Migrant Ships: A multi-jurisdictional approach to planning & response Canadian Press/Jonathan Hayward Presented by: Caitlin Harrison, Public Health Agency of Canada Bob Gallaher, BC Ambulance Service Norma Jones, Vancouver Island Health Authority Kirsten Brown, BC Ministry of Health With input from Ivan Peterson, Canada Border Services Agency
Presentation Overview Canadian Health System Situation overview The Integrated Health Planning Process Lessons learned BC Ambulance Services Vancouver Island Health Authority BC Ministry of Health Moving forward Questions
The Canadian Health System Administration and delivery of health care services is the responsibility of each province or territory, guided by the provisions of the Canada Health Act. The provinces and territories fund these services with assistance from the federal government in the form of fiscal transfers. Provinces and territories manage health system organization and service delivery internally. Some health responsibilities remain with federal government (e.g. Quarantine, First Nations, Veterans) Cross-governmental collaboration on issues of national concern.
BC s Health System The health system in British Columbia is a complex network of skilled professionals, organizations and groups that work together to provide value for patients, the public and taxpayers. The BC Health System is made up of a number of organizations, including: The Ministry of Health 5 Regional Health Authorities The Provincial Health Services Authority and associated agencies, including: BC Centre for Disease Control BC Cancer Agency BC Children s Hospital BC Transplant Cardiac Services BC BC Ambulance Service HealthLink BC
BC s Health Authorities The Health Authorities are governed by the Health Authorities Act, and are autonomous organizations working in conjunction with the MoH. The Health Authorities provide: Mental health Home Care Residential Care Acute Care Public Health
Health System Facts Health Authority Employees Acute Beds Other Beds Northern 7, 000 544 900 Interior 18, 523 1, 232 6, 131 Vancouver Coastal 22, 000 1, 779 7, 157 Vancouver Island 17, 000 1, 500 6, 200 Fraser 23, 000 2, 100 7, 000 Provincial Health Services 10, 000 371 356 Total 97, 523* 7526 27,744 Employees Stations Ambulances BC Ambulance Service 3,800 187 506 * Additional 30% Contracted Services (Over 120,000 employed)
The Situation Late July, 2010 RCMP confirms the MV Sun Sea is bound for BC. 200 500 individuals, several months at sea Arrival date and location initially not clear to health partners Multi-jurisdictional, multi-faceted response required novel partnerships and plans
A Novel Scenario Multi-jurisdictional response required various streams of information sharing: Security Health Federal Provincial Local Integrated Health Planning aimed for practicality and a mutual understanding of the response protocol across a range of stakeholders.
The Timeline July 28, 2010 First Integrated Health Planning Call Aug. 5, 2010 CBSA Table Top Ex. In Surrey Aug. 9, 2010 NESS supplies arrive in BC Aug. 10, 2010 Ottawa NESS staff arrive in BC Aug. 12, 2010 Facilities at VIHA readied for arrivals Aug. 13, 2010 MV Sun Sea docks at CFB Esquimalt; dockside and hospital operations Aug. 17, 2010 Integrated Health Hotwash held June 2010 Officials from multiple countries begin tracking MV Sun Sea July 29, 2010 NESS Mini-clinic requested and approved for deployment Aug. 6, 2010 Provincial Health planning call Aug. 10, 2010 Dockside Process Maps Developed Aug. 11, 2010 Dockside facilities readied for arrivals Aug. 12, 2010 MV Sun Sea arrives in Canadian waters; Vessel boarded by medical team Aug. 14/15, 2010 Migrants transported to Mainland facilities
The Health Players Department of National Defence Royal Canadian Mounted Police Canada Border Services Agency Public Health Agency of Canada Health Canada Citizenship and Immigration Canada Regional Health Authorities (VIHA, VCH, NHA, FHA) BC Ministry of Health Services BC Provincial Health Officer BC Centre for Disease Control BC Ambulance Services
The Integrated Planning Model ASSUMPTION: DND medical has been allowed to board the ship and perform initial triage and care of most urgent. FEMALE plus < 19 CBSA issues wrist bands to all DND triage Dockside decontamination available IF NEEDED (BCAS) * CBSA / RCMP will provide security in ambulance * MCFD will provide child escort if deemed necessary * CBSA staff to meet pts at facility as escort / security / processing FOSS # will be issued to pts when at facility VERY SICK DND medical handoff to BCAS for transport Transport to VGH (BCAS) Acute Care Facility - VGH (VIHA) Mini-clinic in old ER C&W is secondary referral site if needed SICK Quarantineable If Required Shower / hygiene available IF NEEDED (BCAS) SICK requiring medical attention/ assessment Dockside Medical Triage (tented) (VIHA ER Doctor, BCAS staff and Quarantine staff) WELL enough to wait for medical assessment Tented area awaiting processing (CBSA) Processing (CBSA) FOSS # issued Mother and < 19 together Transport to holding facility - < 30 mins (Corrections) Shower / De-louse (Corrections) Transport to final destination approx 4 hrs (Corrections) Arrival Corrections Facility (Corrections) ** Pts considered to be in CBSA custody / care until processed ** C&W Paediatric doctor on standby to provided dockside support if required. ** Quarantine services to follow up with facility regarding any follow-up / paperwork needed Initial Health Assessment (Corrections) * Base line vitals, small physical, history, visual body scan OCC HEALTH * ALL coughing people are to be masked and considered TB+ until proven otherwise. * Mental Health assessment at some point once at final destination * Chest X-ray s will be handled once in corrections * ALL intake workers to wear PPE masks, gloves, gowns
M/V Sun Sea -Role and key responsibilities -Challenges / Lessons Learned -How CBSA linked with BCAS
CBSA - Roles & Responsibilities Dual role Facilitation and Protection The CBSA must act quickly to meet the immediate personal and health needs of the migrants while protecting the safety and security of the Canadian public. At the earliest opportunity, CBSA must assess the demographic make-up and condition on board the vessel and will work closely with health partners to identify and prioritize any serious health cases. Once it is determined that it is safe to do so, for both the migrant population and personnel, CBSA will process these individuals in an efficient manner and according to Canadian laws.
Challenges / Lessons Learned Dynamic nature of event Pre-event duty to maintain secrecy versus duty to notify Innovation and keeping the operating platform efficient Importance of planning and plan sharing
Link with B.C. Ambulance Service Many contingencies included numerous Health Partners, however, C.B.S.A had a particularly strong connection with BCAS for a number of reasons: Potential for acute care - immediate need for transport Security Logistics / space requirements dockside
MV SUN SEA A HEALTH PERSPECTIVE
HEALTH CONSIDERATIONS Public health protection, including the need for TB screening; Responding to the psychosocial needs of migrants and responders; Hygiene care (e.g. showering) for migrants; Providing care to a potentially large number of patients, including the development of integrated contingency plans; Translation services for assisting in the provision of health care; The creation of surge capacity for immediate health needs response; The deployment of National Emergency Stockpile System (NESS) supplies and associated logistical considerations;
HEALTH CONSIDERATIONS CONT D The use of health facilities, both fixed and temporary; The creation of surge capacity for longer acute care needs; Staffing Emergency Operations/Coordination Centers; Situational awareness and notifications; Funding for health activities (provided by Citizenship and Immigration Canada); and The potential for dangerous commodities exposure.
BCAS -MAIN OBJECTIVE The major function of BCAS in this incident is the triage, treatment, and transport of any of the sick or injured migrants from the MV Sun Sea. Additionally, BCAS is responsible for the continued care and decontamination of these patients when they arrive at VGH but before they are handed off to the VIHA team at the hospital. This requires the management of two sites and coordination with allied agencies such as VIHA, Canadian Border Services Agency (CBSA), PHAC, RCMP, and DND.
BCAS ROLES AND FUNCTION Our role is to accept the sick or injured as they disembark and continue with triage, treatment, and transport. We will also provide onboard medical assessment, treatment and extrication advice to and in conjunction with the CBSA. There will be a medical tent that will house our staff and may include as part of the medical team the Public Health Agency of Canada (PHAC) and VIHA. The latter will likely include an emergency physician and possibly a paediatrician. Each patient will be triaged and treated as required and then transported to VGH. The reception area for these patients will be the old Emergency Department where they will be decontaminated by a BCAS team prior to entering the building. The decontamination process may be bypassed for critical patients. The principles of the BC Emergency Response Management System (BCERMS) guide the development of the objectives and structure of our response to this incident and our liaison with partner agencies.
BCAS ROLES AND FUNCTION cont d Safety and health of all responders To ensure paramedic safety, full PPE is to be utilized by each paramedic and reverse isolation of the patient Medical aid to any responder on site as required Decontamination of the patients prior to entry into VGH (unless critical) Save lives The migrants will have a variety of medical conditions that will require appropriate treatment and transport Coordination with other agencies BCAS will work as part of a larger medical team at both sites BCAS will have direct representation within key operation centres Coordination facilitates the incident management enabling seamless flow for paramedics and patients Patient tracking and documentation to facilitate containment and evidence control
BCAS I/C Bob Gallaher Call sign S-1 EMS Group Supervisor- DOCK Call sign - S-5 VGH Site EOC Liason S-7 DECON Team Leader Triage Team Leader Decon Team - VGH Decon Support/Logistics Treatment Team Leaders Transport Team Leader
Flashcard Do you have a skin rash? ( )? Do have any open wounds?? Please point to where it hurts. Do you have difficulty urinating? ( / )? How long have you had symptoms?? Do you have any chronic health problems?? Are you taking any medications?? Do you have any allergies to medications??
LESSONS More planning could be conducted on developing a surveillance/monitoring process regarding migrants health There was a need for a clear command and control structure dockside to assist in information sharing. On scene unified command and a clearly identified Incident Command Post would have streamlined the dockside response. More consideration needed for the need for showering and other hygiene facilities onsite for use as part of the disembarkation process. Agencies working dockside should have an understanding of Personal Protective Equipment (PPE) requirements and use. There is a need to better communicate PPE needs and responsibilities prior to the arrival of a migrant vessel.
Vancouver Island Health Authority VIHA covers approx 35,000 sq miles Serves a Population of 752,000 17,000 staff 15 acute care facilities 1,700 physicians ~ 1500 acute beds and 6200 residential/assisted living Victoria General Hospital Tertiary Level Care, Trauma Centre, Pediatric Obstetrical, Neonatal
Hospital used for medical treatment of Migrants Victoria General Hospital
VIHA EOC
Challenges Need for more timely Information Potential burden of disease (negative pressure, IPC) Involving multiple internal and external stakeholders Set up (refurbishing, supplies, equipment, staffing, etc) Onsite Security Media Scrutiny
Potential Need for Decontamination
Refurbishing Decommissioned Space
Emergency Department Staff
In patient Unit staff 7North VGH
Lessons Learned Security needs Physician Compensation Communication (its never too much) Space issues Dockside vs. Hospital diagnostics/treatment? Joint messaging with unions and professional licensing Importance of celebrating success
Planning and Response Successes An exemplary degree of cooperation was displayed between all organizations involved as well as unprecedented degree of integration between federal, provincial and regional entities; The response was greatly aided by the use of available facilities, particularly the Victoria General Hospital; The early request and subsequent use of the NESS miniclinic highlighted the value of this new resource and the partnerships between federal and provincial agencies.
Lessons Learned The response does not end once the dockside operations have completed. Plans need to address the roles, responsibilities and processes and coordination mechanisms beyond the arrival of migrants and address ongoing screening and treatment once in detention. Recognized benefit of and need to develop relationships with all organizations involved to enhance information sharing and coordination. Plans should consider several contingencies to account for the uncertainty that exists as the vessel arrives in Canadian waters. There is a need to incorporate innovation and flexibility in the response.
Moving Forward Convened a meeting of stakeholder organizations to review after action report and incorporate lessons learned into a revised Integrated Health Response Plan for Migrant Vessel Arrivals. A number of topic-specific calls were convened, including: Discussion on how to respond to an infectious disease scenario. Further clarification of health needs, roles and responsibilities following dockside operations. Continuing to build on the successful relationships built during the event.
Questions? Canadian Press/Jonathan Hayward Presented by: Caitlin Harrison, Public Health Agency of Canada Bob Gallaher, BC Ambulance Service Norma Jones, Vancouver Island Health Authority Kirsten Brown, BC Ministry of Health With input from Ivan Peterson, Canada Border Services Agency