ 9

The Emergency Management and Civil Protection Act ................................ 9

The Health Protection and Promotion Act ................................................. 9

The Health Systems Improvement Act .................................................... 9

The Occupational Health and Safety Act ................................................. 10

The Employment Standards Act ............................................................. 10

HAZARD IDENTIFICATION AND RISK ASSESSMENT ........................ 11

Mitigation and Preparedness Strategies .................................................. 11 Increased Risk of Client / Staff Injury, Illness or Death .................................... 11 Shortage of Supplies ................................................................................... 11 Shortage of Human Resources ...................................................................... 12 Office / Facility Damage / Contamination or Inaccessibility (Including Power

Outage) ..................................................................................................... 12 IT inaccessibility or damage ......................................................................... 12

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Response and Recovery Strategies ........................................................ 12

Increased Risk of Client / Staff Injury, Illness or Death .................................... 12 Shortage of Supplies ................................................................................... 13 Shortage of Human Resources ...................................................................... 13 Office / Facility Damage / Contamination or Inaccessibility (Including Power

Outage) ........................................................... Error! Bookmark not defined.

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Executive Summary The Board of Directors and Management of Vaughan Community Health Centre support the development, evaluation and continuous

improvement of an Emergency Management Program.

The purpose of the program is to develop and maintain a reasonable

level of mitigation against and preparedness for an emergency, and to be able to respond and recover effectively. Objectives include:

First and foremost, to protect the health and safety of staff and clients

Safeguard client and staff records

Safeguard Vaughan CHC property Resume full service as soon as can safely be done during or

following an emergency

The Emergency Management Committee’s purpose is to maintain a reasonable level of preparedness for a community or larger

emergency, including but not limited to the maintenance of a written

emergency plan and the centre’s pandemic influenza plan.

Based on the hazards identified in the York Region Emergency Plan, the following hazards have been identified for Vaughan CHC:

Widespread, epidemic disease in humans

Widespread, multi-day power outages

Slow onset floods from heavy sustained rainfall Widespread property damage from severe summer storms

Transportation-Hazardous Material Incidents

The following common consequences for VCHC have been identified as

stemming from these hazards: Increased risk of client / staff injury, illness or death (including

evacuation) Shortage of supplies

Shortage of human resources Office damage / contamination or inaccessibility (including power

outage)

IT inaccessibility or damage

The committee has outlined high level mitigation, preparedness,

response and recovery strategies for these consequences. Management will coordinate response and recovery activities.

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Plan Contributors Thank you to the following individuals for their contributions to this plan.

Thomas Appleyard

Isabel Araya Annette Bailey

Kaz Dmuchowski

Sarah Hitchins LoAn Ta-Young

Fatima Teixeira Teresa Tran

Other staff members contributed to this plan through consultations

and completion of staff surveys.

These contributors developed this plan based on available information. They are not responsible for the success of the plan’s implementation.

Changes to this plan are expected as information becomes available, including during any emergency.

Pandemic Influenza Plan Because of the volume of information specific to pandemic influenza, a separate document has been developed. These use and maintenance

of these two documents should be coordinated for any activity relevant to pandemic influenza.

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Policy on Emergency Management

The Board of Directors and Management Team of the Vaughan Community Health Centre support the development, evaluation and

continuous improvement of an Emergency Management Program.

The purpose of the program is to develop and maintain a reasonable level of mitigation against and preparedness for an emergency, and to

be able to respond and recover effectively. Objectives include:

First and foremost, to protect the health and safety of staff and clients

Safeguard client and staff records Safeguard Vaughan CHC property

Resume full service as soon as can safely be done during or following an emergency

The Management Team is responsible for all aspects of the emergency

management program and lead the development of mitigation and preparedness strategies, including program development, evaluation

and continuous improvement.

The emergency management program is rooted in the values of the organization:

Diversity, inclusivity, equity, professionalism, accountability, service excellence, collaboration, accessibility and innovation.

Regulated health professionals are also accountable to their

professional codes of ethics in relation to emergency management.

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Should an emergency arise, the following are items for the Management Team to consider:

1. Does the Management Team have current contact information for all staff?

2. Is the vulnerable client list updated? 3. Has stockpile of personal protective equipment / infection control

supplies been checked? Is it still sufficient, undamaged? 4. Are any updates to either emergency plan or pandemic influenza

plan needed? 5. Has all staff been mask-fitted? Update the record

6. Are antiviral stockpiles sufficient and non-expired?

7. Do we need to review who can do what roles in the pandemic influenza plan?

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External Organizational Authorities The following is a list of organizations and provincial authorities and mandates upon which this emergency management program is based.

Ministry of Health Emergency Management Branch

Vaughan CHC expects to receive much of its guidance during an emergency from the Emergency Management Branch of the Ministry of

Health and Long-Term Care.

The Ministry of Health Emergency Management Branch describes the status of an emergency using the Graduated Response Protocol.

Response levels are Routine, Enhanced, Emergency and Recovery.

http://www.health.gov.on.ca/english/providers/program/emu/emu_mn.html

The MOHLTC will assume the role of primary or lead ministry for health emergencies. Specific information coming from the Ministry may

include: Declaration of an emergency.

Screening tools and epidemiological updates Infection control directives, including the provision and use of

personal protective equipment. Changes in scope of practice for health professionals, students

and foreign trained professionals. Policy regarding use of antiviral medication stockpiles.

Emergency Management Ontario

EMO is responsible for the overall coordination of emergency management in the province of Ontario.

Ministry of Labour

Direction regarding application of The Occupational Health and Safety

Act and refusal of unsafe work from the Ministry of Labour

York Region Public Health Branch

York Region Public Health Branch is the lead agency for local pandemic

influenza planning, preparedness and response.

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York Region Public Health Branch is responsible for local planning and

delivery of surveillance and reporting, public health measures such as case and contact investigation and management, liaison with the

health care system, and distribution of vaccines.

City of Vaughan

The Mayor may declare that an emergency exists in the municipality,

or in any part thereof, and may take such actions and make orders as he or she considers necessary and are not contrary to law to

implement the emergency plan of the municipality and to protect property and the health, safety and welfare of the inhabitants of the

emergency area. York Region will normally implement its emergency

plan at this point.

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Legislative Context

The Emergency Management and Civil Protection Act

Gives Cabinet or designate the ability to:

o declare a provincial emergency

o establish facilities such as shelters o authorize those who would not normally be able to do so

the ability to perform certain duties o require any person to collect or disclose information

necessary to respond to the emergency Directs the Ministry of Health to formulate emergency plans for

human epidemics and gives ability of Ministry of Health to assume the role of primary ministry during a health emergency

The Health Protection and Promotion Act

Outlines requirements for reportable diseases to the Medical

Officer of Health

Persons who pose a risk to the public health may be ordered to do, or to stop doing anything to reduce the risk of disease

transmission

Information about patients who are infected with communicable

diseases may be disclosed to the ministry and medical officers of

health, while protecting the confidentiality of sensitive health information

Physicians and registered nurses in the extended class are

required to report to the medical officer of health the name and residence address of any person who is under the care and

treatment of the physician in respect of a communicable disease and who refuses or neglects to continue the treatment in a

manner and to a degree satisfactory to the physician or nurse Appropriate action may be taken to prevent, eliminate or

decrease a health risk

The Health Systems Improvement Act

Authorizes the Minister of Health and Long-Term Care to procure, acquire or seize medications and supplies (subject to

reasonable compensation) when regular procurement processes

are insufficient to address the needs of Ontarians Authorizes the Chief Medical Officer of Health to issue directives

concerning precautions and procedures to health care providers Directives may not be used to compel regulated health

professionals to provide services without their consent

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The Occupational Health and Safety Act

Outlines roles and responsibilities of employers, supervisors, workers and joint occupational health and safety committees.

Outlines workers’ right to know about hazards, to participate in hazard identification and workplace safety planning and the right

to stop or refuse unsafe work, along with the limits to these rights. (This information can be found in Part V of The Act.)

The Employment Standards Act

Outlines employees’ right to unpaid leave because of a declared emergency in order to fulfill an order or to provide care to a

family member Outlines employee’s rights to other relevant leaves e.g. family

medical leave, personal emergency leave

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Hazard Identification and Risk Assessment Based on the hazards identified in the York Region Emergency Plan, the following hazards have been identified for Vaughan CHC:

Widespread, epidemic disease in humans Widespread, multi-day power outages

Slow onset floods from heavy sustained rainfall Widespread property damage from severe summer storms

Transportation-Hazardous Material Incidents

The following common consequences for VCHC have been identified as

stemming from these hazards: Increased risk of client / staff injury, illness or death (including

evacuation) Shortage of supplies

Shortage of human resources Office damage / contamination or inaccessibility (including power

outage)

IT inaccessibility or damage

Mitigation and Preparedness Strategies

Increased Risk of Client / Staff Injury, Illness or Death

Contact information for all program participants is maintained as a part of normal operations

Contact information for clients deemed by their service providers to be vulnerable during emergencies because of isolation (e.g.,

housebound, dependent on oxygen) is maintained by the Medical Secretary Team Lead and kept in hard copy by the Medical

Secretary Team, while ensuring confidentiality Contact information for staff will be updated regularly by the

Administrative Assistant and maintained in hard copy by the Management Team

Ongoing risk assessments and staff safety strategies are developed as part of the VCHC Joint Occupational Health and

Safety Committee process.

Shortage of Supplies

The Executive Director or delegate is responsible for maintaining

a stockpile of health emergency supplies estimated to last at least four weeks based on liberal assumptions. The VCHC

Registered Practical Nurse (RPN) is responsible for maintenance and turnover of the stockpile. The RPN and clinical team are

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responsible for ensuring that guidelines for maintaining supplies

are reviewed and implemented. See pandemic influenza plan for more details.

Other supplies will be stockpiled on a departmental / program level as determined necessary.

Shortage of Human Resources

VCHC has established service and operational priorities during an

emergency, as outlined in the following response section. VCHC is documenting a range of critical business functions,

including processes on payroll and cheque writing, IT functions and use of the autoclave.

Office / Facility Damage / Contamination or Inaccessibility (Including Power Outage)

VCHC facilities are served by a generator that automatically provides lighting during a blackout. The generator does not

provide power to outlets.

VCHC has arranged for access to the fridge in the Mackenzie Health dialysis unit to maintain cold chain of vaccines during an

extended blackout.

IT Inaccessibility or damage

An onsite backup server does daily backups of data. An offsite backup server is established at East End Community Health

Centre. The DMC is responsible for printing a monthly hard copy of all

client contact information.

Response and Recovery Strategies

The Management Team will coordinate all emergency response

activities. This may include designating one Management Team member as the lead for a given emergency response and recovery.

Increased Risk of Client / Staff Injury, Illness or Death

The Executive Director and the Management Team will lead the response to outreach to clients identified as vulnerable to promote

problem solving and safety.

The Management Team will consult and collaborate with the VCHC

Joint Occupational Health and Safety Committee to ensure that all reasonable precautions for staff safety are being taken.

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The Management Team will lead an operational debrief following any emergency response.

Shortage of Supplies

The Management Team will work with funders and suppliers as

possible to retain required supplies.

The Management Team will consult with and collaborate with the VCHC Joint Occupational Health and Safety Committee to ensure that all

reasonable precautions are being taken while there is a shortage of supplies, including ensuring that staff members are aware of their

legislated rights to refuse unsafe work.

The Management Team will lead an operational debrief following any emergency response.

Shortage of Human Resources

In the event of a shortage of human resources, some services and operations may need to be deferred and reassignment of staff may be

necessary.

The following operational priorities during an emergency have been

designated: Payroll and benefits

Bookkeeping IT

Occupational health and safety Board liaison

The following service priorities during an emergency have been

designated: Priority primary care (see chart below from the 2008 Ontario

Health Plan for an Influenza Pandemic)

Crisis response to VCHCs clients Outreach to vulnerable clients

It is expected that temporary reassignment of staff may be necessary

during an emergency to maintain priority operations and services, and will be coordinated by the Executive Director or designate.

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Priority Description Examples

Priority A (Critical,

cannot be

deferred)

Patients who have urgent needs and

require services /

treatment and would otherwise have to go

to a hospital for care Essential preventive

services

Acute exacerbation of a chronic illness that doesn’t

require hospitalization

Complications of pregnancy Certain acute infections

such as media otitis, UTI, cellulites, STIs

Acute major illness / injury Acute minor injuries (e.g.,

lacerations) Acute psychiatric illness

Acute abdominal pain NYD Musculoskeletal pain

Acute headache Palliative care

Patients recently discharged from hospital on new

medication who must be

followed closely (e.g., warfarin)

Infants and children under 5 years old

Patients requiring pneumococcal

immunization

Priority B

(can be temporarily

deferred)

Patients whose

situation is non-critical and who

require treatment /

services that can be deferred for a few

weeks

Stable chronic disease

management, including asthma, diabetes,

hypertension, and stable

cardiac, pulmonary, renal, neurological or hepatic

disease Uncomplicated pregnancy

care – 1st or 2nd trimester Well baby visit

Routine childhood immunization

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Priority Description Examples

Priority C * can be

deferred for duration of

the

emergency

Patients whose condition is non-life

threatening and who require services that

can be deferred or

managed in another way (e.g.,

prescriptions renewed without

seeing a physician) for the duration of

the emergency

Well child and adult checkups

Nutrition and weight counselling

Pap smears

Routine adult immunization Preventive services and

clinics Insurance and other forms

More information about how VCHC will deal with a shortage of human resources during an influenza pandemic can be found in VCHC’s

pandemic influenza plan.

The Management Team will lead an operational debrief following any

emergency response.

Office / Facility Damage / Contamination or Inaccessibility

(Including Power Outage)

As per the Early or Emergency Closure Policy, outlined below are procedures for staff to follow in various types of emergencies:

Early Closure

Management Team:

In situations that will necessitate early closure, the Executive Director or designate will determine when the Emergency

Closure Procedure will be implemented.

Once a decision has been made, the Programs and Services Director will notify all staff either directly or through Team

Leads/Coordinator that the Emergency Closure Procedure will be implemented.

Health Promotion Team Lead will post notification of the closure and anticipated time of reopening (Notice of Service Disruption)

on the VCHC website, if internet access is available.

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Staff will take the following steps:

Medical Secretary Team Lead or designate:

When the Medical Secretary Team Lead is not in the office, the designate is the Medical Secretary Team member that is responsible

for closing that evening.

a) Post notification at building entrances of the closure and anticipated time of reopening (Notice of Service Disruption)

b) Ensure laboratory specimen collection is in lock box at main door

entrance.

c) Ensure that phones will be transferred to on-call service (Answer

Plus) and a detailed message including reason for closure (e.g. bad weather, staff training, emergency) and provide specific instructions

to the operator of any on-call changes.

d) Ensure that the VCHC Physician is on-call to cover the period until the regular on-call shift resumes. Schedule is coordinated by the

Medical Secretary (see shared drive, Medical Secretary folder, on-call schedule).

Administrative Staff in Consultation with Clinicians and Group Leaders:

Contact clients to cancel appointments.. If a client from the ‘Vulnerable-Accessibility Issues Client List’ has a scheduled

appointment to be cancelled, the medical secretary is to ask the

primary provider if any action is required, instead of just cancelling the appointment.

If after contacting a client and there is an unresolved issue,

physicians can work with the social workers or system navigator to support the client.

*Vulnerable-Accessibility Issues Client List: Those clients who have

no family supports and accessibility issues that would be affected by an office closure due to not having access to the VCHC Primary

Care services.

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Group Programs:

Program facilitators will be responsible for contacting program participants to notify of program cancellations.

Prolonged Emergencies

(requiring early closure due to severe weather warnings)

In the event a potential or extended emergency is identified during

regular business hours while providing services to clients, such as a city-wide directive of closure because of impending or continued

severe weather, the following precautions will be taken:

Administrative Staff: 1. Clients will be informed that the Centre will be closing until

further notice due to the severe weather warning

2. A complete client list will be re-printed

3. Appropriate administrative staff will be responsible for notifying

booked clients of the closure by telephone. Specifically,

a. One medical secretary will take a copy of the medical appointments for the next 5 days using an encrypted flash

drive.

b. The Diabetes Receptionist will take a copy of the diabetes team’s appointments and current program participants for the

next 5 days using an encrypted flash drive

Group Programs:

Each Program Facilitator will take a copy of their participants’ list and contact information for each health promotion program currently being

delivered for the next 5 days using an encrypted flash drive.

Management Team and Board of Directors: The Executive Director will inform the Chair of the Board of

Directors and the Local Health Integration Network of the closure. Back up arrangements will be made so staff living within walking

distance --or accessible driving distance -- to the Centre is available to be first on site if necessary.

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Overnight/Early Morning Emergency

In the event that an emergency situation has occurred overnight or in

the early morning, necessitating agency closure before opening, the following steps will be taken:

VCHC Closure due to an Emergency Situation related to Bad

Weather:

The Executive Director or designate will leave/send out a broadcast phone message to all VCHC staff via staff’s personal voice-mail boxes,

providing them with instructions and directions regarding the closure. It is staff’s responsibility to check their voice-mail box, remotely,

during a possible closure. In order for staff to pick up the broadcast message they must follow these instructions:

(a) Dial 905-832-8042 (b) Press star and enter the their mail box number

(c) Enter their voice-mail security code and press the pound key (#)

(d) Listen to your voice-mail messages to confirm whether the Centre is closed and programs have been suspended.

VCHC Closure due to an Emergency Situation other than Bad

Weather:

1. The Executive Director will inform the Programs and Services Director who, in turn, will inform other members of the

Management Team of the Centre’s closure.

2. Members of the Management Team will take responsibility for

telephoning each staff person on their team informing them of Centre’s closure.

3. If one of the members of the Management Team cannot be

reached, the Program and Services Director will ensure that the appropriate staff members are contacted

4. Staff is responsible for contacting students or volunteers that

they supervise.

5. In consultation with the Executive Director, the Medical Secretary will telephone the Answering Service and provide an

altered message for our clients and program participants

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6. The Programs and Services Director in consultation with the Physicians and Nurse Practitioners will determine whether phone

outreach to clients on the Vulnerable-Accessibility Issues Client List is required.

7. The Executive Director or designate will inform the Chair of the

Board of Directors and the Local Health Integration Network of the closure when appropriate

In the event of an agency closure (early or extended) all permanent and contract staff scheduled to work will be paid for regular hours.

Sessional staff (external) will be asked to provide the service at another negotiated time. Locum staff will be compensated according

to the locum contract guidelines. Casual staff (i.e. childcare workers)

will be paid for their scheduled hours only when a same-day cancellation takes place. Partner agency staff will be governed by

their own agency’s policy on payment during emergency closures.

In the event of the complete inaccessibility of VCHC facilities for an extended period, the Executive Director will leave/send out a

broadcast message via staff’s personal voice mail boxes directing VCHC staff to meet at the Maple Community Centre for problem

solving.

Power outage or lack of access to EMR

In case of a confirmed power outage or a lack of access to EMR the Executive Director will make a decision on whether to close the Centre.

This decision will be based on the estimated length of the disruptive

event and other circumstances affecting the disruption.

Management Team: If the Centre needs to be closed, the Executive Director will inform

the Programs and Services Director who, in turn, will inform other members of the Management Team of the Centre’s closure.

Members of the Management Team will take responsibility for telephoning each staff person on their team informing them of

Centre’s closure. If one of the members of the Management Team cannot be

reached, the Program and Services Director will ensure that the appropriate staff members are contacted

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Loss of Power:

Crank flashlights and radios are kept in the reception and clinical

areas. Additional flashlights are available in the second floor storage room.

In the event of a loss of a service such as water, telephone, internet or

power in a specific area or machine and not the whole building, the Administrative Assistant should be notified immediately.

In the event of a loss of power in the entire building the following

actions will be taken:

Medical Secretaries Team: Our regular phone system is power-dependent. The Medical Secretary

Team should transfer the main line immediately to the answering

service, as the telephone system is on a back-up battery and should remain operational for 5 minutes after a loss of power.

All Staff:

All staff should turn off computers and machines that were running in order to avoid a power surge.

As needed, the Mackenzie Health Dialysis Unit can be used to provide plug-in power for laptops/ printers. Vaccines can be

transferred to the fridge in the Dialysis Unit. The Registered Practical Nurse and Medical Secretary Team

Lead/Administrative Assistant will ensure that this happens. If the Executive Director or designate determines that the

Centre should be closed for the day due to a loss of power, the appropriate closure procedures will be implemented

(Refer to Early Closures Procedures – page 3).

Upon restoration of power, refer to VCHC’s infection control guidelines

for dealing with frozen or refrigerated food.

Lack of Access to EMR:

Refer to Policy 6.03.1 NOD Business Continuity

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Service Delivery at External Facilities

External Facility Closed – VCHC Open:

Where Centre staff run programs or activities at sites other than the

Community Health Centre – i.e. a school or church, program staff should contact the facility’s manager or appropriate personnel (get a

name and phone number and keep it at home) to see whether the host facility plans to remain open during a weather emergency. If the host

facility plans to close but the Centre plans to stay open, staff will report to work at the Centre and take responsibility for contacting

clients to tell them of the cancellation.

VCHC Closed – External Facility Open:

Services will be delivered to those clients who are present at the

external facility

Bad Weather – No Closure

In the event that bad weather is expected, but which will not warrant agency closure, staff will be expected to report to work. Staff may

need to leave home earlier to anticipate traffic delays. Staff who is late because of traffic delays due to weather conditions may make up

the time (lieu time) or may use some vacation time.

If staff feels it is unsafe to travel OR the roadways they use have been closed or deemed hazardous, staff may choose not to come to work on

that day. In that case, staff will inform their supervisor about their decision not to come to work and document the time as vacation or

lieu time taken.

Management Team:

Members of the Management Team will rotate amongst themselves to ensure that two members are present at the VCHC during a Bad

Weather – No Closure situation. The members of the Management Team present at the VCHC will ensure appropriate support is provided

to staff on site.

Administrative Staff (i.e. Medical Secretaries, VCHC Receptionists, Diabetes Receptionist):

Administrative staff will be asked by the members of the Management Team to cancel clients who are coming in for one-on-one

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appointments.

NOTE: Staff living closest to the Centre and/or those who can travel

safely to work may be asked to assist with cancelling the appointments of clients of other staff members.

Group Programs:

Program facilitators will be responsible for contacting program participants to notify of program cancellations.

A program may be cancelled in the following cases: o Instructor is not available and CHW is not able to fill in

(i.e. fitness instructors). o A back up cannot be established due to expertise or

certification requirements o Program facilitator does not feel safe to come to work due

to inclement weather and a backup cannot be established

Notification of clients about program cancelations due to bad

weather:

Program Facilitators will be required to take home an encrypted flash drive with program participants contact information.

Should a Program Facilitator not feel safe to come in to work and a backup cannot be established OR program facilitator foresees

being late for the program due to the inclement weather, the Program facilitator will notify clients of the program cancellation

from home on a VCHC cell phone. When cancelling appointments or group programs from home,

staff must use a VCHC cellphone or block their number using *67.

School Closures:

Childcare may be a problem for employees if schools or daycares close during bad weather. If no alternative arrangements can be made,

staff will inform their supervisor of their need to remain home, and will later document their time off as vacation or lieu time. Administrative

staff will call to cancel one on one appointments. Program Facilitators will follow steps outlined above for program cancellation procedures.