After Action Report British Columbia Ebola Tabletop Exercise
Contents 1. Background... 2 2. Objectives... 3 3. Exercise Scenario and Discussions... 3 4. Successes and Challenges... 4 5. Issues Arising and Action Items... 4 6. List of Acronyms... 7 Page 1
1. Background In late October 2014, a Provincial Ebola Preparedness Task Force was formed under direction of the B.C. Minister of Health in response to the national and international threat of the spread of the Ebola virus. As requested by the Provincial Health Officer and this task force, the B.C. Centre for Disease Control (BCCDC), in conjunction with the Ministry of Health s Emergency Management Unit, designed an Ebola tabletop exercise that took place on Nov. 14, 2014. The exercise involved representatives from B.C. s public health system, communications, and members of the Public Health Agency of Canada (PHAC) Ebola Rapid Response Team. The purpose of the exercise was to test B.C. s health system processes for an EVD case, and determine how B.C. s public health agencies will work with the PHAC Ebola Rapid Response Team. The objectives for the exercise were to: 1. confirm the actions required to support public health and epidemiology efforts; 2. exercise plans for contact management and reporting; 3. exercise capacity to revise plans and strategies rapidly when faced with unforeseen challenges; and 4. exercise the PHAC Ebola Rapid Response Team s role in supporting the provincial response. To fulfill the purpose and objectives, the discussion-based exercise was broken into three phases, each addressing a different time period: (1) identification of a potential case of Ebola Virus Disease, (2) confirmation of the positive case, and (3) issues that arise following that confirmation. The exercise took place simultaneously in person at the BCCDC and remotely via videoconference and teleconference. Players participated from a variety of locations throughout the province, and included federal and provincial representatives from public health and communications. The groups that participated in the exercise are detailed in the table below. Agency Public Health Agency of Canada (PHAC) Ebola Rapid Response Team PHAC Western Region B.C. Centre for Disease Control Health Emergency Management B.C. Provincial Health Services Authority Provincial Health Officer Ministry of Health Emergency Management Unit First Nations Health Authority Vancouver Coastal Health Location B.C. Centre for Disease Control, Vancouver Page 2
Fraser Health Interior Health Northern Health Island Health Government, Communications and Public Engagement Fraser Health, Vancouver Interior Health, Kelowna Northern Health, Terrace Ministry of Health, Victoria 2. Objectives The objectives of this After Action Report are to: 1. provide a record of the 2014 B.C. Ebola Tabletop Exercise; 2. document any gaps identified throughout the exercise; 3. document lessons learned from the exercise; and 4. provide specific recommendations on how to improve planning for provincial response to a confirmed case of EVD. This report consolidates the exercise inputs, documented responses and exercise feedback. The purpose is to capture information for future learning and exercises, and provide recommendations for improvement to regional and provincial planning and co-ordination. 3. Exercise Scenario and Discussions The exercise scenario followed the path of a traveler returning from West Africa to his home in Montreal, and subsequently travelling to Vancouver to visit friends and family. The first phase of the exercise provided an initial assessment of the patient and his movements since arriving in Vancouver. In this phase, participants were asked to summarize agency notification procedures and response actions, identify communications objectives and develop a plan for the risk assessment of contacts. During the second phase, the patient was presumed positive for EVD and a detailed timeline of patient movement was provided to the players. The players were asked to assess the specific contact management activities that would need to be performed, and devise information sharing and communications strategies. An urgent teleconference was called by the PHO to discuss these strategies and provide situational updates. Page 3
In the third phase of the exercise, 48 hours had passed and the National Microbiology lab had confirmed the case of Ebola. A number of challenges that target specific player groups were introduced, and players were asked to propose activities that would be taken to respond to overlooked contacts, contacts failing to follow instructions, the movement of contacts across borders, or shortages of resources. The players were also asked to develop communications strategies to address a variety of potential issues around public panic, perception, and the behaviour of identified contacts. A period of debrief discussions took place following the third phase of the exercise. 4. Successes and Challenges There were several successes achieved during this exercise. Some notable achievements included: Wide participation from the B.C. health system and national representation from the Public Health Agency of Canada, with limited travel and resources required. The exercise helped to identify gaps and facilitate improvements in agency co-ordination and current contact management processes. The realistic scenario and exercise facilitation promoted meaningful conversations and discussions relevant to the objectives for the day. While there were successes, the following challenges were identified: Technical issues using videoconference were experienced in some locations. It was challenging for player groups to complete some tasks within the allotted timeframe. 5. Issues Arising and Action Items Issue 1 Supports need to be put in place for those who are in isolation. This may include provision of/for: housing for those who cannot stay at home (e.g., due to distance from an appropriate facility) or will not stay at home (e.g., due to fear of exposing others); acquiring necessities of daily living; visiting by family or public health, lost wages. Action Ministry of Health has developed a guideline specifying the mechanism for health authorities to follow to reimburse those who incur costs as a result of contact management activities. Health authorities have worked to locally identify supports within their region. There may be supports available through provincial and municipal governments, and the not-for-profit sector. Agreements established in the B.C. pandemic plan may be applicable. Page 4
Issue 2 Issues regarding issuance of an order for isolation under the B.C. Public Health Act need to be resolved. An order would be used as a last resort (e.g., when there is non-compliance with voluntary isolation putting the public at risk). There are a number of practical issues that would need to be worked out regarding how this would be enforced over a longer term. For example, police are willing to support issuance of an order, but not to provide ongoing security. 3 There is a need for a public information line to provide timely information and alleviate fear. This could be done through a provincial line (e.g., 811) or through health authorities. Information would need to be co-ordinated so that it is consistent across the province. 4 Communication within public health and associated agencies has been effectively co-ordinated through the Provincial Ebola Task Force and the Public Health Working Group of this task force. In the event of increased EVD activity, there will be a need for rapid information sharing using these networks (e.g., frequent updates, information sharing regarding a person under investigation, testing results). 5 Management of cases and contacts must be consistent across health authorities. Differences between health authorities proposed contact management may arise due to a number of factors. Many such differences have been resolved through provincial working groups during Ebola preparation. Any new issues arising can be resolved during a situation. 6 Management of EVD contacts may involve Canadian Border Services Agency (CBSA) in identification of persons returning from EVD affected regions and information regarding crossborder travel of contacts who are being monitored for EVD within British Columbia. There is a need for ongoing communication with CBSA 7 Communications must be co-ordinated across agencies. Communications strategies should be developed and account for the use of new media that enables rapid sharing of information (e.g., Twitter, Facebook). FAQs should be developed for posting on the Office of the Provincial Health Officer (PHO), BCCDC and health authority websites. Action A draft order has been prepared and agreements on role of policing in support of public health have been developed. HealthLink BC has been engaged to provide this function. Provincial Ebola Task Force and Public Health Working Group meetings have been augmented as needed. Provincial guidance on management of contacts has been developed, approved and disseminated. 1 Continue active engagement between the provincial health officer and Public Health Working Group and CBSA regarding communication related to EVD cases and contacts. B.C., PHAC and agency communications groups have developed communication strategies, and FAQs have been posted on the PHO website. 1 www.health.gov.bc.ca/pho/pdf/british-columbia-ebola-virus-disease-evd-contact-investigation-and-managementguideline.pdf Page 5
Issue 8 The role of the PHAC Rapid Response Team was clarified. PHAC teams include: 1. epidemiology and surveillance; 2. communications; 3. emergency co-ordination & logistics; 4. biosafety; 5. infection prevention and control; and 6. laboratory support. Action Continued communication with PHAC Ebola Response Team. The level of support would depend on the capacity of the province/territory. This exercise addressed items 1 and 2 only and identified a key role of the PHAC team liaison with federal agencies regarding public health response, provision of epidemiology support, and communications planning and liaison. 9 Guidance for management of contacts in First Nations communities to include issues specific to First Nations communities (e.g., who follows up and how contacts are tracked) as well as concerns unique to remote communities. Contact management guideline states contacts must remain within two or four hours of a Type Two or Three facility (depending on risk level). This would prevent them from being in a remote community and therefore mitigate that risk. The regional health authority medical health officer will follow First Nations contacts. FNHA will assist with any First Nations concerns arising. Page 6
6. List of Acronyms Acronym BCCDC CBSA EMU EVD FNHA EOC FH HA IH MHO HLTH NH PHAC PHO PHSA PUI VCH VIHA Meaning B.C. Centre for Disease Control Canadian Border Services Agency Emergency Management Unit Ebola Virus Disease First Nations Health Authority Emergency Operations Centre Fraser Health Health Authority Interior Health Medical Health Officer Ministry of Health Northern Health Public Health Agency of Canada Provincial Health Officer Provincial Health Services Authority Person Under Investigation Vancouver Coastal Health Island Health Page 7