Incident Response at Public Health Ontario Lisa Fortuna Public Health Ontario Toronto, Ontario May 27, 2014
Outline Public Health Ontario Background Structure and functions Incident Response Incident Response functions Daily monitoring and issue triage Daily Morning Rounds Extended Morning Rounds Daily Issues Summary & Situation Report Examples of Issues and Incidents 2
Public Health Ontario - Vision, Mission, Mandate 3
Public Health Ontario Expertise and Services 4
Public Health Ontario Legislated Objects Scientific and technical advice and support Knowledge, best practices and research Laboratory services Data development, collection, use, analysis and disclosure Bridge infection control and occupational health and safety Public health research Education and professional development Contribute to policy development
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Stakeholders Other Academic Institutions Partner Ministries Partner Ministries Academic Institutions Research institutions Professional Associations Legislature Other MOHLTC Divisions Chief Medical Officer of Health (CMOH) Public Health Divisions Ministry of Health and Long Term Care (MOHLTC) Local Public Health Units 36 PHUs Public Health Agencies Not for Profit Organizations Private Sector Hospitals LHINs Community Health Centres Health Care Institutions Physicians Other Health Care Providers International National Provincial 7
Building a Shared Vision: Functions and Responsibilities 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 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) 8
Provincial Leadership PHO and MOHLTC Focused Briefings on Emerging Issues Incident Response Coordination Issues Management Open, Timely and Effective Communication 9
Incident Response Incident Response Issue and incident triage Stakeholder coordination, 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 & Situation Report Daily Morning Rounds Weekly Extended Rounds commons.wikimedia.org commons.wikimedia.org commons.wikimedia.org Public Health Action 10
Incident Response Incident Management System Emergency Preparedness Team Incident Action Plans Debriefs Operations Laboratories Surveillance Investigations Epidemiology Command Planning Epidemiology Surveillance Logistics Getters Finance Payers Cross-functional Teams Ensure resources are dispatched in a timely and effective manner during all public health issues or incidents, e.g., Emerging Infectious Respiratory Diseases Team Scientific and Technical Requests Coordination of requests from clients for knowledge products, e.g., Technical Reports, Statistical Reports, Literature Reviews 11
Daily Monitoring (Mechanisms) 12
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 commons.wikimedia.org commons.wikimedia.org 13
Issue and Incident Response Daily Monitoring - Identifies Issue/Incident Issue/Incident Triage Coordination & Communication w/ MOHLTC PHO Program Area(s) Public Health Unit(s) CFIA, HC, PHAC OMAF, MNR, MOE PHO Laboratory Health Care Facility Next Steps (Investigation, OICC, OOICC) Mitigation & Surveillance (PHA, ESD) Debrief & Review 14
Incident Response A Day in the Life Assess Overnight Morning Rounds Action Items Daily Monitoring & Issue/Incident Identification Communications & Briefings Coordination of Scientific & Technical Requests Coordination of Investigation/Outbreak Meetings Prepare SIT Report of Days Issues and Incidents 8:00 am 9:00 am 4:30 pm 15
Daily Issues Summary & Situation Report 16
Daily Issues Summary & Situation Report Front Page A - 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) updated and reported on daily commons.wikipedia.org commons.wikipedia.org commons.wikimedia.org 17
Daily Issues Summary & Situation Report Section G - Daily Notifications Media On-Call FYIs Emergency Management Branch Notifications News Releases by Health Organizations Publications, Presentations or Announcements International Issues and Incidents updated and reported on daily 18
Total Incidents PHO Supported Incidents PHO Supported 70 60 50 40 30 20 10 0 Outbreaks Case/contact management Cluster Incident Type Emergency management Health hazard January 1, 2012 to May 13, 2014 19
Daily Issues Summary & 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 updated as information is available and reported on weekly 20
Daily Morning Rounds When: Daily, 8:30 am, approx 10-15 minutes High-level representation from: PHO - Emergency Preparedness and Incident Response, Communicable Disease Prevention and Control, Communications MOHLTC - Associate Medical Officer of Health (Chair), Emergency Management Branch, Public Health Policy and Programs, Communications Discussion: Daily SIT Report and contents (Sections A-G) Action items On-call issues Media and communications Emerging issues commons.wikimedia.org 21
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 Review and assess all issues and incidents Ongoing OICC/OOICC, CDI, vector-borne disease, non-enteric OBs Respiratory pathogen surveillance from PHOL Influenza, respiratory syncytial virus, legionellosis, pertussis International outbreaks and incidents 22
Notification: Increase in cases, high # positive mosquito pools Health unit communication Example: West Nile Virus 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 partners Increase public messaging commons.wikipedia.org commons.wikipedia.org 23
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/OOICC Health Risk Assessment; Health Hazard Alert Increase public messaging, targeted communications commons.wikipedia.org commons.wikipedia.org commons.wikipedia.org 24
Acknowledgements and Contact Information Kyle Boulden Jastej Dhaliwal Erik Kristjanson Amrita Maharaj Mark Nelder George Pasut Brian Schwartz E-mail: EPIR@oahpp.ca For more information on PHO, please visit our website at 25